Ultherapy Vs Thermage for Skin Tightening

Which is better for skin tightening - Ulthera or Thermage?

Doctor Answers 67

Ulthera is Effective for Non-Surgical Facial Rejuvenation

Ulthera™ has only recently been approved by the FDA for use in the US. It has, however, been available in Asia and in Europe for several years, and preliminary results have been impressive. Ulthera™ is currently only being offered to select physicians within the US who have significant facial aesthetic practices, many of whom are involved in research and clinical studies as well.

To refer to Ulthera™ as a "gizmo" is to discredit the technology behind the device.
Unlike Thermage ™ , which many doctors and patients have found to be disappointing, Ulthera is the first device that uses ultrasound technology to stimulate the body's own collagen response for lifting and tightening the skin and underlying soft-tissue of the face. This system also uses acoustic imaging to enable the physician to see the layers of soft tissue beneath the skin prior to treatment to ensure a uniform and accurate application of the ultrasound waves. This differs significantly from any other device that is currently on the market which typically use radio frequency or lasers to stimulate the skin.

While Ulthera is not going to yield the dramatic results of a surgical face-lift, many patients in my practice prefer the subtle, yet significant tightening and lifting of the skin that Ulthera provides. It is less expensive than a traditional facelift or MACS lift, has no downtime, and no bruising or swelling. I see Ulthera™ as one tool in a full spectrum of options we have available to help patients achieve their desired outcome for facial rejuvenation. Physician credentials and experience, communication, education and expectation of the patient are all key to having an optimum outcome, regardless of whether the procedure is surgical or non-surgical.

Grand Rapids Plastic Surgeon
4.9 out of 5 stars 58 reviews

Skin tightening with Ulthera, thermage and others

Keep in mind these are only tools and by themselves are neither good nor bad.  A scalpel is neither good nor bad but can be used to perform beautiful surgery or make a terrible mess.  That being said, these devices are commonly used by practitioners with no formal training in plastic and reconstructive surgery and thus no understanding of what interventions, forces structures and vectors make a beautifully rejuvenated face.  Now that Thermage has a long history, people are begining to understand that the patients are nearly universally displeased to enraged with their results.  I have seen several difficult reconstructve cases resulting from them paying for aesthetic enhancement with Thermage. 


Now comes Ulthera the new better thermage and can you guess what is happening. . . the same thing.  I personally do not like deep heating of the face.  it causes the absorbtion and atrophy of fat which over time makes patients look aged and there is no control of vectors.  When a plastic surgeon restores a face with a facelift, there are multiple different vectors created with different forces to create a natural concavity and convexity.  The contraction forces created by these technologies are concentric and pull equally in all directions, flattenening the faces- a very undesirable form.


I use infrared energy(Sciton SkinTyte) mostly when skin and tissue tightening is the goal,  I like it because it is gentler and not as deeply penetrating.  I really dont think there is anything wrong with a well trained plastic and reconstructive surgeon using any of these devices in a responsible manner after explaining the risks and benefits to their patients.  I think these technologies are applicable for moderate correction of neck laxity but should really be of limited application in the face because of the inability to control form.  Aesthetic form with wrinkles and laxity is much preferable to unaesthetic form with smooth skin.  There is no question that significant tightening can be achieved, but at what cost?  Remember whether a scalpel, thermage or ultherapy, the hands holding the device are much more important than the device.  Make sure the hands are connected to an experienced and well trained plastic and reconstructive surgeon so that you can benefit from their experience, knowledge and insight.



All the best,


Rian A. Maercks M.D.

Which works better Ulthera or Thermage?

While the only way to know for sure is by performing a 'double blind study' in which both the doctor and patient don't know which treatment is being used. however in our practice 1) patients see results more immediately 2) the treatment is somewhat faster than thermage 3)we seem to get more reproducible improvement in about 80. per cent of our patients and a significantly lower percentage for thermage. The pain for Ulthera also seems to be slightly less but usually requires one or more forms or analgesic ..

Joshua L. Fox, MD
Long Island Dermatologic Surgeon
4.9 out of 5 stars 18 reviews

Skin Tightening with Ultherapy

Ultherapy is the only FDA approved device to lift skin. As the skin is lifted there is a tightening effect seen.  Thermage, which uses radiofrequency, may be able to target fat, but it's tightening effect is not well understood.

Asaad H. Samra, MD
New Jersey Plastic Surgeon
5.0 out of 5 stars 39 reviews

Ultherapy vs Thermage

Ultherapy definitely works based on clinical studies using Ultrasound to correct mild to moderate laxity of the face and neck.  The results with Thermage on the other hand, were disappointing and as such it is no longer recommended.

Edward J. Gross, MD
Orlando Facial Plastic Surgeon
4.7 out of 5 stars 24 reviews

Ultherapy-Preferred over Thermage

Although both procedures are promoted for their skin tightening effects based on thermal stimulation of collagen production, this is where the similarity ends.  Ultherapy utilizes ultrasound technology that allows for visualization of the tissue during treatment with the energy penetrating the skin before converging at a pre-determined depth below the surface where the heat is deposited.  Thermage utilizes radiofrequency where the energy radiates inward from the surface thereby requiring cooling of the skin surface prior to delivery of the energy.  At this time, there are 3 different depths that the Ultherapy energy targets: 4.5 mm, 3 mm and 1.5 mm.  The two deeper depths are used for lifting and tightening whereas the newly released 1.5 mm depth transducer is utilized for softening surface wrinkles.  In my practice, I have used both technologies and have found Ultherapy to offer more consistent and superior results.  It is important to remember that even though the procedures are nonsurgical, they should be performed by qualified practitioners to minimize risks and maximize the benefits.  Realistic expectations are also important since as with any nonsurgical procedure, results are not completely predictable nor are they comparable to those that can be achieved with surgery or laser but in the educated patient this is a nice option when looking to freshen ones appearance.

Pamela Henderson, MD
Phoenix Facial Plastic Surgeon
4.7 out of 5 stars 15 reviews

Ulthera is apparently more effective than Thermage

As I researched Ultherapy with MANY phsyicians prior to starting to use the device, I learned that many in the country who had done a lot of Thermage, as I had done, now are preferentially using Ulthera.  The energy is differenet and penetrates deeper than Thermage.  I still prefer Thermage for the upper eyelids, mid forehead and the body.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 36 reviews

Best Non-Surgical, Non--Invasive Treatment for Lifting and Tightening Skin and Muscles of Face, Neck, Eye Brows, and Other Areas

Hi Steffi,

Great question! 

I have followed both technologies since their inception, Thermage for about the last 10 to 12 years, and Ultherapy by Ulthera for the past 2 years.  Based on the science behind them and the patient satisfaction results, Ultherapy by Ulthera is a superior treatment.

Ultherapy by Ulthera is the only FDA approved device for both tightening and lifting of the muscles and skin of the face and neck, including the eye brows.  Ultherapy is the only technology available that uses ultrasound to heat the muscles and skin to create both deep and superficial collagen production.  The level of the treatment is visualized on an ultrasound screen to insure that the energy is being delivered to the proper level. 

The muscle fascia or SMAS is targeted in the neck and face.  This is the same layer that we as surgeons tighten when we perform surgical face lifts.  Ulthera energy goes deeper than any other energy device, 4.5 mm for the SMAS, and 3.5 mm for the deep skin collagen production.  The patient satisfaction rate with Ulthera is about 90% in our clinical studies.

Thermage is a radio frequency technology device that heats the skin and subcutaneous tissue superficially.  Although Thermage has been improved over the years, it's main problems have been a very high patient dissatisfaction rate (up to 66%), and a very painful patient experience.  Ulthera can cause discomfort as well, but if patients are enduring pain, they appreciate a result that they can notice. 

Ultherapy, featured in this month’s Vogue (Apr 2011), is a safe and effective non-invasive ultrasound (US) treatment that can lift and tighten facial skin and muscle without downtime.  According to Catherine Piercy, author of the well written Vogue article, “Ulthera…is making it much easier to imagine a world in which hooded lids, falling cheeks, and lazy jaw lines can be treated without a single incision”.

Originally FDA approved for lifting eyebrows non-surgically,Ulthera’s unique state of the art technology is now used to lift and tighten the face, neck, and other areas of the body.  It has successfully treated the lines along the upper lip that are most difficult to treat with injectables.

Ultherapy is performed in the office with only ultrasound gel applied to the skin.   An ultrasound screen image allows the physician to visualize the level of treatment before US energy is applied to the targeted tissue.  The treatment takes from 45 to 90 minutes depending on the area(s) treated.  Cost also depends on the areas treated. 

What about the discomfort level?  Again from Ms. Piercy in Vogue, “If anything, Ultherapy’s greatest drawback may be the pain factor, which ranges from a hot prickling sensation to short but intense bursts of discomfort”.  Patients can be given oral medications or local anesthetic nerve block injections if needed, but the majority of Ulthera patients are able to tolerate a properly performed treatment with just a cold air blowing on their skin.

Although many patients see immediate lifting results, the ultimate results do not happen overnight, but gradually over time.  It can take up to 2-3 months for optimal rejuvenation.   Ulthera has been used for close to 2 years.  Some patients treated 1 1/2  to 2 years ago are now returning for second treatments.  Though they still appear improved from their pre-treatment “before” photos, most desire further improvement, further turning back the hands of time.  Practitioners have reported that even in cases where they don’t see a big difference  in before and after photos, patients feel and notice the tightening to the point of being satisfied.   Ultherapy is ideal for patients between 35 to 60.   Older patients and those with excessively loose skin will benefit from either laser therapy or surgical face lifting.

After two years of personal research and due diligence about the clinical benefits of Ulthera, as well as being impressed by the findings and experience of worldwide  respected cosmetic physicians, I am convinced that Ulthera is both safe and effective, and have therefore have decided to add Ulthera to our practice.  As with all cosmetic treatments, results will vary depending on the skill,experience, and aesthetic sense of the treating physician, physician’s assistant, nurse, or staff member.  Results will also depend on proper diagnosis and patient selection.  Side effects may include some bruising, swelling, and a feeling of tightness in the days after the procedure. 

Ultherapy by Ulthera has been recently featured  on Dr. Oz, The Doctors,as well as on Real Self reviews, links which you may access for further information about this amazing state of the art technology.

As with all aesthetic treatments, do your homework and choose your treating physician most carefully.  Be well.

Dr. Persky



Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Too Early To Tell

Thermage utilizes radio-frequency to contour and firm the skin and subcutaneous tissue while Ulthera's thing is ultra-sound. This is the third version of Thermage and while it certainly can not be worse than the first version, one should be very skeptical.

It is impossible to compare the two at this point. Much more data would be needed. The guidance of real self members who have undergone the procedure should frankly be a better source of information than either the before-after pictures the companies provide or even some of the papers their investigators have written.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
4.7 out of 5 stars 14 reviews

Ultherapy to tighten and firm skin

An important distinction between Thermage and Ultherapy is that Ultherapy is the first and only device with an FDA approval for LIFTING facial skin and neck skin.  No other device has this LIFTING approval from the FDA, including Thermage.  Most of my patients are very interested in the possibility of lifting – this is a major advantage of Ultherapy.   An ultrasound transducer is placed on the skin to see where energy is needed.  The skin’s response is to stimulate the growth of collagen (the main component of connective tissue).  This causes gradual tightening and firming which results in a natural lift of skin over time.  The ultrasound allows the clinician to see the micro thermal zones and determine exactly where low levels of focused heat need to be applied.  This reduces the chance of burning, which is often a result of Thermage treatment.  Ultherapy offers a more accurate treatment and therefore produces better results.  


Paul L. Leong, MD, FACS
Pittsburgh Facial Plastic Surgeon
4.9 out of 5 stars 42 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.