Ultherapy Vs Thermage for Skin Tightening

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.

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.

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.

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.

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 ..

Both Ultherapy and Thermage are great skin tightening treatment for the face and neck. I have both treatments in my office. With Ultherapy, it's my experience that the results are quicker and more noticeable. I would highly recommend Ultherapy to patients who are 45 and older; while Thermage might be a great choice for younger patients with less loose skin. In either case, it is important to choose a physician who can accurately deliver your treatment with precision, with customization to fit your needs. In my office, I often use Thermage CPT eyelids in addition to Ultherapy forehead, full face/neck to give an extra lift on my patients' eyelids.  

For body, Thermage CPT would be a great choice. I would also add Ultherapy to Thermage to treat the most difficult areas, such as wrinkles on the knees.  

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.

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.

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.  

Our office has both Ulthera and Thermage and done a large number of both. Although none of the noninvasive technologies will give the same results as surgery, they do provide a subtle, yet noticable improvement without much downtime or cost. Ulthera is my choice for skin tightening in the face and neck, since I have seen a definite improvement in the face and neck of the the patients who had Ulthera.  Thermage is great for tightening the abdomen, thighs and buttocks!