Should I get Ultherapy or Fractora?

Question

Can someone tell me the difference between Ultherapy and Fractora? I am looking to tighten my jaw line and slight jowls. I don't have any wrinkles. I am 48.

Gregory S. Keller, MD, FACS · Answer

Ulthera is "HIFU": High Intensity Focused Ultrasound.  Ultrasound can be diffuse and low intensity, and you can image a heart or a baby.  Or it can be High Intensity and focused at a particular target and can dissolve a liver or prostate tumor.  Ulthera uses dots of high intensity ultrasound focused on the skin and SMAS (facial and neck fascia and muscle structures immediately under and attached to the skin).  This energy tightens the face and neck (and other structures in the chest and body).  It hurts, but there is usually no downtime.
Fractora is microneedling with radio frequency energy.  The handpiece looks much like that of a laser, but a lot of tiny needles enter the skin and shoot radio frequency under the skin.  It differs from other machines that are similar by the wide "bipolar" method that it places energy under the skin.  It can give a more powerful reaction than the others or can be "toned down" and require multiple treatments.  It particularly requires more skill to use than some of the other machines and the treatment needs to be tailored to each patient.  It does give incredible results in the right hands.
We have both machines (and several others including lasers, RF devices,etc).  I recommend Fractora for people who have wrinkles (particularly around the mouth and eyes) and loose skin in the eyelids and lower neck.  Often it is great for patients who have had a facelift, but still have looseness and wrinkling of the neck skin. It is also great for scarring, particularly acne scarring (though other similar devices that I own are great for this also). I recommend Ulthera for people who want some tightening with little or no down time.   Both treatments require a couple months to see the ultimate results, and may require more than one treatment.
Interestingly there are reports that either PRP (platelet rich plasma) and DefenAge skin serum improve the results and recovery of microneedling (and Fractora, in particular) if applied directly after and again within 6 hours. The "micro needle" holes are open enough (though you cannot see them open) for this period of time to allow the substances to penetrate.

Jason Emer, MD · Answer

Fractora is a radiofrequency device and Ultherapy is an ultrasound device. My recommendation to all my patients who are RF treatments is Thermage. I recommend seeing a cosmetic dermatologist for a formal evaluation. Best, Dr. Emer

Lisa Vuich, MD · Answer

Thanks for your question. The two devices you mention use different energies to generate a thermal injury- which then stimulates neocollagenesis (new collagen formation). Ultherapy uses microfocused ultrasound which can be delivered superficially (for surface smoothing-1.5 mm) or deeper 3 to 4.5 mm for lifting such as the jawline/under chin region you mention. Fractora uses radiofrequency and produces a fractional (partial) tissue ablation. This starts at the surface layer of the skin or close to it (they have coated tips which try to skip the surface layer, because one cannot "focus" RF energy the way we focus ultrasound energy, RF works through bulk heating...).

You mention not having wrinkles. I would say Fractora is more geared towards surface/textural concerns like wrinkles but that it not to say you couldn't get some tightening. A consultation is really needed to answer your question for you specifically. Ultherapy as I mentioned is very good at lifting.

A big consideration will be downtime. Ultherapy focuses below the surface layer of the skin, so downtime is often none in terms of anything visible on the surface though occasionally there can be a small bruise. Fractora will often leave visible marks on the surface for a period of time. If possible go to an office which offers both, or obtain two separate consults. I would also expect that Fractora will require sun avoidance for a period of time, but Ultherapy does not. This may be a consideration since you are in Florida.

Best,

Lisa Vuich, MD

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