Ultherapy & Restalyne - Not Working and Not Sure Why?

I had Ulthera done by a v expensive dermatologist in NYC, followed by Restalyne and Botox one week later. I saw almost immediate results with the Ulthera, but now it's almost like the injections reduced the impact of the Ulthera. Both procedures added up to over 7,000 USD I am concerned that the interaction between the procedures caused them to "cancel each other out" or something. I'm writing this about a month on from the injectables, and really see no difference at all than before I even started.

Doctor Answers 6

Ultherapy with Radiesse in Los Angeles

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Ultherapy results have been excellent in our Los Angeles practice. Rather than Juvederm, a customized Ulthera treatment in our office employs a stimulatory filler such as Radiesse or Sculptra. Raffy Karamanoukian, Los Angeles

Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Ulthera and fillers work differently

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Thanks for your question.  It is highly unlikely that the Botox and fillers you received negated the initial results you saw from Ulthera.  This is because they have different, non-opposing mechanisms of action.  Botox relaxes muscles and fillers create volume whereas Ulthera tightens the underlying tissues and stimulates new collagen formation.  It is more likely that some of the immediate results you saw from Ulthera could have been from post-procedure swelling, which is normal.

Joshua L. Fox, MD
Long Island Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

Ultherapy takes time to complete the process

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Some people get some immediate permanent effect from Ultherapy and others have to wait a bit. You will have some initial swelling that may be perceived as immediate effect, but when that swelling subsides, you might think, "Gee, it didn't work after all" - but that is not he case. Expect to wait 6 months for the body to complete the response to the treatment. Everyone responds on their own body's time schedule.

You had the treatments in the correct sequence so there is little chance they worked against each other. Be patient and when you reach the 6 month mark, review your pre treatment and final post treatment photos. It's at that point you can see the differences that Ultherapy makes.

Not knowing the location of your Restylane placement, it's hard to say why you might not notice an improvement.  Your treating physician will have the best answers for you.

Never hesitate to revisit your doctor for clarification of a treatment response or expected response. Often the answers are simple and there's little need to force yourself to second-guess or worry.

Rebecca Fitzgerald, MD
Los Angeles Dermatologic Surgeon
4.1 out of 5 stars 22 reviews

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Radiesse and Sculptra with Ultherapy is preferred

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We prefer to combine Ultherapy with Radiesse or Sculptra because of their stimulatory effect on collagen production - as opposed to Juvederm.

Read the Ultherapy book provided on the link below. 

Ultherapy for facial lifting and tightening and Restylane or Juvederm for volume filler

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You mentioned you had Ultherapy in NYC and then had Restylane but don't see the benefit.  Ultherapy usually provides increasing benefit over six months as more collagen is deposited.  the Restylane should have added volume which makes a more rejuvenated face. However if the placement of the Restylane was not ideal, it possibly could add weight where it's not needed. Please see the doctor who did the treatment and compare your before and current photographs.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Ulthera and Pelleve : Two technologies that drive me nuts!!!!

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Ulthera and Pelleve, two technologies that drive me nuts!

  Ulthera is hyped as a face-lifting and neck tightening technology that is revolutionary because of its use of focused ultrasound that creates ridiculously high amounts of heat in tiny little spots underneath your skin. The thought is that a line of these spots will create a vector of pull or lift. Well, the results are difficult to appreciate (if you do not take a post procedure picture with an elevated chin which makes the neck appear tighter) and the long term results are just sad. The heat deep in the face must dissipate and no matter how focal energy delivery is, healthy facial fat suffers. It has been around long enough to have many patients see the horrible eyelid retraction and fat atrophy that it can cause. I see young patients in my practice, who otherwise would not need a surgical intervention, present with discontent after these treatments that need blepharoplasty and canthal suspension as well as fat grafting to restore them to reasonable aesthetics.

Pelleve is a radiofrequency device, actually a powerful electrosurgical generator for cutting cauterizing and fulgarating tissue that for marketing reasons developed a special handpiece with lower power settings branded as a cosmetic intervention to increase market share. The results of Pelleve are sometimes even more devastating. This is because Ulthera charges doctors every time they push the button for a pulse which results in generally limited energy delivery.

With most of these technologies one should consider themselves lucky if no result is seen because changes caused are usually negative. I encourage patients to avoid the latest name branded repackaging of last years' disastrous technology and to find a plastic surgeon who has resisted the urge to join corporations to shake money out of patients. Many of us including myself use ultrasound, radiofrequency and other technologies under true surgical judgement and let experience and knowledge guide us to offer reasonable treatments that do not harm patients instead of following directions from sales representatives with business degrees on how to alter someones face.

Also if you are going to let someone deliver energy near your eye, make sure they are a surgeon that understands the surgical anatomy, do's and don't's, risks and potential complications. Otherwise there is no way you will avoid them!

If you are impressed with before and after pictures of a neck or face, look at the position of ear landmarks to eye landmarks, hold a straight edge to the picture and you will likely see a relatively elevated angle in the post picture that will explain any improvement. If the ears are not in the picture, well now you know why. Also be careful with lighting flash and exposure settings as well as frank manipulation.

Be careful it is not pretty out there!

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.