Long Term Effects of Ultrasound Tightening/Ulthera on the Skin?

I am interested to know what might be the expectations of this type of tightening long term. Should this be of any concern?

Doctor Answers 13

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!


Long Term Effects of Ulthera Tightening on the Skin

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Hi Bethe,

Good question.  We know that with up to 4 years of clinical use Ulthera has had no adverse effects reported on how it affects the skin.  It has been shown histologically that Ulthera promotes natural collagen formation, which like chicken soup, "can't hurt." 
Anecdotally, our patients are reporting that their skin tone, texture, and brown spots are improved a few months after their Ulthera treatment. 
I don't believe that there are long term adverse effects on the skin after Ulthera that we need to be concerned about, or I wouldn't be having the procedure myself. 

I respectively disagree with Dr. Maercks opinion on Ulthera (found below).  We have treated hundreds of happy patients over the past 3 years without any of the problems that he claims to see in his practice.  Our physicians perform all of the Ulthera treatments.  I do not know who is treating patients in his area getting the results he is seeing, but I do agree that a technology or treatment is only as good as the operator perfomring the treatment.  Choose your treating physician most carefully.  Good luck and be well.

Dr. P 

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Ultherapy may provide long term results

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As Ultherapy is a relatively new treatment we don't have 10 year follow-up, but extrapolating the results based on what has been seen with other procedures, the new collagen that is formed is not expected to go away. Biopsies taken ten years after dermabrasions showed new collagen formation that lasted!  The aging process continues and there is a constant heading south of the facial features, but the Utlherapy of today can keep you ahead of where you would be in the future if you didn't have the treatment .

Ultherapy is safe enough to repeat for further improvement as the time marches on. Some might do it six months to a year later, but others might not feel they need it for a few years.

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

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Long term effects of Ultherapy

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Ultherapy has been around close to 10 years.  Since Ultherapy uses ultrasound energy to increase your own collagen content, the long term effects would be from an increased amount of collagen.  We are not aware of any negative long term effects of ultrasound energy treatment.  It's the same energy used to visualize fetuses in the womb and has been used for that purpose for decades without any untoward effects.  

Mike Majmundar, MD
Atlanta Facial Plastic Surgeon
4.5 out of 5 stars 50 reviews

Long term effects of Ultrasound tightening

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Ulthera stimulates collagen production within your skin. There should not be any long term complications associated with the treatment, as it is simply causing your body to stimulate its own collagen and using ultrasound waves which have been used to visualize images for years.

Jeffrey W. Hall, MD
Austin Plastic Surgeon
4.4 out of 5 stars 19 reviews

There are no known long term side effects or limitations from having Ultherapy

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There are no known long term side effects or limitations from having Ultherapy in the mid and lower face and or neck. 

Read the Ultherapy book provided on the link below. 

Long Term Effects of Ultherapy

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Ultherapy is stimulating a natural process of collagen growth and tightening of the layer deep to the skin to produce a lifting effect and is therefore very safe. The treatment is felt to slow some of the aging and sagging of this layer due to the qualitative improvement that occurs. However, the aging process does continue so ongoing maintenance treatments at 18-24 months are recommended for most patients. Of course, there will come a point where the aging issues will be better addressed surgically with a facelift. This is best discussed with a board certified plastic surgeon. 

Bryan G. Forley, MD
New York Plastic Surgeon
4.9 out of 5 stars 13 reviews


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Ultherapy uses focused ultrasound to treat the skin. The goal is to increase collagen in the skin, thereby creating some lifting and tightening. Collagen develops and breaks down differently in each individual however, any procedure that increases collagen can be effective in improving the appearance of the skin.

James Chan, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

Ultherapy sets back the aging clock

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Ulthera uses high intensity focused ultrasound deliverd in brief bursts under the skin to stimulate collagen regeneration, which then creates some lifting and tightening. It takes about 3 months for the full effect to appear, but because it is a change in the collagen it isn't a temporary efefct. So think of it as setting back the clock, but the clock keeps ticking of course!

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Long Term Effects of Ultherapy

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Great question.  To answer this, one needs to understand what Ultherapy is doing to the skin.  Using ultrasound, energy is transmitted to a precise location under the skin and a small injury is created.  The body will repair this injury by making new collagen and reorganizing the collagen that is there.  It is this effect on the skin that which gives the aesthetic improvement.  Because there is nothing left behind and the body will repair the injury that the Ultherapy treatment creates there is no long term adverse effect that you need to worry about.

Joseph Campanelli, MD
Portland Facial Plastic Surgeon

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.