Difference Between Ultra Sound Face Lift and Fraxel Repair Laser Treatment?

Question

I am considering a procedure to tighten the skin on my face and neck and also looking to improve the lines around my eyes and lips. I heard fraxel repair was expensive, very painful and there was a lot of recovery time needed. I have recently heard of an ultra sound face lift, could you please tell me the differece between the two and which would give the best results with the least amount of down time and money???

Brian S. Biesman, MD · Answer

Fractional resurfacing is best suited to treat fine wrinkles and discoloration of the skin while focused ultrasound treatments are intended to tighten and contour the skin. Ultrasound treatments do not address skin color changes. There is no recovery period after ultrasound treatments whereas approximately 1 week of recovery is needed after ablative fractional resurfacing treatment. These treatments tend to be complementary as opposed to competitive. That is to say, many patients can benefit from both of these treatments.

Ron Shelton, MD · Answer

Resurfacing for lines around the lips improves these lines but the lines will not usually go away completely. The best results are obtained with laser resurfacing but it does take a week or more to heal and there is a risk of scarring. Fraxel Repair, non-fractional carbon dioxide laser and Portrait plasma therapy can be done but all do require at least a week to heal. Tightening procedures with radiofrequency, such as Thermage, do nothing to help the surface lines. Often patients undergo both and can do the Thermage the same day and immediately preceding the Fraxel laser. Fraxel Restore can be done in a series of multiple treatments with minimal downtime and no need to stay at home, unlike the Fraxel Repair, but the results are not expected to produce as good a dimunition of wrinkles of the lips.

Michael A. Persky, MD · Answer

Hi Brookhaven,

	Fraxel repair will give you skin rejuvenation by improving the tone, texture, and color of your skin as well as tightening select areas of crepe skin such as around the eyes, cheeks, and somewhat in necks.  Fraxel repair is the best technology for wrinkles around the eyes and lips. The treatment should not be painful when performed by a physician who knows how to use local anesthesia.  Thankfully, the post-treatment recovery is pain free (in 4 years I have not prescribed a pain med for a patient after Fraxel repair).  The acute recovery period is 7-10 days, but it takes 4-8 weeks for the skin color to return to normal. 

	The current ultrasound technology used for tightening the face and neck is Ulthera.  Ulthera can be quite painful during the treatment, and there can be some discomfort afterwards.  Ulthera will "lift" the eyebrows, face, and somewhat the neck more so than Fraxel repair, but will not treat the crepe skin of the eyes and lines of the lips as well.  I have been treating patients with Ulthera for the past 2 1/2 years with excellent patient satisfaction.  The new "Amplify" protocol cuts the discomfort of Ulthera greatly by decreasing the amount of energy per pulse by 25% and increasing the total number of pulses by 33%.

	As with many of the procedures in facial aesthetics, the old saying, "No Pain, No Gain" applies.  Good luck and be well.

Milan Doshi, MS, MCh · Answer

Dear Brookhaven, 
UlTherapy uses ultrasound energy to bring back a more youthful look. Fraxel uses lasers to reduce the signs aging. The end goals with both the procedures are same and deal with anti-ageing techniques. They are both used to reverse signs of aging.

Tanya Kormeili, MD · Answer

Ultrasound tightening is directed towards pulling your muscles and deep tissue tight to lift up against gravity vs. Fraxel is used to produce collagen and improve the skin itself.
Here is more info!
Ulthera is the first FDA-approved device that uses sound waves, ultrasounds, to offer skin tightening and rejuvenation. Because sound waves can penetrate deep into the skin, Ulthera can cause deep tissue tightening that was not possible in the past. It can treat not just the skin but the deep underlying support structure of the skin.

Ulthera causes tightening, lifting and toning of the skin in various areas of the body such as the eyebrows or lower face and neck, giving an open-eye, refreshed, less “saggy” appearance. And because Ulthera uses sound waves, it is very safe and requires no surgical cutting to the skin. Each treatment takes about 60 minutes and requires pre-treatment with numbing creams and medicines to help with the discomfort of the treatment.
Fraxel is a unique laser because it has the ability to rejuvenate the skin in a non-invasive, effective fashion with minimal downtime. It can be an ideal treatment for sun damaged skin on the face, neck and chest. In addition to brown marks, it can used to improve scars, stretch marks, fine lines and wrinkles and age spots.
By placing tiny columns of energy into the skin, the Fraxel laser promotes the body’s natural healing response and development of new collagen. The Fraxel laser is used fractionally treating a patient’s skin in specific areas, while leaving some skin unaffected nearby, allowing for an easier and less invasive rejuvenation.
The net result is tighter, smoother, and more radiant skin.
Treatment with the Fraxel laser begins by first using a numbing cream to make the procedure comfortable. Generally three treatments are needed for great results.  Because the process requires new collagen to form, maximum results take few weeks to show. After each treatment there is about a 1 week period of “downtime” where a patient may experience light redness and discoloration in the skin while the skin is undergoing this healing and rejuvenation.
Best of luck with your treatment!

Joseph A. Eviatar, MD, FACS · Answer

The one thing that I always caution people about is the use of these new technologies which are just not proven over the long term. There is ultra sound that has been used in medical applications. But, as far as using ultra sound instead of a surgical facelift, I wouldn’t recommend it. Fraxel is a different story. It shouldn’t be painful and usually is not that expensive and is appropriate for skin wrinkling and skin tightening, superficially. But, it’s not a lifting procedure. Face lifting and Fraxel are really two different procedures that achieve two different things and work in different layers of the face. Fraxel works superficially for finer lines and skin tightening. A facelift works deeper to lift the deeper tissues of the skin. In general, a lot of these technologies that sound too good to be true, are too good to be true. They may not be expensive, but you’re usually just wasting your money as they usually don’t deliver the results promised. I like to see several year’s worth of real results before I recommend a technology.

A. John Vartanian, MD, MS · Answer

Dear Brookhaven: This is a common question in the mind of many patients who want to deploy their hard earned resources in getting the best result.  Comparing the Fraxel Repair (FR) versus other skin tightening treatments (like the Ulthera) is tough because they treat different things and have different downtimes. The FR works very well to rejuvenate the surface of the skin, but can have 3-6 downtime depending on the treatment levels.  The ultrasound technology attempts to tighten the deeper skin tissues and has NO downtime, but is somewhat painful.  Another more established non-invasive deep skin tightening technology with a similar goal includes the Thermage which is designed to tighten deep skin.  In theory, we would like to use both in synergy to rejuvenate the entire face.  Now, it is really a bit too much marketing to call the Ulthera, "an ultrasound facelift" device...subtle facial tightening- maybe, slight reduction in facial sagging volume - maybe, looking a bit better-yes, noticeable facial tightening - I have not seen it or heard of it, as of yet.  Again, the Ulthera is relatively new device, so I cannot definitively comment until I see more results.  In contrast, the changes with the FR are much more noticeable where almost all patients see a reduction in:

	
		Fine lines around the eyes
	
		Some of lines around the mouth
	
		More even skin texture and color
	
		Reduction in freckels, red spots, etc.
	
		Improvement of skin acne scars and lines
	
		Skin looseness / laxity


	The main negatives with FR are the downtimes involved and the need to numb the face.  But for those who have funds for only one procedure to look better, I would steer most towards the FR and generally away from newest (think marketing) not yet fully proven technology platforms. 

	Hope this of help, Dr. Vartanian

Mary P. Lupo, MD · Answer

Fraxel Repair and other fractional CO2 systems give some tightening, but mainly help general photoaging symptoms like lines, wrinkles and especially blotchy discoloration. Ultrasound and radiofrequency tightening just gives some improved contours and lift. Many patients actually do need both.

Richard P. Rand, MD, FACS (retired) · Answer

Neither Fraxel (despite Dr. Oz's recent show) nor Ulthera will give you anything close to a "best" result. At best they might slightly tighten you up but in no way will they do much very impressive. Keep your expectations in line with what a treatment can realistically do and you will be happy.

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