Best Long Term Filler - or Should I Try Ulthera?

Please suggest. Main concerns are: 1. Looking natural 2. No puffy/plumb look/result 3. Cost I am undecided between Ulthera and Radiesse or Juvederm.

Doctor Answers 24

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!

Miami Physician
4.9 out of 5 stars 75 reviews

Ultherapy vs Filler

In our experience, Ultherapy can help to tighten up the mid face but your major aesthetic problem appears to be volume loss.  For this area, both Radiesse and Juvederm will work well.  This is a tricky area for filler, so choose who you have do it carefully.

Joseph Campanelli, MD
Portland Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Ulthera-vs-Fillers or Both

Based on your photo it seems that most of your issue is in the midface and is lack of volume.  While Ulthera can provide some lifting in he midface, I think the most predictable option for you is adding a filler.  This will also reduce the depression of the cheek fold.    Furthermore if you end up with a slight loss of subcutaneous fat after Ulthera you may find yourself requiring more volume to achieve the result you are looking for.  Both of the fillers you mentioned are effective for adding volume to the midface with the one of the advantages of the radiesse is that the syringe is 1.5 cc as compared to 0.8 cc for a syringe of Juvederm.  This may cost you less depending on the pricing of the fillers.

Christopher Tolan, MD
Saint Paul Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

Ulthera for tightening, fillers for volume: not the same

There isn't really much overlap between what Ulthera does vs what injectable fillers do. If there is some early skin laxity then Ulthera can be very effective, but fillers will add volume to replace what is missing. From the picture you posted, the skin tone appears good but there is some hollowing along what we call the "tear trough" from the inside corner of the eye obliquely down the cheek. Go for a filler and either Radiesse or Juvederm should give a good long-term result.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 53 reviews

FILLER and ULTHERAPY Correct Two Very Different Problems

Filler corrects volume loss issues. Ultherapy and Facelift do not.   Even a Facelift, which repositions muscle, and repositions and or removes fat and skin more than Ultherapy, as a rule, cannot help volume issues unless you add fat or other filler injections to the procedure. And in that case, I strongly recommend  volume injections and lifting at the same time. The Facelift or Ultherapy needs to settle and mature; and the swelling needs to be resolved before adding volume. This helps to assure a much more accurate result from the filler....common sense. Volume deficiency is corrected with Filler. Repositioning/lifting and fat reduction/removal are accomplished with Ultherapy and Face and Neck Lifting.

I know it has been 5 years since the question I am answering was asked, but things have changed in the 5 years. Ultherapy is in more experienced hands now and now we have Juvederm Voluma, which is superb for cheek volume, much better than fat in my view. For Volume loss under the eye, along the orbital rim (the sad circle), I prefer Restylane. 

Vincent Voci, MD
Charlotte Plastic Surgeon
4.5 out of 5 stars 2 reviews

Consider a combination of Juvederm Ultra and Juvederm Voluma.

Ultherapy delivers very natural results, which can be dramatic. Nevertheless, the lifting and tightening occur gradually, over the course of three months. So if you want to see immediate results, Ultherapy won't meet your needs. Addtionally, from the photo, it appears that loss of cheek volume is contributing to the appearance of nasolabial folds and marionette lines on either side of your nose and mouth. That being the case, I would start with Juvederm Voluma to add volume to the hollows in your cheeks. After that, I'd address the folds on either side of your face with Juvederm Ultra to smooth out the creases and eliminate the sagging. If the two are used in concert by an experienced professional, you'll look less haggard and far more youthful without losing your facial contours. 

Hal Michael Bass, MD
Miami Plastic Surgeon
4.7 out of 5 stars 49 reviews

Ultherapy vs. dermal fillers

Ultherapy will not add volume to a face, but it will tighten the face and occasionally negate the need for facial fillers.  However, as we age we do tend to lose volume in our faces, and despite the tightening effects of Ultherapy, fillers are often a useful addition in the preservation and restoration of a youthful appearance.  In you situation, based on the photo, Ultherapy may be the best choice, though may not fully correct all the areas on concern.  Another argument for Ulthera is that the results are permanent vs temporary in the case of most fillers.  Again, the best option is to budget for both.

Leif Rogers, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 26 reviews

Ultherapy lifts and tightens, fillers restore volume

Ultherapy and fillers address different issues. Ultherapy uses ultrasound technology to lift and tighten the subcutaneous tissues of the face. Fillers, such as Radiesse and Juvederm, restore volume to the areas of the face that have lost it. If your issue is that you feel that your skin is sagging a bit and want the tissues of your face to look a bit more lifted, then Ultherapy is the way to go. If you are concerned that there are areas of your face that look hollow and deflated or there are prominent folds, then fillers will help restore volume and natural contours to your face. There are many patients who would benefit from both Ultherapy and fillers. Both Ultherapy and fillers can produce very natural looking results as long as they are performed by someone who is experienced and knowledgeable.

You also wanted to know which lasts longer. The longevity of these treatments vary by the individual. On average, the Ultherapy results last anywhere from 1 year to a year and a half.  Juvederm lasts approximately 6-9 months and depends on which part of the face it is used. Radiesse can last up to a year. Sculptra, which is not a filler, is an injectable which stimulates your body to lay down your own collagen. The results of Sculptra last approximately 2 years.

Depending on how many areas of your face you want treated with Ultherapy or how much filler you would need to restore adequate volume, the costs may be pretty comparable. If you are trying to decide between Ultherapy and fillers,  I would recommend you base your choice on what specific concerns you have about your face (laxity vs volume loss) rather than cost or longevity. Hope this helps!

Dr. Sarmela Sunder
Beverly Hills and Los Angeles

Sarmela Sunder, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

FDA Approved Long Term Filler

Kasya  thank you for the question and photographs.  An in person consultation is necessary to devise your best course of action. The two most cost effective long term fillers are:

  • Bellafill
  • Body Fat

Both are excellent choices.  Bellafill is the only FDA approved filer that shows longevity of 5 years.  It is also a biostimulant  and will improve your own collagen.  Fat is very dependent upon technique for both removal and placement.

Mark Berkowitz, MD
Sterling Heights Oculoplastic Surgeon
4.7 out of 5 stars 61 reviews

Filler and Ulthera in the cheek

Best result would be to use both.

First, Ulthera both deep and superficial to get the cheek  lifting and skin tightening benefits

Then supplement the result as needed with filler

Richard A. D’Amico, MD, FACS
Englewood Plastic Surgeon
4.9 out of 5 stars 25 reviews

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.