Best Long Term Filler - or Should I Try Ulthera?

 

 



  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!

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:BellafillBody FatBoth 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.

I would definitely consider both.  Fillers can be used to lift and restore volume to areas that have started to sag with the aging process.  Ulthera can be used to restore some of the lost collagen.  If you are looking for a longer lasting filler, then I would consider Sculptra as this also stimulates collagen, and works great with Ulthera.  If you are concerned with which one to choose first, then I would start with the fillers as this will provide a more visible change and when done by an experienced injector, can look very natural.

Ulthera is a wonderful noninvasive option that lifts the face, without the need for added volume. Results endure for 2.5 years after a one-time treatment. In you, Ulthera can lift the cheek and fill the depression between the lower lid and cheek and smooth the nasolabial crease while improving the overall freshness of your look. Fillers like Sculptra will fill and lift the cheek, but will do this through adding volume and requires 3 sessions. Alternatively Restylane could be injected to the lower lid/cheek junction and Juvederm or Perlane to the nasolabial fold - results should last at least 9 months after single treatment session. Cost ranges are fairly comparable.

Hi Kaysa,

Your question and concerns are shared by many of our patients.  The most important aspect of your treatment is making sure that your treating physician shares your artistic vision; without artistic vision there can be technical success with aesthetic failure!   The best way to avoid "puffy/plumb look" or as it is frequently referred to "pillow face" or "HouseWives of ...... face" is to choose your treating physician most carefully.

 If cost were no object then the best long lasting treatment plan for you would be to have an Ulthera treatment of your face followed shortly by a series of Sculptra injections.  The Ulthera treatment will lift and tighten the muscles and soft tissues of your face.  Sculptra will re-inflate your face replacing lost volume.  The two treatments compliment each other to extent that some call it "Sculptherapy"!  Once corrected you should be good for 2 to 5 years.

If you are looking for a quick fix for an upcoming event then the use of a syringe or two of Radiesse injected strategically will help with your mid-cheek hollowing, nasolabial folds, and marionette folds.  Though less costly up front, it will not last as long as the sculptherapy option above, likely needing more in 12 to 18 months.  Juvederm may also be used, but Radiesse has a bit more lifting strength.

Good luck and be well.

Dr. Persky

Encino, CA

As with most comparisons of different procedures, each has advantages and disadvantages.  The results of fillers are immediate, but the results are probably not as long lasting as Ulthera.  Fillers can't lift necks and jowls as Ulthera can.  Fillers  can be used to camouflage jowls, however.  The results of fillers can be un-natural if done by a provider that is not very experienced, whereas the results of Ultherapy are very natural.  

Your best result may be from the combination of fillers for the loss of volume in your mid and inner cheek and smile creases, whereas the Utlherapy could help lift the cheek and corner of the mouth. You will see more immediate improvement with volume correction so I would vote on fillers if you can only have one of the two treatments. If you decide on Ultherapy in the future, you would consider doing that prior to the next session of fillers rather than after.

Ultherapy is tightening technology - Fillers or collagen stimulators restore volume or augment insufficient volume.

Your photo appears to suggest you would get some very pretty results from Sculptra that could lift up the cheek and in doing so, also minimize the nasolabial fold and lower face laxity.

The face is like a puzzle in that you need all the pieces to complete the picture.

Volume loss under the eyes can be attended to with a filler like Restylane - you "could" use Radiesse for cheek augmentation,but again, Sculptra would likely be the most efficient base and in actuality, provides some very precise sculpting action when it's injected properly. Plus, you can put Sculptra in a lot of areas that you can't put  Radiesse,

Ultherapy certainly has its own advantage with tightening sagging skin, but it can't address a volume deficiency or age related volume loss (happens to all of us so there's no escape!). Often what many women discover after volume restoration is a delight in looking younger and more balanced in their facial contours...without surgery or any tightening measures.

Ultherapy is proven to lift the brow and has a substantial effect on the neck area of most. But since we all continue to age, even a full on surgical facelift isn't a "one shot" solution.

General good health, good diet, sun protection and appropriate product use can make anyone's skin hold up longer and keep the collagen in better shape too.

 

From you photos it appears that both could address some potential concerns you may have.  The nasolabial folds can be improved quite naturally with fillers such as Juvederm or Radiesse.  Ultherapy works differently than fillers in that its effect will tighten the underlying muscle to promote a lifting change to the face.  Regions which ultherapy can address include the cheeks and prejowl region, neck line, and jawline.  If you are looking for a focused treatment of a certain region of the face (such as the nasolabial folds) a filler is a better option.  If you are looking for a generalized skin tightening for any early skin laxity issues in the lower face, ultherapy may be a better option.  Hope this helps!

As others have already posted, Ultherapy and fillers generally achieve different goals.  Although the angle of the photograph is not ideal, the image seems to suggest that addition of volume to the mid-facial area would provide more benefit than soft tissue tightening.  For this purpose, I would suggest Sculptra first as a way to gradually add volume in the deeper soft tissues of the face.  Radiesse and Juvederm can add immediate volume, but won't last as long as Sculptra.