Neck tightening - ulthera or fractora. (photos)

Often a treatment combination approach is the way to go.  Ultherapy is great for skin tightening and fractora works well for skin texture.  In our office, we will often use Ultherapy for tightening followed by the non-ablative 1540 fraxel laser.  The two treatments together show great results. Based on your photos, I recommend Ultherapy followed by a procedure to treat the skin texture. You could also consider filler in the "necklace lines". 

You would really need an in-person consultation and evaluation to determine which treatment would be appropriate for you. Looking at your pictures I think you would do best with a combination of treatments. If you are looking for a lift and tightening, then Ultherapy or ThermiTight would be appropriate. For texture improvement and fine lines/wrinkles the treatments can be combined with microneedling, chemical peels, thermismooth, or laser. Fillers can help soften the deep horizontal neck creases. Please make sure you find an experienced provider. Hope this helps!

Ultherapy is a no downtime procedure that is FDA approved for noninvasive skin lifting. With your age and condition you are a good candidate. Be aware that every nonsurgical treatment has a range of responses.

While I do like ultherapy for skin tightening of the face and neck, one major drawback of the technology is that it does nothing for fine lines and wrinkles (texture issues).  Texture issues such of those are best addressed with resurfacing devices  i.e. laser, peels, microneedling.   I do not have much experience with fractora personally, but the device makes me nervous as it has uninsulated needles an is very technician dependant.  I Personally prefer Lutronic's Infini, In my opinion this device is the gold standard in regards to RF Microneedling devices.   It has insulated needles which makes it more controllable with less downtime.  I find it works great on necklace line and the perioral region.   As opposed to fraxel and other lasers it has less downtime and also gives a degree of skin tightening.  

A combination approach is needed. My recommendation for neck tightening for all my patients that are candidates for RF treatments is Thermage combined with exilis or Ultherapy. Liposuction with energy on the neck such as ThermiRF also does very well to tighten. Fillers can go directly into the lines for improvement. I suggest seeing an expert for an in person consultation.  Best, Dr. Emer.