Risks of Having Ulthera over Fillers?

New clinical research has shown that Ulthera can work synergistically with stimulatory fillers such as Radiesse and Sculptra to stimulate collagen formation. We advise patients to undergo Radiesse with Ulthera. Raffy Karamanoukian, Los Angeles

It has been a question that physicians have had, and one that has not been scientifically proven, if fillers dissolve faster because Ultherapy energy was passed through the filler. If it can be scheduled such that Ultherapy is done before the fillers then there is no concern. I am not aware of any cases of Utlherapy making a filler change in its chemical properties or make it migrate.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs

Ulthera at the upper cheek or undereye region targets a more superficial depth than where filler is typically injected in that area. If you had Restylane injected at the undereye region or "tear trough" area, typically the filler is injected deep, along the bone. Most practioners are concerned that Ulthera directly over fillers may dissolve the filler more quickly (not that the Ulthera will cause the filler to move), so we recommend doing Ulthera first, then injecting filler after. There are other possible side effects with Ulthera in general, regardless of fillers, such as bruising or swelling or even blistering. Whoever is performing the Ulthera (plastic surgeon, dermatologist, or supervised nurse or physician assistant) should take a thorough history and advise you to stop any blood thinning medications and herbs in advance of your treatment. It's an excellent technology that I'm excited about, and have had great results with. Technique and safety are key.

Regardless, I generally wait 2 weeks after a hyaluronic acid placement to perform the procedure on my patients and I keep in mind where I have placed the filler.  Studies have been done to evaluate the effect of other energy devices that heat the skin as deep as 3 mm, immediately over 4 different fillers, and they have shown through biopsies that it doesn't break the filler down any quicker.  I would recommend seeing someone that does many Ulthera treatments for evaluation and treatment. Good luck.

For a variety of reasons due to our patient's schedule changes or change in priorities, we have had several experience performing Ultherapy over recently injected fillers (e.g. cheek augmentation) and we have not encountered any difficulty whatsoever. It is theoretical that the filler materials may not last as long when Ultherapy is directly applied on top the skin where the filler material was recently injected; however we do not have any empirical data to support this notion.