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.

The issue of whether Ultherapy & Fillers are safe together is really not that complicated. Ultherapy causes collagen tightening by heating the layers of tissues of the face in a targeted way. Fillers restore volume in those tissues.  Ultherapy before fillers is very safe.  We often combine ultherapy with fillers by first doing the ultherapy then placing the fillers so that the heat does not affect them.  Heat is more likely to affect botox than fillers.  Ultherapy after fillers immediately after fillers and botox probably is not a good idea, but in a delayed fashion is safe. Ultherapy is usually a one time treatment where filler are not.  Even if you have some absorption of fillers which will happen anyway...you can get more.  The combination together is very effective!

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.

There really isn't much to go on in terms of the effects of Ulthera over fillers such as Restylane or Juvederm, because it is common sense not to treat over them and so there is no experience to draw upon. However, the areas we usually target for fillers do not overlap much with the areas where Ulthera is done so it isn't a major issue.

There is clinical data that shows that Ultherapy can be combined with certain fillers and the effect is compounded with the combined treatment.Read the Ultherapy ebook provided on the link below. 

As you mentioned, the main risk of preforming Ulthera over fillers is that is can dissolve the fillers faster. In the future, I recommend having your Ulthera treatment prior to filler injections to ensure. This time, just make sure you communicate to your physician that you have had filler injections on the cheek and eye area.

The risk of performing Ulthera after fillers is that the filler will dissolve faster.  I prefer to perform Ultherapy before fillers.  After the lift from Ulthera, the patient may need less filler.  However, you can have fillers first.  I would wait 2 weeks betweeen treatments.  It is useful to go to the same physician for both, since they will know exactly where the fillers are and easily avoid them.