Thermage or Ulthera for Crows Feet?

A combination of Xeomin and customized Ultherapy treatment can help improve this very important cosmetic area of concern. Raffy Karamanoukian, Los Angeles

There are multiple ways of trying to improve crows' feet near the outer eyelids. Botox is the most effective, but in those patients whose lines are so deep that despite botox-inhibition of eyelid muscle function, and preventing their skin from wrinkling during muscle contraction, their lines persist, resurfacing with Fraxel, or Portrait plasma, or radiofrequency devices such as Thermage and Pelleve, and Ultherapy ultrasound may help. These devices won't produce very smooth results as good as Botox in most instances. ultherapy is limited to the tear trough area and can't treat the skin right underneath the eyelids. Pelleve and Thermage can treat this skin, and we have seen some very good results, with Pelleve, especially, and there is no significant pain.                                                                

Ultherapy is FDA-approved for a non-surgical eyebrow lift, because it is able to actually lift and tighten the eyelid skin enough to achieve this indication. Thermage is only FDA- approved for the improvement of fine lines and rhytides.  If you have skin laxity within the orbital rim you may need to combine the procedure with a fractionated CO2 device.  Good luck!

While Botox is the gold standard, some of the wrinkles along the crows feet is due to loss of volume and diminished skin and muscle elasticity. Judicious placement of hyaluronic acid filler can help to replenish volume within and near the orbits. In my clinical opinion, Ultherapy is more consistent than Thermage overall, particularly in the case of periorbital areas due to precise nature of Ultrasonic energy delivery where the subcutaneous tissues are visualized real-time with Ultherapy as well as more potent skin retraction and stimulation of collagen with Ultherapy vs. radiofrequency technology associated with Thermage.

There isn't a definitive answer to your question, but it might be helpful to describe the similarities and differences between Ultherapy and Thermage. Both apply heat into the tissues under the skin to stimulate collagen remodelling, which causes tightening over a period of a few months. Thermage uses radiofrequency which is sort of like an electric current. Ulthera uses microfocused ultrasound, so it is applied with precision at specific depths under the surface. For crow's feet, a neuromodulator such as Botox is usually neeeded too because it is the muscle contraction that produces the crow's feet, not skin laxity.

In our Buffalo Niagara offices we have used the 1.5 mm transducers to reduce the crow's feet phenomenon and accentuate upper face and eye features with Ultherapy combined with regular maintenance Botox injections. Read my Ultherapy ebook. It is a free access ebook. 

Ulthera is great option since there are almost no side effects and it can be preformed in addition to Botox. I personally prefer to use Ulthera and have experienced remarkable results with this technology for my patients.

There are a number of different treatments options available to help reduce the appearance of crowsfeet.  I prefer using either ultherapy, Botox Cosmetic, or fractional laser treatments.  In some cases, I will often combine more than one of these treatment options.  Ultherapy produces safe ultrasound waves of energy to firm and tighten skin, reducing wrinkles.  Botox paralyzes and relaxes muscles, which results in smooth skin and our Palomar Starlux 500 fractional treatment eliminates old surface skin and stimulates the growth of new healthy skin. 

I hope this helps.

Hello and thank you for your question.  My office offers both modalities and in most patients, ulthera is better for skin/muscle tightening in this area.  While Thermage does have results in a certain population of patients, Ulthera is more predictable.  Botox is usually needed as well.

Best Wishes,

Pablo Prichard, MD

Ulthera probably delivers more predictable results than thermage because it utilizes focused ultrasound that can be visualized while treating as opposed to radiofrequency technology.  You could also try this is combination with Botox.