Although it sounds very mysterious, radiofreqency energy (RF) is really only electrical current. Devices that use RF pass an electrical current through the tissues which then causes them to heat up, the same way passing an electrical current through the metal of the stove top burner of your electric oven causes it to heat up. This is an effect that we surgeons have been using literally for decades. Things like electrocautery devices used in surgery to stop bleeding vessels, certain types of cutting and dissecting intruments used in surgery, and certain types of skin treatment devices have been around for years. There is even a very commonly used RF device used to heat up and ablate (destroy) the lining of the uterus to stop severe bleeding. The way these devices work and the effects of the electrical energy on tissues have been well understood, viewed as safe when used properly, and approved by the FDA. As with all such concepts that work in reliable ways, inventors, engineers, and researchers are always looking for new ways to exploit those concepts to treat different conditions or treat the same conditions more safely and effectively. That is part of the reason why you are seeing so many different devices out there, all of which purport to do similar things. The big thing to understand is that some do those things better and safer than others.Ultherapy is an ultrasound device, so it doesn't use RF energy at all. It uses a focused beam of ultrasound, or sound waves that vibrate so fast that they actually deliver enough energy to the tissues that they heat up. All of these tightening devices you're seeing out there, including lasers and other light based devices, RF devices, Ulthera, plasma devices, or anything else that purports to tighten tissues, use the same basic principle - they create a controlled heat injury to the tissues to stimulate new collagen and shrink and tighten existing collagen. The issue then becomes one of deciding which device is safest, most effective, most reliable, and has least pain, downtime, and risk. Make sure you consult with only doctors who are board certified in the specific treatments on the specific part of the body you are seeing help with. This is the best way to ensure that you will receive the most accurate and useful information to help you make a decision about what is best for you. Best of luck.