Thermage and Ulthera use radiofrequency and ultrasound respectively to deliver heat to stimulate collagen remodeling. Thermage targets the skin dermis and is therefore most effective for patients with good skin quality and density. Using the newest tips and protocols, treatment is painless without anesthetic or pain medication and there is no down time. Ulthera has the option to target different depths, most commonly the fibrous tissue within the fat and beneath the dermis, but the dermis can also be targeted. Because the heat can be targeted more deeply, it wiill work even if the skin quality is poor and there is significant laxity. Ulthera is uncomfortable - it requires either injectable anesthetic or oral pain medication (some physicians actually use sedation). After ulthera patients can experience mild swelling for a few days, a late onset bruise even the following week and numbness for several weeks.In my practice, I use thermage primarily for anyone with good skin quality trying to maintain or improve their skin tone. It is an excellent full face treatment and can be done annually or every few years as needed. Although ulthera can be used for full face treatment, I tend to use it more targeted for patients with greater laxity who have had thermage previously or for whom thermage is not appropriate.Although some results are seen immediately for Thermage and at a month for Ulthera, final results of both are seen at 3 to 6 months after treatment. I hope this helped answer your question. Best wishes.