Ultherapy Vs Fraxel for Skin Tightening and Shrinking Pores

Hi, I am mid 40s & have aged pretty well, no wrinkles.BUT I have sagging in the jowl & neck & recently noticed my cheeks have started sagging too,which makes my eye hollows look deeper(I have naturally high cheekbones & deep set eyes).

With my cheeks sagging my once poreless skin now has stretchy large pores.I had restylane filled in the eye hollows.I have read on both Fraxel & Ulthera. Which is better for tightening/pore shrinkage & general skin texture smoothing? Can they be used together?Thanks

Doctor Answers 27

Ultherapy Vs Fraxel for Skin Tightening and Shrinking Pores

First of all, the Ulthera and Fraxel cannot truly be compared to one another. The Fraxel is a procedure that works from the top of the epidermis down. It works by breaking up the pigmentation and then having it slough off a few days later. Due to the stimulation from the heat it does help promote collagen growth and provide a bit of firming of the skin. Also because the skin is being deeper exfoliated, fine lines are smoothed.

The Ulthera is not a type of exfoliation, rather a collagen stimulant, due to the heat that is placed in the lines/pulses of the Ultrasound treatment. Also the treatment goes as deep as the muscle and helps the muscle contract, thus lifting and firming – the results can be instant, but continued results happen over the next 6 months post treatment.

Houston Plastic Surgeon
4.8 out of 5 stars 106 reviews

Ultherapy Vs. Fraxel

Ultherapy treats underneath the skin so it will do nothing for hyper-pigmentation, and very litte for texture, fine lines, wrinkles or pore size but, it does tighten and lift skin. So, it’s a great treatment to combine with laser skin resurfacing because the laser treats the surface of the skin. The best treatment/technology for laser skin resurfacing is a CO2 fractional laser. This laser is considered the most effective treatment for combating wrinkles, aging, and many other skin imperfections on the surface level. It’s important to consult with a board certified facial plastic surgeon to see if you are a good candidate for either Ulthera or laser skin resurfacing and to discuss the possible risks and benefits of both.

James Chan, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 58 reviews

Don't expect your pores to change after Ultherapy with Ulthera, Fraxel may or may not help

Some patients do get improvement in their pore size with Fraxel, but some do not. I have not ever seen it get worse, though.  Ulthera is not going to affect the pore size as it only affects the deep dermis and connective tissue layers without changing the surface of the skin.  You mentioned that your pores are visible now after your cheeks have sagged but if they are lifted to some extent with Ulthera, the pores will not look better.  Sometimes volumization of deflated cheeks can help the surface look better in some patients. I have not found one device, nor chemical peel, whether a superficial or medium depth peel, to consistently shrink pore size, but I have seen a greater percent of Fraxel patients see improvement in pores than other treatments.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

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Best Treatment for Skin Tightening and Pores...Ulthera or Fraxel Laser?


Ulthera is better for the treatment of sagging of your jowls, cheeks, and neck.  Ulthera is a deeper treatment, targeting the muscle lining and deep undersurface of the skin with ultrasound heat energy.  It is the only device FDA approved for both tightening and lifting of the facial skin and muscles. 

Fraxel is a more superficial treatment that is better for wrinkles and pores (though there is some improvement of pores in the areas treated with Ulthera).  These two treatments can be used together, even at the same treatment setting (Ulthera before Fraxel).

The other synergistic treatment with Ulthera and Fraxel is Sculptra injections. Choose your treating physician most carefully, make sure that they share your artistic vision.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Ulthera is all about face lifting without sugery

The "Big Deal" about Ulthera is not just skin tightening, thats the same page we have been on with Lasers and Thermage for  now over eight years, but whats different about Ulthera is "Lift", and lift comes from Ulthera's noninvasive ultrasound energy tightening of the SMAS that same deep collagen over muscle, underneath the fat of the face, that are tightened with a face life, so the big deal with Ulthera is not just tightening of the deeper skin collagen, but the actual  lift of the underchin and cheeks, with the great news that you get to go work the next day.  Yes, you can do lasers right after Ulthera, and we love C02 lasers, but then you are buying into a recovery time of about a week,  why not take in one step at a time and just see how you do with Ulthera alone, because surprise of surprise, all of our several hundred patients after Ulthera, also are taking about something else, there skin is smoother, our men say, "My wife says my cheeks are more Kissable"

Douglas J. Key, MD
Portland Dermatologic Surgeon
4.5 out of 5 stars 15 reviews

Ulthera and Fraxel are great in combination

Each technology is great on its own, but they address different issues and achieve results in different layers of the tissue. I use the Ulthera in conjunction with a Fractionated CO2 Laser (Alma Pixel CO2) to achieve better results than either could on its own as they complement each other. Ulthera is the premier technology for noninvasive facial tightening by causing its effects in the deeper layer of the skin and the more superficial subcutaneous tissue--with amazing results for jowls,sagging cheeks, and the neck. Fractionated CO2 works on the texture (pores) and tone of the skin while tightening superficial crepey skin and fine wrinkles. The Alma Pixel CO2 works on the superficial layers of the skin by affecting the mid-dermis. They complement each other wonderfully and in conjunction with Botox and Restylane can achieve a "nonsurgical facelift". We are one of the few practices in the New York area to offer this combination therapy. Best wishes in achieving your goals.

Luis Zapiach, MD
Paramus Plastic Surgeon
5.0 out of 5 stars 9 reviews

Two completely separate procedures

Fraxel and ultherapy are two different procedures.  Fraxel is a laser that resurfaces the skin which targets your pore size, skin texture, pigment, reverses sun damaged skin and helps soften fine lines and wrinkles. Ultherapy targets collagen production using ultrasound and thermal coagulation points causing a small injury in the deep dermis, in result the body starts to heal itself by stimulating collagen, which then helps tighten and lift, thus helping the sagging skin and jowls. The two procedures together can make a great difference being that your working inside out (if your a candidate for fraxel and ultherapy). I hope this answered your question.

Warm regards,

Dr. Jeffrey Goldstein

Ultherapy and Fraxel both have their place for skin rejuvenationI

If your primary concern is skin texture, fractionated laser resurfacing with the Fraxel Dual using the erbium option, is the procedure I would recommend.  If it is sagging, then Id steer you toward Ulthera, high intensity ultrasound tightening and lifting.

However, since most of us have multiple signs of aging, some volume loss, sagging, texture and color issues, a combined approach is necessary to maximize improvement with noninvasive treatments.  It sounds like you've already had some filler.  The next step might be ulthera - those results take about 6 months after treatment to see fully.  In the meantime, you can have a series of three or four Fraxel treatments at 4 - 6 week intervals.  You will see continued improvement over the course of the planned treatments.  

I hope this answer helped.  Best wishes.

Heidi A. Waldorf, MD
New York Dermatologist
5.0 out of 5 stars 10 reviews

Ultherapy vs Fraxel

Ultherapy is a treatment that treats deeper layers of the skin, fascia and even muscle. This treatment is for sagging and causes a more lifted appearance. The most superficial treatment is a depth of 1.5 mm and this we use to treat deeper wrinkles. Laser resurfacing treatments such as fraxel treat more superficially for skin texture and extend to a depth of less than 0.5mm.  In short, these treatments are more complementary to each other rather than competitors.  Most people can benefit from both treatments for improvement at all the various levels.

I hope this helps!

Dr. Quenby Erickson

How does Ultherapy compare with Fraxel?

Fraxel is known to treat mainly the tone and texture of the epidermis, thereby correcting uneven pigment and shrinking pores. There is some resulting collagen stimulation, however, not significant enough for a lift. Ultherapy on the other hand, does not treat the epidermis in any way. The treatment goes deep to stimulate collagen and elastin. Therefore, the two treatments cannot really be compared.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.