Does Ulthera Damage Fat Transfers Done to the Face?

  Ulthera is hyped as a face-lifting and neck tightening technology that is revolutionary because of its use of focused ultrasound that creates ridiculously high amounts of heat in tiny little spots underneath your skin. The thought is that a line of these spots will create a vector of pull or lift. Well, the results are difficult to appreciate (if you do not take a post procedure picture with an elevated chin which makes the neck appear tighter) and the long term results are just sad. The heat deep in the face must dissipate and no matter how focal energy delivery is, healthy facial fat suffers. It has been around long enough to have many patients see the horrible eyelid retraction and fat atrophy that it can cause. I see young patients in my practice, who otherwise would not need a surgical intervention, present with discontent after these treatments that need blepharoplasty and canthal suspension as well as fat grafting to restore them to reasonable aesthetics.

Pelleve is a radiofrequency device, actually a powerful electrosurgical generator for cutting cauterizing and fulgarating tissue that for marketing reasons developed a special handpiece with lower power settings branded as a cosmetic intervention to increase market share. The results of Pelleve are sometimes even more devastating. This is because Ulthera charges doctors every time they push the button for a pulse which results in generally limited energy delivery.

With most of these technologies one should consider themselves lucky if no result is seen because changes caused are usually negative. I encourage patients to avoid the latest name branded repackaging of last years' disastrous technology and to find a plastic surgeon who has resisted the urge to join corporations to shake money out of patients. Many of us including myself use ultrasound, radiofrequency and other technologies under true surgical judgement and let experience and knowledge guide us to offer reasonable treatments that do not harm patients instead of following directions from sales representatives with business degrees on how to alter someones face.

Also if you are going to let someone deliver energy near your eye, make sure they are a surgeon that understands the surgical anatomy, do's and don't's, risks and potential complications. Otherwise there is no way you will avoid them!

If you are impressed with before and after pictures of a neck or face, look at the position of ear landmarks to eye landmarks, hold a straight edge to the picture and you will likely see a relatively elevated angle in the post picture that will explain any improvement. If the ears are not in the picture, well now you know why. Also be careful with lighting flash and exposure settings as well as frank manipulation.

Be careful it is not pretty out there!

This is a great question and to my knowledge there has been no research done on this subject so no one knows for sure. However I have heard panel members note that RF procedures like Thermage, and possibly Ultherapy can make some of the transplanted fat resorb even years later.

No, but I would not do Ulthera within 6 months or possibly avoiding the area where the fat was injected.  You want to give the fat a good chance to gain a good blood source and maintain supply.

Fat transfers over the cheekbone are not affected by the treatment area.  However, we advise our patients to undergo stimulatory and autologous augmentation after their Ulthera treatments. Raffy Karamanoukian, Los Angeles

No, Ulthera should not affect or damage a fat transfer that has been performed on the face, just be sure to discuss all past procedures with the dermatologist during your Ulthera consultation.

The answer to your question is not currently known, but is possibly being studied. There have been no data that shows fat atrophy can be consistenly produced by the ultrasound treatment. In case, however, this could occur, it would be best not to treat with ultherapy right over the fat injected areas. Better yet, would be to plan fat injections after, even immediately after, fat injections than having the fat done before the Ulthera.

Hi Dianne in Seattle,

Ultherapy by Ulthera can possibly effect fat....which is both good and bad.  It is advantageous in those patients who have excess submental fat and those who have had too much fat transferred.  It can be bad in the patient who is happy with their fat transfer procedure if they are treated aggressively and too deep.  Best to discuss your concerns with your treating physician.  Make sure to choose your doctor most carefully.  Good luck and be well.

Dr. P

One good thing about Ulthera is the ability to visualize the layer to be treated and know exactly where it is going. Because of this, it would be possible to avoid the fat transfers but that might mean skipping areas where some lifting would be beneficial. So for that reason, the best sequence may be to do the fat transfers first.

Thank you for posting this important question which will help guide others who are seeking treatments for both skin laxity and volume loss in the face.The answer is not known. What is recommended, if at all possible, is to do the fat transfer immediately following the Ultherapy at the same session, or thereafter, so as not to destroy the grafted fat cells. The same would apply to injectable fillers. 

Fat transfer should be done after Ulthera.  Although, Ulthera allows visualization of the layers of skin, fat and muscle, you may still have some atrophy of fat with the treatment.  To get the most out of your treatments, have open conversations with your plastic surgeon about what you have had and what your concerns are about potential future treatments.