Does Ulthera, as it goes past the fat layer to the SMS layer dissipate the facial fat? (Photo)

Question

Is there any way to measure (test) this? Like with an ultrasound before and after? My understanding is that Collagen will be stimulated and that the results last up to two years; but after two years will there be both less collagen and less fat?

Rian A. Maercks, MD · Answer

The short answer is yes, heating little tiny points underneath your skin with devices like Ulthera cause fat atrophy and tissue destruction.  It works by creating wounds that you dont see that heal with the formation of scar tissue.  There will always be loss of healthy soft tissue volume with procedures like this and I urge you to stay away.  I dont think there is anything too horrible about using these devices at the jaw line and below but they have no place on the face and frankly there are more effective ways of getting noninvasive neck tightening.  I use a combination of five different energy delivery systems that we call MMT (Maercks Multimodal Therapy) and get what I believe are the best safest results that noninvasive interventions can deliver.  Still about half of patients that come to my practice seeking MMT are either turned away or recommended for surgery.  There is no magic wand and the most important part of your treatment is a thoughtful practitioner that can help you select the best intervention from the array of noninvasive, minimallly invasive and surgical options.  Rather than follow predatory marketing of a business, find an ethical well trained and experienced plastic surgeon- you will be in much better hands!  I hope this helps!All the best,Rina A. Maercks M.D.

Ron Shelton, MD · Answer

The ultrasonic energy that is delivered through the skin during Ultherapy does not heat the epidermis or dermis as it passes down to the deep layers.  The physician can see on the ultrasound monitor the exact level that he or she will be treating.  The fat layer is not targeted as no tightening is expected in that tissue.The improved collagen in quality and quantity persists after Ultherapy but the aging process continues to degrade the preexisting collagen and fat.

Rebecca Fitzgerald, MD · Answer

Focused ultrasound does not impact tissue as it "passes through" since nothing happens elsewhere other than at the pinpoint focal point. So fat loss is not an issue.Aging doesn't stop - any treatment meant to affect collagen only has so much leverage and once the action of a procedure stops, then the natural aging process picks up again ...with the attendant natural degradation of collagen and volume loss..With Ultherapy you get a new starting point of sorts with the contouring and lift. The recovery action lasts about 6 months when it reaches its full potential and then stops. But you have that new starting point. We'd all love it if a procedure kept us at a stand still, but that's impossible. Backing up a little with tightening and lifting and volume replacement is a nice way to look a little younger and enjoy younger contours for a longer period of time.We love the collagen-stimulation of Sculptra and the longevity of Voluma.filler to take the place of lost collagen, lost fat and bony support loss.Combining either or both with the lift effect of Ultherapy has some distinct advantages because they are all easily performed outside of the surgical arena. Since volume loss tends to be a perpetual event, some maintenance treatment is called for if you want to slow down the visual effects of the aging clock.

Michael A. Zadeh, MD, FACS · Answer

Hi Sunny,The SMAS layer is actually located above the fat layer, so the fat layer is not affected during the treatment. The production of new collagen after an ultherapy treatment will tone and tighten the skin of your face. Even though the fat layer is not affected, by the ultherapy treatment the tightening of your skin will provide a slimming appearance. This makes it a win win situation! If you are in the LA area, feel free to contact us for an in-person consultation. You will be very happy with your Ultherapy results. Good luck in your research!

Richard Baxter, MD · Answer

There are two key features to Ultherapy: One is that the ultrasound is microfocused, meaning the tissue response is located precisely without affecting the layers through which the ultrasound passes before the focal point. The other is the imaging component, which allows visualization of the desired layer where the treatment is applied. For these reasons, the fat layer is not affected. It is also not true that there is less collagen after a period of time, if anything there would be more.

Michael A. Persky, MD · Answer

Hi Sunny in LA,One of the great advantages of the Ulthera is that during the entire treatment, I am able to see the level of treatment, and target the desired level.  When treating the smas level, the micro-focused ultrasound is aimed within 1 mm of this structure.  In the great majority of patients treated with Ultherapy, we do not wish to decrease the volume of the face by destroying fat.  Fat can be targeted if we wish in certain areas such as under the chin, but fortunately, for the most part in the face we have not seen fat atrophy.  With all due respect to Dr. Maercks opinion, I have been using this technology for the past 4 years without seeing a single patient with fat atrophy. Ultherapy, when performed properly should not be lumped into his "devices" category of things that cause fat atrophy.  After two or three years we are not seeing less fat and collagen in the face. IN fact, I saw a patient just this afternoon whom I had not seen for the past 2 1/2 years.  We compared her photos from before the treatment to todays photos.  I asked her if she had fillers in her face since her Ulthera treatment because of the noticeable increased volume of her cheeks and face.  She smiled and said, "No, it's all from my Ulthera treatment!" From your photo, should you decide on Ultherapy, you appear to be an ideal candidate for an excellent result.  Good luck and be well.Dr. P

Reza Momeni, MD, FACS · Answer

After two years, you will have exactly the amount of collagen and fat you would have had without Ulthera, except for what you've lost naturally through the aging process.  Ulthera creates extra collagen, so the net effect is that with Ulthera, you will have MORE collagen within your tissues than what you would have had without Ulthera.  Although it's theoretically possible for Ulthera to "dissipate" facial fat, in reality this has not been seen in 100s of thousands of treatments to my knowledge.

Hratch Karamanoukian, MD, FACS · Answer

Yes you can measure this fat layer and it will probably cost you around 800 dollars and a good ultrasound lab can do that for you. They would have to get measurements in 10 more areas and do follow up scans every 6 weeks to see a trend etc. This will be an expensive proposition for a patient to get the answer to. You would have to spend bout 3000 dollars just on serial ultrasound scans over a course of 6 months or more. I will submit that the amount is going to be so negligeble that it will be 'academic'. We don't see that type of fat loss that you are surmising in our experience with Ultherapy. Neither have other physicians who have perform Ultherapy. Your assertion may have some basis because Liposonix uses same type of technology to get rid of fat in the abdominal wall, love handles, thighs, etc. Why don't you fund a study yourself. For the amount of thickness (which is going to be negligeable), you would need to study outcomes in 200 plus patients. You can read our e-book about Ultherapy. We have 3 machines in 2 offices - Santa Monica at Kare Plastic Surgery and Upstate NY.

Does Ulthera, as it goes past the fat layer to the SMS layer dissipate the facial fat? (Photo)

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