Does it Make a Big Difference Who Performs Ulthera on You?

Question

Is it so important who does Ulthera treatment - plastic surgeon, dermatologist or even nurse? I see here very different results and I wonder why somebody have good results and many any improvement even if they are 30 , 35 or 40 years old. What do the results depend on?

Young R. Cho, MD, PhD · Answer

I have had Ultherapy in my practice since 2011, and I have found that my own results have improved with time as I have learned to customize and taylor my protocols to each patient.  I do have aestheticians that provide Ulthera but I also do a fair number of patients myself.  I have found that very soon after I received the device, I started increasing the amount of energy used to where I was using twice the recommended protocol.  This made a big difference in outcomes.  Ulthera then changed their protocol to increase the overall amount of energy towards the end of 2012.  Since then, I have further increased the amount of energy we deliver to patients.  I work very closely with my aestheticians and often develop the treatment plan together, even if they perform the procedure.  This way, I get to help customize the plan for the individual patient.

	One thing to bear in mind, when you go to a core board certified aesthetic provider (e.g. Plastic Surgeon, Dermatologist), they are usually the ones leading advancing the use of these technologies.  The technology companies, however, need to grow so they quickly start selling to a lot of non-core customers.  So I would say it does matter what type of practice you go to, and how involved the the doctor is with your consultation and treatment plan.

Ron Shelton, MD · Answer

The non invasive tightening and lifting of facial features with Ultherapy ultrasound treatment has evolved over the last several years. Newer transducers allow different levels of the dermis to be treated giving, potentially, a better result. To say that a doctor does a better treatment than a nurse would not be valid if that doctor isn't using the newest technologies available. There are developments also in the technique that the provider may or may not have been practicing.

	Physicians are able to modify the treatment customized to the individual patient's concerns. Some people are asymmetric and the treatment can purposely be delivered with greater lines of Ultherapy in the areas that deserve more attention.

	Experience is important. Knowledge of anatomy is important and communication with the patient. If a nurse is doing the procedure in a doctor's office, then the doctor(s) are usually supervising the treatment in the sense of ensuring that the nurse is trained adequately. Requirments allowing or not allowing nurses to provide such treatment is regulated by each state differently.

Richard Baxter, MD · Answer

Ulthera, which uses micro-focused ultrasound for noninvasive skin lifting, works by precise placement of thermal stimulation under the skin. The body responds to this by remodeling the collagen layer, so because it is ultimately the body's response that determines the result there is some inherent variability. Age, thicklness of the skin, and other factors are probably more important than who does the procedure provided that they are well-trained. However, Ultherapy must be done under the supervision of a physician if the doctor does not do it.

Farhan Taghizadeh, MD · Answer

The question of who does a procedure is a complicated one, encompassing many questions regarding qualifications, training, and patient customer service. In general Ulthera has an excellent program to train interested physicians and nurses on performing the procedure. The device is very intuitive, and allows for good control as one does a treatment.

	 

	However, in my practice, I have often noted that with ablative technologies like Ulthera, having a practitioner who has extended experience with these technologies can help achieve better results. The ability to visualize tissue response and make subtle adjustments in the treatment protocol can greatly enhance the outcomes.

Rebecca Fitzgerald, MD · Answer

Ultherapy is still a fairly new technology so as time passes, we will likely see improved results.

	Since Ultherapy is ultrasound and not a laser, the technical expertise is not as critical as it would be for certain other technologies (though you certainly want to be certain your provider is well trained). This makes it an appropriate procedure to be provided by trained medical staff as well as physicians and surgeons.

	The variables that exist with Ultherapy outcomes include

	
		Age - younger people have more robust collagen response so they will typically get faster and better results.
	
		Patient health - again this affects how the skin and body respond to the intentional injury to tissue. If your body is already attending to illness, there is less available to respond to new stimulus.
	
		Amount of energy delivered. Ultherapy can be customized, so some patients may have more total energy delivery than others. With Ultherapy this is called "lines".
	
		BMI - Fat is not affected in the process, so someone with more facial fat may not see the underlying structural lift as much as someone who is leaner
	
		Technician skill - this is one of your concerns and it does matter. Ultherapy treatment energy is focused at predetermined depths and this requires that the technician - no matter if a physician or a nurse - be constantly paying attention to the system screen to target appropriately.
		 


	Photography - Many practices don't have dedicated photo studios so the changes in lighting and position will affect how well you see actual results. And some post photos are taken earlier than the 6 month "end" point, again not fully representing actual outcome.

Hratch Karamanoukian, MD, FACS · Answer

Ultherapy is a great procedure and in my opinion is very dependent on the provider. Whoever you choose to perform the procedure should be someone who has done many and understands the way the technology works and uses various vectors of treatment - the lines that are routinely used and custom lines of treatment that are not necessarily 'up and down the face and neck'. Read the Ultherapy book provided on the link below.

Daniel Shapiro, MD · Answer

The FDA-cleared Ultherapy procedure has been established to be safe and effective in clinical studies and tens of thousands of patient treatments worldwide. In addition, every Ultherapy practitioner undergoes extensive hands-on training, so you can schedule your Ultherapy procedure with complete confidence. In selecting a practitioner, it is important to find someone who is experienced and has achieved positive results with his or her patients. It does not matter so much whether it is a doctor or nurse, but rather their expertise or experience.

Joseph A. Eviatar, MD, FACS · Answer

The results from Ultherapy depend upon the technique used by the provider. In our office, our nurse provides Ultherapy because she has extensive experience with it and is a consultant and works with the company that developed the technology. Plastic surgeons, dermatologists, and nurses can all perform the procedure. However, their knowledge and experience with the technology determines what frequency they will use for each individual situation which will ultimately determine the success of the results. If a practice offers Ultherapy, make sure the machine is being used consistently and that you have the treatment by a provider that is most proficient in its use.

Cameron Rokhsar, MD, FAAD · Answer

I think it is really important to search for a doctor that is experienced in this procedure. I personally belive that perfomring a good thourough treatment is technically challenging. Look for an experienced dermatologist or plastic surgeon and make sure that it is that person that performs it. you are spending a lot of money and dont settle for a nurse or an aesthetician. Ask for their credentials. How long have they been doing it?

Chang Son, MD · Answer

Although standard therapeutic protocol is similar, there are many "expert" treatment protocols that can be performed by an experience Ultherapy provider. I do recommend that you search well experienced medical professional.

Does it Make a Big Difference Who Performs Ulthera on You?

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