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Ultherapy: What You Should Know
What is Ultherapy?
Ultherapy is a noninvasive skin tightening procedure. It uses high-focused, intense ultrasound energy to tighten and lift skin by gently heating the tissue and stimulating the body’s collagen-building process, with visible results from a single session.
It’s approved by the U.S. Food & Drug Administration (FDA) for the brow and décolletage area (the neck, chin, and chest), but some doctors also use it off label, on other parts of the body with loose skin (such as the stomach and above the elbows or knees).
“The treatment is very effective,” says New York City dermatologic surgeon Dr. Ronald Shelton. “It doesn’t duplicate the results of a facelift, but it can postpone the need for surgery for many years.”
The noninvasive procedure bypasses the surface of the skin, so side effects and downtime are minimal.
You may see an immediate improvement, with increasing benefits over the next two to three months.
It’s safe for all skin types and tones.
Treatment sessions can be painful, but most doctors will give you medication, to make it more comfortable.
You’ll have to wait a few months in order to see significant results.
Results are far less dramatic than the lifting and tightening of a surgical facelift, and they don’t last nearly as long.
A good candidate has skin that’s started to look less firm, leading to a lowered eyebrow line, sagging neck skin, or jowling. Typically, people with mild to moderate skin laxity find Ultherapy most beneficial. The treatment is safe for any skin tone.
“The key characteristic for improvement with Ultherapy is not the patient’s age but the elasticity of the skin and lack of deep sun damage,” says Dr. Shelton, who encourages people to have realistic expectations. “The amount of improvement is never the same as a facelift.”
Depending on whether you’re doing a face-and-neck procedure, a chest treatment, or all of the above, one session can take 30 to 90 minutes. An ultrasound conductive gel is applied to the skin, and your doctor moves a handheld device across your skin’s surface, to transmit the ultrasound energy to the deeper skin layers. This energy enters your skin at precisely the right depth to jump-start collagen production.
“The advantage with Ultherapy is that thanks to the ultrasound monitor, your doctor can see where they’re treating, visualize the connective tissue, and know at what depth they need to treat in order to be effective,” Dr. Shelton says. Your doctor will adjust the treatment depth with different ultrasound transducers that attach to the handpiece in order to deliver the energy to specific layers of tissue—the superficial dermis, at 1.5 mm; the deep dermis, at 3 mm; and the SMAS/platysma muscles, at 4.5 mm.
RealSelf Tip: Why is collagen so important? It’s the natural protein that provides structure to the skin—making up 75–80% of it. Your body’s collagen production slows with age. When collagen thins out, the skin is left with a weaker inner structure and becomes prone to sagging and wrinkles. Treatments like Ultherapy trick your body into re-upping its collagen production, to regain lost thickness and plumpness.
An Ultherapy session is no walk in the park. The treatment is ultrasound-based, but it’s not the same kind of procedure as a diagnostic ultrasound imaging: this one uses heat energy, with temperatures reaching as high as 140°F in the deep subcutaneous tissue.
“My patients do typically get some pain medication, so we like them to come in an hour before the actual treatment,” Dr. Shelton says. Depending on a person’s pain threshold, that could be Percocet, Ativan for relaxation, a little nitrous oxide (laughing gas), or even numbing cream. “All that certainly makes it more manageable for patients,” he says. The good news is that any pain you feel will last only as long as the ultrasound energy is being delivered (usually only a second and a half or less per pulse).
There have been clinical studies to measure patient comfort during Ultherapy, so doctors are well aware that setting expectations for pain management is important for building patient trust. “What I tell my patients is, ‘It hurts, but it works,’” says Dallas-based dermatologist Dr. Mary Hurley. “My patients have seen tremendous results in the face, neck, and chest from Ultherapy.”
Typically, there’s minimal downtime, though you may experience some slight redness, swelling, and (very rarely) bruising. You may also feel a bit sore or tingly in the treated areas for anywhere from a few hours to a few weeks afterward.
“After the treatment, it is common to experience some tenderness under the chin, near the cheekbones, and along the jawline, which is often described as a soreness that is really only noticed when touched,” says Dr. Pamela Henderson, a plastic surgeon in Scottsdale, Arizona. “It’s also common to experience some degree of numbness in those same areas. Both of these symptoms generally resolve in days or [within] a couple of weeks, depending on the intensity of the treatment. Overall, Ultherapy is a well-tolerated procedure, especially by the informed patient who is aware of what to expect.”
According to Dr. Shelton, the residual soreness is actually a good sign. “It means you are producing more collagen.” And while the soreness may persist for a few weeks, it won’t interfere with your quality of life. “It’s not anything that has bothered my patients,” he says. “They haven’t had to curtail their activities.”
In rare cases, bruising can be a side effect. “Patients would be advised to stop their blood thinners, if their physicians allow them, as much as 10 days before the procedure—as well as aspirin, nonsteroidal anti-inflammatory agents, fish oil supplements, vitamin E pills, and other things like that,” Dr. Shelton says. However, this isn’t mandatory, and he has successfully treated many patients who were not allowed to stop taking anticoagulants.
Depending on the type of pain medication you’ve taken, you may need to have someone take you home after your treatment. But you should be able to go back to work and resume your normal activities as soon as the effects have passed.
Many people see an initial effect right after their treatment, from the contraction of existing collagen fibers. But according to Dr. Shelton, “the real magic happens over the next 3 to 6 and even up to 12 or more months as your body steps up collagen production.” The biological response takes time.
When choosing someone to perform an Ultherapy procedure, be aware that “the more experience a technician has, the better the results,” according to Seattle dermatologist Dr. Jennifer Reichel. “Also, you have to be the right candidate. Noninvasive lifting devices will not replace a surgical facelift, if that’s really what you need.”
It’s key to have a consultation with a doctor who's board-certified in dermatology or plastic surgery in advance of setting up your procedure. This way, you can establish that Ultherapy is the right treatment for your goals and set reasonable expectations.
“People often ask me, ‘Well, how long does it last?’” Dr. Shelton says. “The new collagen lasts for years, but we’re fighting the ongoing aging process and gravity.” Because of this, you’ll likely need to return for more sessions as the natural aging process continues.
“It’s not unusual for people to return every two years for an additional Ultherapy treatment, to maintain their results,” according to Dr. Shelton. “More and more, we are seeing patients who would like to be proactive and ‘prejuvenate’ rather than rejuvenate their skin and forestall the aging effects of their skin and start treatment very early, when the skin has a hint of sagging, then repeat it as frequently as every six months.”
Even though Ultherapy is considered a “safe” treatment, there are still risks and potential side effects. Too much heat applied close to the skin’s surface can cause welts, and there can be numbness, burning, and even nerve weakness, in rare cases.
A 2017 study published in Lasers in Surgery and Medicine noted five patients who had developed blisters, erosion, or ulceration of the skin as well as inflammation and swelling, followed by tissue atrophy or necrosis after a single treatment session with the ultrasound technology. They concluded that "despite their rarity, serious adverse events secondary to microfocused ultrasound are nevertheless possible and may be underreported."
To mitigate this risk, seek an experienced provider with a proven track record of positive reviews and before and after photos from real patients. Most adverse effects can be avoided with careful monitoring throughout the procedure, to ensure that appropriate levels of heat are delivered at the right depths.
RealSelf Tip: There have been some reports of Ultherapy dissolving dermal fillers, but a 2016 study showed that no problems occurred when both treatments were done in similar time frames. Still, inform your doctor before your treatment if you’ve had filler injections within the last year.
Ultherapy costs about $2,600 on average, according to RealSelf member reviews. You could pay $4,000 or more, depending on the experience level of your provider, their office location, and how many areas you’re having treated.
Because Ultherapy is considered a cosmetic procedure, it’s not covered by health insurance.
Ultherapy uses ultrasound energy to stimulate collagen production, while a facelift is a surgical procedure that lifts and tightens muscles, removes excess skin and fat, and redrapes the remaining skin in order to smooth deep wrinkles and folds. The procedure requires anesthesia, small incisions, and a few weeks of recovery, and it can cost about $10,000 more. But it provides far more dramatic, long-lasting lifting and tightening results than Ultherapy.
People who aren’t good candidates for Ultherapy, because they either have too much sun damage or have lost too much skin elasticity already, may find that the cosmetic surgery route is the best option, to get significant results.
Thermage is another nonsurgical, noninvasive treatment option used to tighten the skin. It uses radiofrequency energy instead of ultrasound energy to stimulate collagen production. Most patients find it isn’t as effective as Ultherapy and takes longer to deliver results.
“When more tightening is needed, I turn to Ultherapy,” says Dr. Heidi Waldorf, a New York City dermatologist. “If a patient has thinner or more sun-damaged skin or the problem area is mostly lax skin under and on the neck, Ultherapy allows me to target multiple levels of deeper tissues.”
Fabi, Sabrina G, et al. “Practical Guidance for Optimizing Patient Comfort During Microfocused Ultrasound with Visualization and Improving Patient Satisfaction.” Aesthetic Surgery Journal, 14 Mar. 2019.
Fabi, Sabrina G., et al. “Combining Microfocused Ultrasound With Botulinum Toxin and Temporary and Semi-Permanent Dermal Fillers.” Dermatologic Surgery, vol. 42, May 2016.
Friedmann, Daniel P., et al. “Complications from Microfocused Transcutaneous Ultrasound: Case Series and Review of the Literature.” Lasers in Surgery and Medicine, vol. 50, no. 1, 20 Nov. 2017.
Office of Device Evaluation Center for Devices and Radiological Health. “510(k) Summary for the Ulthera System.” United States Food and Drug Administration, 20 June 2014.