Narcissista: Battle Of The Energy Devices ... Ultherapy Vs. Thermage

3 Jun 2013 at 9:00am

Last week, I posted about my Laser, Needle, Knife or Nothing quest to uplift the sagging lower part of my face; baby jowls, chin dumpling and crepey neck.

I’m not ready for a facelift, mini or otherwise and it hasn’t been recommended (thank you). What I did hear a lot about was Ultherapy and Thermage.

This got me thinking; what’s the deal with these energy devices? They’re not cheap, so do they really work?  And if so, what are the downsides?  How much does this stuff actually hurt?  Will the fat melt off my face leaving me looking like Edvard Munch’s “The Scream” in 10 years?

Lets take a step back and look at the whole spectrum.

Energy devices have been around for more than a decade with the goal of skin tightening. You may have even heard of some of the early pioneers, such as TITAN, eMAX and Thermage. The technology largely centered around radio frequency and/or infrared light to goes deep into the dermis and uses heat to smack that lazy collagen around so it would remodel, reorganize and behave like younger collagen.
The result?  You, but tighter…sort of.


All this innovation resulted in trial and error. There were inconsistent results at first; some patients saw nothing, but others had burns, divots, nerve damage and fat atrophy because the industry was “learning” how much heat is too much (and sometimes it was done in the wrong hands). Not a great time to be an early adopter if you’re a patient. Secondly, there was the pain which required either local anesthesia or narcotics.

I had eMAX back in 2008.  The only thing that hurt was my wallet because my results were a big nothing.

Flash forward to 2013; energy devices have come a long way baby. 

Most of the manufacturers have learned how to get good results at lower settings so there’s less risk of burning and pain.  Further, there’s more knowledge on who the right patient is so expectations are managed up front.

For instance, if you need a facelift, you need a facelift – none of these devices will give you facelift results.  But for someone like me with mild to moderate sag, jowl, chin dumpling and laxity, they’re a good option.

So what’s most effective?

Lets get started with a cheat sheet of some of the skin tightening options available.  I included a comparison between what each brand’s actual FDA approval is (when I could find it) to draw a contrast between what gets casually talked about among doctors and the media.


This distinction is important because there is a lot of off label use in cosmetic medicine. This isn’t necessarily a bad thing, for instance, Botox is not FDA approved for crows feet.  his means Allergan cannot promote the fact it works on crows feet.  Still, it’s talked about so much we assume it’s technically indicated for that use.

But the world of skin tightening is more confusing. You’ll notice a lot of the devices are approved for wrinkles, or something incredibly vague like dermal heating, but not necessarily tightening or lifting. Plus, it’s easy to blur the lines when we talk about laxity and sag because they intersect to make your neck and jaw area look soft.

There’s a bigger story beyond the above chart because innovation has improved.  TITAN, even though it has a moderate approval rating (small sample size of only 56 reviews) is rarely used anymore given the advances in technology.  Doctors and patients seem to have mixed opinions about the effectiveness of ReFirm.


Pelleve is fairly new, but the chatter doesn’t suggest a home run as much as a nice complement to Ultherapy because it works on the upper layer of the skin, particularly around the eyes and mouth.  But it will cost ya $2000 for 2 to 3 sessions, yikes.  Syneron has two offerings – eTWO (which boasts sublative and sublime radio frequency, but not sure I understand the benefit) and ePRIME (Evolastin), but patient and doctor reviews on Real Self are limited and mixed, so the jury’s still out.

It seems from the buzz in the medical and patient community, that Thermage and Ultherapy are the only two horses in the skin tightening race.
In the right medical, experienced hands, both have little risk of fat atrophy, nerve damage or over correction.  With any skin tightening energy device, the results generally take 3 to 6 months to show up, but I like that because I don’t want to come back from lunch looking 33, that would freak people.


So I’m thinking, between the two of them, if Gwyneth uses Thermage, it’s good enough for me, right?
Mmm…not so fast.

On the upside, Thermage has been around for over 10 years and used in over a million patients.  They’ve optimized their product with the launch of the CPT cooling tip that makes the experience less painless, and can be used on the under eye area (Ultherapy can only be used in the outer orbital area).

But a few things make me pause before I fall prey to the GOOP effect:

The worth it ratings on Real Self aren’t high at 38% out of 278 patients, but in fairness, this is probably a by product of Thermage being on the market longer and living through its own set backs, which they’ve corrected for.  A lot of doctors like it, but many feel it’s a little less predictable; great on about a third of their patients, but hard to tell which ones will benefit the most.

Ultherapy, on the other hand, not only has higher worth it ratings of 74% (out of 304 patients), but it’s the only device FDA approved to tighten and lift the chin, neck and eyebrows.  Thermage’s indication for towards wrinkles. Not only that, the doctors I spoke to with who had both Thermage and Ultherapy in their practice recommended Ultherapy for me because my issue was sagging over wrinkles.

What seduces me one step more is the science.  I’m not one to geek out, but the technology is newer than anything we’ve had before.  Ultherapy uses ultrasound to go deeper, reaching down towards the SMAS with more precision, depth and heat which is apparently what provides the lift.


Narcissista is New York ad exec, RealSelf community member, mom, wife, and self-described “beauty veteran” Becca Smith whose blog,, deliciously and incisively examines the intersection of beauty, anti-aging, and loving (and navigating) life.