Beginning in our 30s, our skin loses a little bit of its collagen and elastin every year—and over time, this causes it to deflate and sag. Jowls form along the jawline, the skin above the knee develops a crepey texture and other areas lose their youthful bounce (all that plump cheek pinching from Grandma we got as kids now makes sense). If it bothers you, a consultation with a dermatologist or plastic surgeon is the best place to start, and two of the top in-office technologies they may recommend for addressing the issue are Ultherapy and Thermage (though not everyone is a candidate). But what’s the difference between them? We tapped the experts.
The Key Difference
“Thermage and Ultherapy are devices that use heat to tighten skin, and the key difference comes down to the type of energy used,” says Palo Alto, CA facial plastic surgeon Sachin S. Parikh. “Ultherapy uses ultrasound energy, which reaches the deepest layers of the skin with a high level of precision. Thermage, an older technology, uses radio-frequency energy, which targets broader areas and more surface layers of the skin.”
Wayne, NJ facial plastic surgeon Jeffrey B. Wise, MD says Ultherapy is considered the gold standard because it can go deep into the SMAS—superficial musculoaponeurotic system—layer of skin, an area typically addressed by facelift surgery. “In contrast, Thermage works more superficially, and although it doesn’t provide much lift, it does work on smoothing out wrinkles. These days however, Thermage is considered somewhat of an outdated technology. We are bigger fans of Morpheus8, which combines radio frequency with microneedling to gently reshape and revitalize the skin from the inside out.”
The Ideal Candidate
An ideal candidate for Ultherapy is someone with mild-to-moderate skin laxity on their face, neck or décolleté (the device is FDA-approved for use to lift the neck, chin and brow, and improve lines and wrinkles on the upper chest). Thermage can be used on the face as well (and even around the eyes), but is generally used on larger areas of the body where there is mild skin laxity or surface-level wrinkles.
“The ideal candidate for either is anyone with mild skin laxity that’s looking for skin rejuvenation, but is not yet ready for a surgical procedure,” says Dr. Wise. “We recommend Ultherapy for patients as young as their early 30s, who are noticing some laxity and want to take preventive action. It’s also an excellent treatment for patients who have had a facelift procedure and want to maintain their results.” However, Dr. Wise adds that “these treatments can’t address other issues that often happen concurrently, such as submental fullness—aka a double chin caused by extra fat—or excess skin/bags around the eyes, which typically require surgery. The real advantage of surgery is that it can dissect and reposition tissue, addressing the multitude of concerns simultaneously and giving you natural-looking results that last for many, many years.”
After years of using the devices, Lincolnshire, IL dermatologist Amy Forman Taub, MD has found that Thermage is better-suited for patients with thicker or oily skin. “The reason for this is that the heating of RF is dependent on tissue resistance, which tends to be higher in thicker skin with more sebaceous glands and hair follicles,” she explains, noting that men are good candidates for this reason, as they have thicker skin than women. “Ultherapy can be used in thicker skin, but we have found that it works great in people with thinner or medium-thickness skin. Precise targeting with Ultherapy allows you to get really deep in thin skin, and the injury takes up more volume in the skin relatively.”
Number of Treatments Needed
Both treatments—they take anywhere from 30 to 90 minutes, depending on the area—encourage new collagen growth over time. “Because of that, it can take a couple of months before patients see their final results,” says Dr. Wise. “But the beauty of Ultherapy is that you only really need one treatment to give you results that can last several years. We recommend getting it once every two years to keep gently rewinding the clock on your skin as it continues to age with time. That being said, some patients elect to do it more frequently, and there’s really no harm in that.”
Dr. Parikh agrees, saying most of his patients see their desired results after one Ultherapy treatment, but they may come back in a few years later for a touch-up treatment. “For some people, a nonsurgical intervention makes sense if they have mild concerns or they want a treatment with little to no downtime,” he adds. “But at some point, if a patient wants optimal results, then they should look into surgical options. We tell our patients that it comes down to their aesthetic goals, timeline and finances.”
It’s important to note that no matter how many treatments you have, these devices are not a magic bullet that will make you look 10 years younger overnight. “Skin-tightening remains the category with the most inconsistent results,” says Fort Lauderdale, FL dermatologist Dr. Matthew Elias,” which is why patient selection and operator experience are so important.” Germantown, TN dermatologist Purvisha Patel, MD agrees. “The results are in the hands of whoever is administering the device and manipulating the settings. Board-certified dermatologists and plastic surgeons have an intimate knowledge of the amount of energy needed and anatomy of the treatment area.” It’s also common for these treatments to be paired with volume-replacing fillers and expression line–smoothing neurotoxins for enhanced results.
Pain + Downtime
As far as pain goes, most experts agree these treatments aren’t a walk in the park—some form of numbing is typically administered beforehand, and even then, some patients can feel a bit of discomfort—but they are manageable. “Both are uncomfortable, but in my experience, Ultherapy is more so,” says Dr. Taub. “Sometimes, certain spots on the face are more painful than others—each patient feels differently.”
Once you leave the office, some swelling and tenderness is normal for a few days, but the doctors interviewed here agree most patients feel comfortable resuming normal activities right after treatment.