As we age, our skin loses collagen and elastin and begins to deflate and sag—jowls form along the jawline, skin above the knee develops a crepey texture and other areas lose their youthful bounce. There’s no sugar-coating it, but there are ways to fix it if it bothers you. Two of the top in-office technologies for addressing the issue, without surgery: Ultherapy and Thermage. But what’s the difference between them? We tapped the experts.
“I have spent a long time studying this, as we have both in our office and have used them for many years,” says Lincolnshire, IL dermatologist Amy Forman Taub, MD. The principle difference lies in the energy used: Thermage utilizes radio-frequency (RF) and Ultherapy, focused ultrasound, but there are other variances as well.
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Thermage has been around longer, and is considered the OG skin-tightening device—it utilizes monopolar radio-frequency energy to heat collagen fibers in the dermis, stimulating collagen production. Ultherapy, on the other hand, can penetrate deeper, “using focused ultrasound to create small, nonvisible wounds in the skin,” Dr. Forman Taub adds. As Dallas dermatologist Elizabeth Bahar Houshmand, MD explains, “Ultherapy works on the ‘facelift’ layer of the face called the SMAS, which is basically the connective tissue layer beneath the subdermal layer of skin and above the facial muscles that gets recontoured when you get a surgical facelift.”
Both methods encourage new collagen growth over time, and some create change in collagen immediately—doctors we spoke to agree only one treatment is generally needed (some patients do treatments once a year, depending on the results they’re looking to achieve). “Proper follow-up timing—three to six months—should ensure 90 percent of patients get a meaningful clinical result,” says Dr. Forman Taub.
Dr. Bahar Houshmand says Thermage can be used on the face and around the eyes, targeting aging trouble spots such as the forehead, eyelids, jowls and jawline, as well as on the body, focusing on the stomach, arms and even the knees where there’s sagging and/or wrinkled skin. “Ultherapy excels on the neck and chest, but is also approved for the chin and brow,” adds Dr. Forman Taub.
“Over the years I have found that Thermage is more suited to patients with thicker or oily skin. The reason for this is that the hearing of RF is dependent on tissue resistance, which tends to be higher is thicker skin with more sebaceous glands and hair follicles,” says Dr. Forman Taub, 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.”
Treatments take anywhere from 30 to 90 minutes, depending on the area, and as far as pain goes, most experts agree they aren’t a walk in the park, but manageable. “Both are uncomfortable, but in my experience, Ultherapy is more so,” says Dr. Forman Taub. “Sometimes, certain spots on the face are more painful than others—each patient feels differently.” And as for pricing, the cost for each depends on the area you’re having treated, and often, the region you live in. Your doctor can give you a more precise idea of cost based on where you want to see results.
Experts we spoke to noted that skin-tightening remains the category with the most inconsistent results, which is why Fort Lauderdale, FL dermatologist Dr. Matthew Elias says 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 [plastic surgeons as well] 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.