Ultherapy vs Thermage
Medically Reviewed by Arash Akhavan, MD, FAAD
When it comes to non-surgical skin tightening, two of the most well-known treatments are Ultherapy and Thermage. Both procedures have been used for years to help patients achieve firmer, more youthful-looking skin without the need for surgery or downtime. However, while they are often grouped together as skin-tightening treatments, they work in very different ways and deliver different types of results.
Ultherapy uses focused ultrasound energy to stimulate deep collagen production, tightening and lifting the skin from within, making it the gold standard for non-invasive skin lifting. Thermage, on the other hand, uses radiofrequency (RF) energy, which works more superficially and is often marketed for skin smoothing rather than actual lifting.
Both treatments have their place in non-surgical aesthetic medicine, but when it comes to achieving real, long-lasting skin lifting and tightening, Ultherapy has distinct advantages over Thermage.
Thermage vs Ultherapy
Both Thermage and Ultherapy are designed to tighten and rejuvenate the skin, but they work in different ways and target different depths of the skin. Below, we’ll take a detailed look at how each procedure works, what it treats, and what patients can expect from the treatment process.
Thermage: Radiofrequency Skin Tightening
Thermage is a radiofrequency (RF)-based treatment that delivers heat energy to the skin to stimulate collagen production and improve skin texture and firmness. It uses a monopolar radiofrequency device to heat the deep dermal layers of the skin while cooling the surface to protect it. The controlled heat causes collagen fibers to contract, which can result in smoother, firmer skin over time.
What Thermage Treats
- Mild skin laxity (loose skin)
- Fine lines and wrinkles
- Crepey skin texture, particularly around the eyes and mouth
- Body skin laxity, including areas like the abdomen, arms, and thighs
Thermage Treatment Experience
- Treatment time: About 60-90 minutes, depending on the area
- Sensation: Patients typically feel warmth and mild discomfort, but a vibrating handpiece helps with comfort
- Downtime: No downtime, but some redness and mild swelling may occur for a few hours
- Results: Some immediate tightening, with full results developing over 3-6 months as collagen production increases
- Longevity: Results typically last 1-2 years, though maintenance treatments may be needed
Thermage is best suited for patients with mild to moderate skin laxity who want a modest improvement in skin tightness and smoother texture, particularly in areas with thin skin, like the eyelids or neck.
Ultherapy: Ultrasound Skin Lifting and Tightening
Ultherapy is an FDA-cleared, non-invasive procedure that uses microfocused ultrasound (MFU) energy to penetrate deeper than Thermage, reaching the superficial muscular aponeurotic system (SMAS) layer, which is the same layer targeted in surgical facelifts. By delivering precisely focused ultrasound energy, Ultherapy triggers a natural healing response, leading to collagen and elastin production that lifts and tightens the skin over time.
What Ultherapy Treats
- Mild to moderate skin sagging on the face, neck, and décolletage
- Lower face and jawline laxity (jowls)
- Drooping brows and eyelids
- Loose skin under the chin (double chin area)
Ultherapy Treatment Experience
- Treatment time: Ranges from 30-90 minutes, depending on the area
- Sensation: Some patients experience mild to moderate discomfort, but numbing and pain management options can make the procedure comfortable
- Downtime: No downtime, though some patients may experience temporary swelling, redness, or mild tenderness for a few days
- Results: Some immediate tightening, with full results appearing over 3-6 months as collagen production increases
- Longevity: Results last up to 2 years or more, depending on individual collagen response
Ultherapy is particularly beneficial for patients looking for a non-surgical facelift alternative, as it lifts the skin in addition to tightening it. It is one of the only non-invasive procedures capable of reaching the SMAS layer, making it the most effective non-surgical treatment for sagging skin.
Comparison: Ultherapy vs Thermage
| Comparison | Ultherapy | Thermage |
|---|---|---|
| Technology | Utilizes focused ultrasound energy to stimulate collagen production in deeper skin layers, including the SMAS layer. | Employs radiofrequency energy to heat and tighten the skin, promoting collagen production in the dermis and subcutaneous layers. |
| Treatment Areas | FDA-cleared for non-invasive lifting and tightening of the brow, chin, neck, and décolletage. | Effective on the face, neck, eyelids, hands, and various body areas, including the abdomen, thighs, and buttocks. |
| Depth of Treatment | Targets multiple layers up to 4.5 mm deep, reaching the foundational SMAS layer addressed in surgical facelifts. | Treats up to 3 mm deep, focusing on the dermal and subdermal layers. |
| Procedure Duration | Approximately 60 minutes for a full face and neck session. | Around 90 minutes for a comparable treatment, due to additional cooling requirements. |
| Results Onset | Gradual improvement over 4-6 months. | Gradual improvements with full results typically seen within 6 months. |
| Ideal Candidates | Individuals with mild to moderate skin laxity seeking non-surgical lifting and tightening, particularly in the face and neck areas. | Those looking to address superficial lines, wrinkles, and skin laxity on both the face and body. |
| Side Effects | Possible redness, swelling, and tenderness, typically resolving within a few hours to a few days. | Mild swelling, redness, or tingling, usually subsiding shortly after treatment. |
| Pain Management | May require pain management strategies due to deeper tissue targeting; great pain management strategies available. | Generally well-tolerated with minimal discomfort; cooling mechanisms enhance patient comfort. |
| Maintenance | Results can last over two years; maintenance sessions may be scheduled as needed. | Results typically last up to two years; periodic treatments may be recommended to sustain effects. |
Why We Think Ultherapy is Better Than Thermage
While both Ultherapy and Thermage are non-invasive skin-tightening treatments, we firmly believe that Ultherapy is the superior choice for patients looking for real, long-lasting lifting and tightening. Here’s why:
1. Ultherapy Penetrates Deeper for True Skin Lifting
One of the most significant differences between the two treatments is how deep they penetrate. Thermage uses radiofrequency (RF) energy to heat the dermal layer, which results in surface-level skin tightening but does not effectively address deeper structural support layers.
In contrast, Ultherapy penetrates all the way down to the SMAS (Superficial Muscular Aponeurotic System) layer, which is the same layer that plastic surgeons lift during a surgical facelift. By reaching this deeper foundational layer, Ultherapy creates a lifting effect that Thermage simply cannot achieve.
2. Ultherapy is More Effective for Jawline, Jowls, and Neck Lifting
Because Ultherapy tightens and lifts from deeper layers, it is far more effective for improving jawline definition, reducing jowls, and tightening loose skin under the chin and neck. These areas require deep tissue remodeling for significant improvement, something Thermage is not as well-equipped to do.
3. Longer-Lasting Results
Both treatments offer results that develop over 3-6 months, but Ultherapy results tend to last longer. While Thermage results typically last 1 to 2 years, Ultherapy can last up to 2+ years, providing a better long-term investment for patients who want lasting skin improvement.
4. Ultherapy Provides Real-Time Imaging for Precision
Ultherapy is the only non-invasive skin-tightening treatment that uses real-time ultrasound imaging. This allows providers to see exactly which layers of tissue they are targeting, ensuring the most precise and effective treatment possible. Thermage, on the other hand, does not provide live imaging, making energy delivery less precise and potentially less effective in reaching the ideal treatment depth.
5. Ultherapy Is the Gold Standard for Non-Surgical Skin Lifting
While Thermage can be useful for minor skin tightening, Ultherapy is the only non-invasive treatment cleared by the FDA specifically for skin lifting. This makes it the gold standard for patients who want visible lifting and firming without surgery.
Final Thoughts: Ultherapy vs. Thermage
If you’re looking for superficial skin smoothing, Thermage can provide some mild tightening effects. However, if you want true lifting, deeper collagen remodeling, and longer-lasting results, Ultherapy is hands down the better option.
At The Dermatology and Laser Group, we recommend Ultherapy as the best non-surgical facelift alternative, providing natural-looking, long-lasting results with no downtime. If you’re considering skin-tightening treatments, Ultherapy delivers superior results, especially for areas like the jawline, lower face, neck, and brows—where lifting, not just tightening, is key to a youthful and refreshed appearance.
Arash Akhavan, MD is founder and owner of The Dermatology and Laser Group, one of the top centers for cosmetic procedures in New York City for over a decade. Arash Akhavan, MD, FAAD is a Board Certified Dermatologist and an Associate Professor at The Mount Sinai School of Medicine. Dr. Akhavan is a Castle Connolly Top Doc, New York Magazine Best Doctor, and Super Doctor featured in The New York Times. Dr. Akhavan is a key opinion leader that has been featured on hundreds of media publications including The New York Times, Allure, Marie Claire, Women’s Health, Cosmopolitan, ABC News, Fox News, Fox 5, NY1, WPIX, and more. He has been featured on nationally syndicated television programs such as The Doctors.
Dr. Akhavan serves as an educator and lecturer for multiple aesthetic device and injectable companies. This allows his office access to newer technologies at an earlier date than other offices, as well as a higher level of expertise in the use of these devices. This, in turn, translates to more effective and safer treatments for our patients.
By Arash Akhavan, MD, FAAD | | Categories: Face and Neck, Lifting Procedures, Ultherapy
