Medical Beauty Non surgical alternatives

Skin Tight Smack Down: Ultherapy vs. Thermage

ultherapy review

Earlier 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 face-lift, 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.


Treatment grid

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.  This 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 thru it’s 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.

evolution of aesthetics

Source: Ultherapy

Here’s the fancy science in a picture:


Source: Ultherapy

But are the results worth the money? And will this hurt like a motherf**ker?

See for yourself.  These women have that little chin dumpling that I have.  The results are natural, which is what I want right now.


beforeafter beforeaft

Ok, the pain, the legendary pain that reportedly makes natural childbirth seem like a paper cut.  Apparently, the Ultherapy team as learned you can achieve the same result with much lower settings with something called the Amplify Protocol, which your doctor should know about.  In fact, some suggest avoiding narcotics all together and taking nothing more powerful than a Tylenol.

I’m tempted by Ultherapy.  Wait, no I’m salivating over Ultherapy as I pinch my face up fantasizing about what a life less jowled would look like.

So what do you think, should I give it a try?  Would you try it?



  • Reply
    May 22, 2013 at 6:38 PM

    I am in the same boat, contemplating the same procedures. I am in the graphics field and what bothers me about many of these images is that lighting is altered to make results seem better than they are.Of course mds want these images to look good. They know how to play with lighting. Ever notice how many women wear much more makeup in their after photo? Its as though they want to convince themselves their money was well spent. Maybe not the case here. The woman in the lower image looks like she is sticking her jaw out. The woman in the middle photo looks like she has less volume, something I can’t afford to lose since my face is very narrow. The upper woman has a tad less volume under her chin, the only difference I see. All women have better skin texture but I still see sagging and jowls. I bet most men would say there is no difference, for whatever that is worth. To me there is not enough of a difference to warrant spending a few thousand dollars. Are you considering a fractional laser? That is another treatment I was thinking of.

    • Reply
      May 22, 2013 at 8:07 PM

      You are dead on about the before/after pictures needing to be incredibly accurate to be honest. Not only with the lighting, but with a patient’s weight and if they ate or drank too much the night before (my face always looks much better on a Friday than it does a Monday) and the angle of the chin. What’s worse, are the cellulite devices where lighting can make all the difference in the world. If I go ahead with this, I’ll do my best to be accurate and will disclose my weight and stuff (yay).

      I like the man test though! If a guy can tell the difference, then it’s a home run, yes??

      To your Fraxel question, yes in fact I had that done two years ago. It was Fraxel Restore: 1927, meaning it was the laser that took care of the brown spots (more on that later). It did a little something for tightening the face, maybe a touch better than some of the chemical peels I get, but that wasn’t the main goal – more like a nice side effect. I think you would be disappointed if you got Fraxel for tightening to be honest, and the cost comes close to Ultherapy when you add up all the sessions you need.


    • Reply
      Kim pajtas
      December 14, 2016 at 11:45 PM

      So I am also in the same boat. Sagging skin on the lower jaw line by my chin. Did Thermage in March (it’s December). My doctor showed me before pics and all that he showed was under my chin telling me how much better I look now. Problem is that isn’t what I had issues with. I am now considering Ultherapy. Hoping that has the results I am looking for. Ugh

  • Reply
    May 22, 2013 at 6:54 PM

    Also, your sagging is so miniscule, you may get nice results with just some Radiesse in the jaw area. Have any docs mentioned that to you?

    • Reply
      May 22, 2013 at 7:39 PM

      Yes, in fact they have! And I know fillers will be part of my “uplifting jowl journey”, but I’m still investigating. In the post from Monday, I talked about how I got a lot of different opinions on the fillers. A little overwhelming to say the least.

    • Reply
      May 22, 2013 at 7:48 PM

      P.S. thank you for telling me my sag seems minimal. There’s only so many of those iPhone selfies I can look out without getting seriously down:)


  • Reply
    Sonic Youth: My Date With Ultherapy - NARCISSISTA.ME | NARCISSISTA.ME
    June 1, 2013 at 7:33 AM

    […] I mentioned in last week’s post, I’m encouraged by Ultherapy versus Thermage because of its specific FDA approval for lifting […]

  • Reply
    August 16, 2013 at 12:15 PM

    Excellent information! I ruminated over taking the plunge with skin tightening; wound up doing Thermage a few months ago. Contrary to promotional literature, it was painful (I’ve had 4 kids so I can put this into perspective). Honestly, the results are subtle, but I’m cautiously optimistic. Right now it’s hard to gauge the jowl area, as I had filler as well. My problems weren’t so much wrinkles, as sagging. My neck texture definitely improved (I’m 50); not as crepey. There is some time to wait and if things continue to improve, I’ll be pleased (it wasn’t cheap!).
    Ulthera is only offered at one Derm’s office where I live, and wouldn’t let him touch me with a 10 foot pole. Otherwise, that would’ve been my first choice.

  • Reply
    August 16, 2013 at 12:16 PM

    Excellent information! I ruminated over taking the plunge with skin tightening; wound up doing Thermage a few months ago. Contrary to promotional literature, it was painful (I’ve had 4 kids so I can put this into perspective). Honestly, the results are subtle, but I’m cautiously optimistic. Right now it’s hard to gauge the jowl area, as I had filler as well. My problems weren’t so much wrinkles, as sagging. My neck texture definitely improved (I’m 50); not as crepey. There is some time to wait and if things continue to improve, I’ll be pleased (it wasn’t cheap!).
    Ulthera is only offered at one Derm’s office where I live, but I wouldn’t let that guy touch me with a 10 foot pole. Otherwise, Ulthera would’ve been my first choice.

    • Reply
      August 18, 2013 at 8:05 AM

      Laurel thank you so much for sharing your experience with Thermage. I’ll be revealing my Ultherapy after results in early September. Given my Ultherapy experience today, I agree the results are subtle, but that’s not necessarily a bad thing. I just wish these treatments didn’t cost so much, where as with Botox it’s easy to see the before/after for a lot less money (although Botox certainly isn’t right for everyone).

      • Reply
        August 26, 2013 at 9:24 AM

        I love this post. Thank you all for sharing. I had Titan done about a year ago. It was supposed to take up to 6 months to see full affect. I honestly didn’t notice much until I looked at old pictures. The results were subtle but there were results. I had three treatments about 4 weeks apart. As far as Ultherapy, I was considering it. The price you quoted, I think $2700 sounds great. I was quoted $4000! I also have a thin face and just want to lift the sagging jowls a little and I’m thinking about that as well.

        • Reply
          August 29, 2013 at 6:24 AM

          Hi Jill – I’ll be posting my full Ultherapy results in early September. I do notice my chin dumping is a little tighter, even with some mild weight fluctuation, but it is subtle. $4000 could have been for the full face. The lower face is usually between $2000 and $3500 in NYC.

  • Reply
    mark hughes
    September 1, 2013 at 11:47 PM

    Thanks for sharing this interesting piece..with so many competing products and claims, it is increasingly hard to know where to turn.

  • Reply
    October 18, 2013 at 11:44 PM

    Hello, could you please share how your ULTherapy results look. I am considering getting it done very soon, and am looking for any info.
    Thank you! Lena

    • Reply
      October 23, 2013 at 6:10 AM

      Hi Lena – I posted my results with pictures in this article here. I’m posting again in late November to share my 60 month results.

      One thing to make sure of is that your doctor – and yes, make sure a board certified COSMETIC plastic surgeon or derm is doing the procedure – has done several of them and uses the new Amplify setting. Much safer, less painful and the same result.

      Good luck and would love to know how it goes.

  • Reply
    December 5, 2013 at 3:03 PM

    What about Fractoral vs Ultherapy, and what do you think about the home products (the various equipment that cost from$100-$400)?
    Is there any home equipment at any price that makes a difference?
    I have the same issues you do.
    I do know that Fractoral doesn’t hurt — at all. It has no redness — and I’m prone to redness.
    I’ve only taken it over the past month, twice, so I can’t tell yet if it works.
    cost: $300 for face. I’m going to try a sagging arm wings and anywhere else they say it works.

    • Reply
      December 30, 2013 at 8:34 AM

      I think you mean fractional lasers? If so, they do different things and there are many different types of fractional lasers. Depending on the one you get, the stronger ones can hurt and have a few days of downtime so they’re not exactly a walk in the park. $300 also seems very cheap, so I would double check with your doctor on the name of the laser and the manufacturer.

      I wouldn’t make a comparison between in office devices and the ones used at home because they’re likely set to a much lower setting to avoid injuring yourself, although I haven’t used one personally.

  • Reply
    December 5, 2013 at 9:12 PM

    Please file complaints with the FDA.
    I do know Solta is claiming on their website they can tighten loose skin and improve the neckline. Even though they did not apply for the fda approval for usage to improve the neck. My thyroid was burned by thermage as a result. Have your thyroid checked if you have had a thermage treatment on the neckline. You might find your thyroid was damaged too.

    • Reply
      December 30, 2013 at 8:36 AM

      Good council Mary. The Ultherapy treatment “map” specifically avoids the thyroid for that very reason and my doctor mentioned that as one reason to see a doctor who understands how to use the device.

  • Reply
    December 7, 2013 at 4:29 PM


    I’m 49 have the lovely naso’ lines – HATE them! My face is fine otherwise. I tried fillers, they looked great for 1-2 weeks then dissolved!!! No one!! mentioned that that was a possibility (my body quickly absorbing them). So total waste of a lot of hard earned money! So now I’m considering trying the new thermage or ultherapy. But only if I can find a reliable physician that is willing to put their money where his/her mouth is (with some kind of guarantee or back-up offer if it doesn’t work).

    • Reply
      December 30, 2013 at 8:39 AM

      Susan it may be worth the time and money to get three different opinions. Try 1 PS and 2 derms and make sure they have more than one laser device for treatment otherwise you’ll likely get a reco to use the one machine they have if there’s a slight chance it will work. I would ask them what they would do to make you look like you’ve had a nap and the best you possible. You may be surprised that they don’t recommend either machine, but perhaps a thicker filler like Radiesse, Voluma or Perlane in your cheeks instead of injecting into your nasal labs.

      Good luck!

  • Reply
    December 18, 2013 at 2:49 PM

    My Thermage experience……first of all it does hurt. When they get to a boney area, look out!

    I had it done in a plastic surgeon’s off and had absolutely no change. It cleary did nothing for me so I literally threw $3,500 away.

    They called the Thermage rep and they offered to give the Dr a new Thermage tip to redo it and I could just pay cost for the tip…..get this, the tip was $400. Think about those profit margins. Anyway, I said I wouldn’t pay the $400, why should I? The Dr’s office agreed and pushed and the Thermage rep gave me the tip for free. So I had treatment #2.They cranked the machine as high as it would go and yes, the pain was pretty intense but I figured I had to in order to see results. 6 month later and 2 treatments and still, the Dr. even had to agree that there was no improvement.

    I did not get my money back but I am just telling you to realize that nothing is guaranteed and you literally could end up with no improvement. 🙁

    • Reply
      December 30, 2013 at 7:44 AM

      Ouch, I’m sorry to hear that! It was Thermage, not Ultherapy? What was it that you were trying to treat? Wrinkles or sagging? If it’s Thermage, the FDA only indicated it for wrinkles, not lifting. Ultherapy is indicating for lifting. I have to say, my results with Ultherapy were subtle, but my doctor was very upfront about the fact that it’s unclear who will benefit from it and who won’t, but he didn’t think I was an ideal candidate (I was trying to address a chin dumpling more than a turkey neck).

      And I’ll let you in on a secret; it’s not just the tip the doctor is paying for. Each machine costs around $250K (depending on the laser) so they’re trying to get return on investment. This isn’t wrong at all, but it’s the reason the cost of the treatment is so high.

      Thanks for sharing your story Jenny!

  • Reply
    Is Ultherapy Worth the Hype? 90 Day Treatment Results ‹ NARCISSISTA.ME
    January 30, 2015 at 7:40 AM

    […] loosens as we age) with more precision, depth and heat which radio frequency can’t do. (Click here to learn more about the trade-offs between Thermage and […]

  • Reply
    Bad Botox. What it Looks Like, How to Fix It ‹ NARCISSISTA.ME
    January 30, 2015 at 7:42 AM

    […] The Battle Of The Energy Devices! Ultherapy vs. Thermage […]

  • Reply
    marvel mighty heroes hack
    April 13, 2015 at 1:46 PM

    Paragraph writing is also a excitement, if you be acquainted with then you can write otherwise it is complicated to write.

  • Reply
    May 8, 2015 at 1:35 PM

    Hi I’m trying to figure out the difference between RX treatments and ultherapy? I have had seven Rx treatments done in my neck /chin area at 87$ a time sometimes I think this is working then I see a picture or worse a video of my jaw line chin area and I see sagging no change. Is Rx suppose to tighten ? That’s what they say. Is ultherepy better for tightening does it really work. I hate my sagging skin my chin really bothers me. I get it from my mother. Who just had a facelift done at 77 years old look good now but even she said don’t do what I did find something else But does anything work please help I don’t mind spending the money if you see results I’m getting upset that after seven of these RX treatments I really haven’t seen any results. Do I continue to go for more RX? And dose ultherapy hurt? I will wait to here your comments hope you can help me. Regards

  • Reply
    June 5, 2015 at 9:05 AM

    What’s Happening i am new to this, I stumbled upon this I have discovered It positively
    helpful and it has aided me out loads. I hope to
    contribute & aid other customers like its aided me. Great job.

  • Reply
    June 30, 2015 at 4:35 PM

    I had ultherapy two and a half years ago. I was very pleased. It didn’t hurt. A little discomfort that i would not qualify as anything near pain. The results kept increasing and peaked at about nine months after the treatment. In Miami it cost $2,500. At about two years i started to see my neck skin loosen. I am not living in the states just now or i would have it again. I have been told that the most cost effective treatment for my fine lines, etc., is to have a mini face lift. I will not have voluntary surgery so this is where i am holding. If you can do Uthera go for it . Just know that it isn’t permanent.

  • Reply
    July 5, 2015 at 3:58 PM

    Hi Ladies and gentlemen,

    I just stumbled onto this blog feed and wanted to make a few comments. First off, I am a Certified Aesthetic Nurse Specialist and I’ve worked in the aesthetic industry for many years in a variety of practice settings including dermatology and plastic surgery private practices. Additionally, I formally worked at Ulthera’s Corporate HQ as the Global Clinical Education Liaison and the per and post treatment photos shown on your blog are my personal patients. I can assure you that none of theses photos are retouched. I’ve treated 1000’s of patients and the clinical result will vary. It’s important that you select an expert because as you know not all clinicians are equal. You should expect a through consultation prior to your treatment where your medical/surgical history is reviewed and appropriate expectations are set base on your medical history, age, degree of laxity and treatment goal. I love this technology so much that I purchased an Ultherapy system for my aesthetic center! I think that says a lot…

  • Reply
    Jacqueline Cornell
    August 28, 2015 at 12:23 PM

    I just had Ultherapy done on my lower face, Jowl area and underneath my chin 2 days ago and it was extremely painful, even with litocaine injections to help soften the pain. I had done a lot of research and read in so many posts and articles that there’s no down time and you can go right back to work. However this is not true! My lower face, jawline & underside of chin is massively swollen! I look so ugly and freakish! There’s numbness and hardening underneath the skin surface. They don’t prepare you for this. The doctor said the swelling will go down in 3 days. I’m on day two and still swollen and looking like a freak. I researched horror stories on Ultherapy and others have had the swelling take weeks to go away. Some people claim it distorted their faces and jawline, along with fat loss, wrinkles and nerve damage etc. I’m terrified that I may have ruined my face. I would never ever do this had I known the pain involved and the horrible side effects. Don’t do it! Save your $ for a mini lift.

  • Reply
    November 1, 2015 at 7:21 AM

    Jacqueline Cornell: It has now been a few months. How did your results turn out? Did you have any of the bad side effects that you were worried about?

    Becca Smith: Thank you for this article. It is the most informative I have found. You mentioned your own before/after photos, but I don-t see them. All I noticed was photos from the companies. Where are your photos?

    • Reply
      December 22, 2015 at 5:00 AM

      If you search for Ultherapy you’ll see two other posts about my experience, complete with the photos. Also, an updated post will be coming in January 2016

  • Reply
    January 9, 2016 at 11:37 PM

    I tried ultherapy on my neck nearly five months ago. I declined the narcotic and took 800mg Ibuprofen. It was very painful especially towards the end. I had slight swelling for a couple days, redness, welts, and bruising, all of which I had been warned may happen as I am a red head with pale skin. The most worrying after affect was loss of sensation on parts of my neck. Five and a half months later all side affects have passed but I see no difference in appearance and it cost $1400. I am wondering if I should give it one more shot or not. I am 45 143lb with slight skin laxity.

  • Reply
    July 14, 2016 at 5:17 PM

    What is the latest on ultherapy? Does it work?

  • Reply
    Jasmine M.
    December 13, 2016 at 9:28 PM

    Check Real self Ultherapy reviews. I almost had it done, PHEW!!! I would not take the chance on this ruining my face and health. I am so glad I researched this. I purchased the Groupon and then chickened out last minute.


    Groupon was great about it.
    They will not refund my money, but I can use it towards something else.
    One young woman had her eyelids burned off.
    You can find her blog.

    I will embrace aging!

  • Reply
    January 5, 2017 at 2:48 PM

    I had Ultherapy in December of 2014. I was very pleased with my results but I am feeling I need it again. I will tell you, it was extremely painful and they gave me a demerol shot before we began. They had to stop and give me another one in the middle. Not sure if I can do that again. I have a pretty good pain tolerance – I do not need to take pain pills when prescribed after my hysterectomy. I have had laser treatments on my face for sunspots and they could turn it up more than they normally do but this is very painful. I did my full face, neck and decollate’. Thinner skin areas are the most painful. I was swollen for about two days after as well.

  • Reply
    January 16, 2017 at 3:55 PM

    They both have poor ratings on Real Self. Surgery is safer.

  • Leave a Reply