Anti-Aging Face Treatments: “What’s the Difference Between Thermage and Ulthera?”

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Reader question: “What’s the difference between Thermage and Ulthera and which one is best? My pals and I are all confused.” — Kathy

When it comes to non-invasive treatments to tighten skin, there are actually three similar (though slightly different) methods of improving loose skin and lines — Thermage, Ulthera and Pelleve. Here, dermatologist and founding director of New York Laser & Skin Care Dr. Arielle Kauvar shares the scoop on each method …

How the three tightening treatments are similar:

Thermage, Ulthera and Pelleve all tighten skin, which “is achieved by increasing collagen production in the deep layers of the skin by means of heating the deeper layers of the skin,” says Kauvar.

So, all three “can be used to lift the eyebrows by treating the forehead skin; treating around the eye area will reduce fine lines and loose skin around the eyes; the cheeks, jawline and neck can be treated to tighten the jawline, reduce early jowls and reduce early looseness of the neck,” she says. And though they won’t “replace surgery, … they can provide substantial improvement in patients who have early skin looseness without invasive procedures, and delay the need for surgery,” she adds.

How the three tightening treatments are different:

Each of the devices use different methods to heat the under layers of the skin. “Thermage and Pelleve use monpolar radiofrequency (RF). RF produces an electrical current,” says Kauvar. The deeper skin tissues actually resist the electrical current, which causes heat to build up in the skin. This heating of skin actually causes new collagen to be produced, which makes skin “plumper and tighter over a period of 3-6 months,” says Kauvar.

Ulthera on the other hand uses focused ultrasound energy to heat the skin, but offers up similar effects.

The 411 on each process:


Treatment length: 60 minutes

Pain factor: Thermage rapidly heats the skin to a high temperature, which can be painful. And though “new changes to the Thermage treatment [include] using bursts of cryogen (ice) spray to cool the skin surface and a vibrational element (to distract the nerve fibers that sense pain) have greatly reduced treatment discomfort … most patients still require some medication to tolerate the procedure such as an injection of an anti-inflammatory such as Toradol or an antianxiety medication,” says Kauvar.

Downtime: No real downtime, but skin will be red and swollen.

Number of treatments needed: One (though you will be evaluated after three months to see if you need an additional treatment, says Kauvar).


Treatment length: 30 minutes

Pain factor: “Each skin area is treated several times with repetitive circular movements to bring the skin to this therapeutic temperature. The continuous motion of the handpiece helps distract the nerve fibers that sense pain. Since the heating occurs gradually, rather than in one burst, there is limited discomfort and no pain with this procedure so … there is no need for any anesthetic or pain medicine as is required with the other technologies,” says Kauvar.

Downtime: Skin will be pink for less than 30 minutes. You won’t have swelling.

Number of treatments needed: Four monthly treatments.


Treatment length: 60 minutes

Pain factor: “Compared to the RF technologies, Ultherapy [which uses focused ultrasound energy to heat the skin] tends to be the most painful, and pain medications and anti-anxiety medications are usually required,” says Kauvar.

Downtime: Swelling and redness will stick around for several hours after the treatment. And, “some patients develop bruising and some have numbness that may last for several weeks,” adds Kauvar.

Number of treatments needed: One, with an evaluation after three months to see if you need an additional treatment.

The bottom line: “The results seen with each of the technologies is relatively equivalent since they are all using different techniques that result in deep skin heating. a repeat treatment every year or two is usually required to maintain optimal results,” says Kauvar.

Image: Before and after Thermage treatment from

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