The short answer
These are two different ways of heating tissue. Ultherapy places focused points of ultrasound heat at set depths. Thermage heats the deeper skin broadly with radiofrequency. Two small head-to-head trials could not separate them on laxity.
So the useful question is which one fits your face, if either does. Dr Sin Yong looks at two things: where the laxity sits, and how much facial fat you have. He performs both himself, and for some faces he advises neither.
Where the heat goes
Focused points at about 4.5 mm in the muscle-and-fascia layer, 3.0 mm in the deep dermis and 1.5 mm in the superficial dermis.
Current runs through the skin to a return pad. It warms the deeper dermis and its fibrous septa over a broad area.
How the choice is made
Along the jawline and under the chin, Ultherapy may fit, because it reaches the deeper layer directly. It is for mild to moderate laxity in a face that has kept its volume.
Thermage is often a closer fit. It is used here for the face and eyelids, with different single-use tips.
Ultherapy and HIFU are not used on a lean face here. The VF Lift on Volnewmer takes their place.
He generally uses Time Freeze Laser LCLR®.
Dr Sin Yong does not use Thermage on the neck. He uses the VF Lift and Time Freeze Laser LCLR® there.
Who should wait or avoid them
Wait if pregnant or breastfeeding, with open wounds, active infection or inflamed acne in the area, or recent filler or threads in the zone. A pacemaker or implanted electronic device needs assessment first.
Wait if pregnant, or with infected, broken or inflamed skin, an active cold sore or an eczema flare. Anyone with a pacemaker, implantable defibrillator or other implanted electronic device is not treated.
Nearby metal implants, recent filler or threads, heat-sensitive skin conditions, slow healing or reduced sensation.
What neither can do
Neither device adds volume, removes fat or removes excess skin. Significant skin excess or heavy jowls go to a plastic surgery specialist. Ultherapy does not resurface the skin or replace a surgical facelift. Thermage does not reposition deeper tissue, lift a descended brow, remove a lower-lid fat bag or relax neck bands. It also does not help eyelid droop caused by the muscle.
Risks and side effects
All three of Ultherapy, HIFU and Thermage can leave a face looking hollow. Lean faces are most exposed, as stray heat may reach fat that was never the aim. After Ultherapy, redness, swelling, bruising and tenderness are normal. Less often there are surface burns, temporary nerve irritation that can cause weakness, or fat atrophy. After Thermage, expect redness, warmth, mild swelling and tenderness, and eyelids may stay puffy for longer. Small welts, bruising or temporary numbness are less common. Superficial burns, blisters, crusting or a contour dip are rare.
What the studies show
A split-face trial of 20 patients found both improved laxity over six months, with no significant difference. A neck trial of 20 patients also found no significant difference, and ultrasound was more painful. Both trials were small. One lower-face study found weaker outcomes in patients with a BMI above 30.
Recovery
After Ultherapy, redness usually settles as the skin cools. Tenderness, mild swelling, occasional numbness or tingling and small bruises can last for a while. Ordinary activities, make-up and skincare can resume. After Thermage, redness and swelling come first, with tenderness that evening, easing over the following days. Any result builds gradually as new collagen forms. Please ask for review if a ridge does not flatten, a blister forms, or you notice new facial weakness or numbness that is not improving.
Sessions and fees
There is no fixed number of sessions, and any repeat is decided at review. No duration of result is promised. Fees are not published. For Ultherapy they depend on zones, number of lines, doctor time, any combined treatment and review. For Thermage they depend on tip and pulses, areas, any combined protocol and review. A written quote follows at consultation.