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Ultherapy or Thermage for Skin Tightening


Two of the most well-known names for non-surgical skin rejuvenation in the world of dermatology are Thermage and Ultherapy. Both Thermage and Ultherapy are cosmetic procedures that reduce the appearance of loose skin (skin laxity). These treatments are designed to activate collagen production without the need for any downtime or invasive surgeries.

Thermage treatment stimulates this new collagen through the use of radiofrequency energy (RF), which is able to heat the dermal layers of the skin while keeping the surface of the skin cool. It’s an incredibly gentle, painless procedure that has virtually no side effects or recovery time, and is FDA-approved to treat the the face and the majority of areas on the body, such as the abdomen, legs, buttocks, and upper arms. Ultherapy uses ultrasound energy to target similar treatment areas, treating deeper layers of the skin.

Both Thermage and Ultherapy are anti-aging procedures and excellent alternatives to surgical facelifts or other procedures offered by plastic surgeons, but the different methods of treatment are important to consider when choosing which option is best for you. Though Ultherapy treatment can be good for some skin tightening needs, the painless and universal success of Thermage makes it a competitive choice.

If you’re looking to reverse the visible signs of aging, from jowls to body contouring, board-certified NYC dermatologist, Dr. Michele Green, is here to help. Contact the office today to design your own custom skin rejuvenation treatment plan.

Skin Tightening Treatment: What is the difference between Thermage and Ultherapy?

The primary difference between Thermage and Ultherapy is the type of energy through which they activate stores of collagen in the skin. Thermage uses radiofrequency technology, whereas Ultherapy relies on ultrasound energy to target layers of the skin.

Is Thermage the same as Ultherapy?

Thermage is an FDA-approved skin tightening treatment that relies on patented monopolar radiofrequency energy, which smooths and contours the skin to create an overall younger appearance. Thermage treatment uses a handheld radiofrequency technology device. During treatment, the tip of the CPT hand piece is directed along the skin in the treatment area.  A coupling gel is applied to the skin during treatment with Thermage in order to gentry glide the handpiece. The device alternates with sensations of cool and hot air, in order to heat the deeper layers of the skin while keeping the surface of the skin cool.

Through this process, the heated skin stimulates the production and regeneration of collagen. This new collagen naturally improves the skin’s elasticity to become firmer, smoother and tighter. Thermage pinpoints the collagen-rich dermis, as well as the fiber septae (the fibers that connect the dermis to subcutaneous tissue) in the subcutaneous adipose tissue layer by uniformly distributing heat energy to denature and then remodel collagen.

Thermage treatment has a two-fold approach: initial, immediate collagen contraction due to heat application, and progressive collagen remodeling. This remodeling process comes from the body’s natural immune response as a means of addressing the controlled trauma that Thermage creates. This means that results can be seen immediately post-treatment, and will continue to develop over the course of the following six months. Thermage is also able to temporarily reduce the appearance of cellulite surrounding the treatment area.

The newest Thermage devices in use is Thermage FLX. Thermage FLX has innovative treatment tips that provide an even delivery of radiofrequency energy. Plus, Thermage FLX offers AccuREP™, a patented algorithmic technology that allows for adjustments in real time. This allows for optimal radiofrequency energy delivery, as it offers precise adjustments on a per-pulse basis. Thermage’s exciting new technology has led to glowing approval, with endorsements from celebrities like Demi Moore, Oprah, and Jennifer Aniston.

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Is Ultherapy the same as Thermage?

Ultherapy, unlike Thermage, relies on ultrasound technology to stimulate the collagen response. Designed by the company Ulthera, Ultherapy is FDA-approved for both tightening and lifting the skin, particularly on the muscles of the face and neck. This technology targets deeper layers of the skin than Thermage, including the Superficial Muscular Aponeurotic System (SMAS) area, which is the area typically addressed by surgery. Ultherapy’s ultrasound technology allows the doctor to visualize the tissue that is targeted during treatment.

During Ultherapy treatment, an ultrasound gel will be applied on the skin surface before the device is placed over it. The doctor searches for the appropriate area and delivers the ultrasound energy. Patients may feel a tingling or burning sensation, and this is often treated either through the use a local anesthetic, or with a sedative and/or pain medication.

HIFU and Ultherapy

HIFU stands for high-intensity focused ultrasound, which is the technology through which Ultherapy treatment is administered. HIFU is used for a variety of medical devices and, in the case of Ultherapy, heats the SMAS layer of the skin up to 60-70 degrees Celsius. Through this ultrasound energy treatment, Ultherapy is able to tighten saggy skin caused by this SMAS layer without the need for surgery.

Does Ultherapy Work?

So, does Ultherapy really work? The innovative ultrasound technology does provide some positive results, particularly when it comes to treatment for the brow line, the double chin, neck and jawline, as well as the chest area. However, some patients do find the treatment to be uncomfortable and, unfortunately, it does not yield optimal results for all patients.

In order to answer does ultherapy really work, it’s important to consider who is being treated. The best candidates for Ultherapy are patients who have mild to moderate skin laxity.

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Which is better Ultherapy or Thermage?

Both Thermage and Ultherapy are non-surgical skin rejuvenation procedures that can reduce the signs of aging on the skin. Both are safe for all skin types, and can be combined with other procedures, such as Botox, dermal fillers, or CoolSculpting, for a revitalizing treatment plan that can act as a non-invasive “facelift.”

However, when it comes to a wide array of aesthetic goals and needs being met, Thermage treatment is Dr. Green’s top recommendation for skin tightening. In an interview with Haute LivingDr. Green describes the exciting combination treatments that Thermage offers: “The ‘trifecta’ that I use for the aging neck in my practice is a combination of Thermage to tighten the neck, Botox injections for the wrinkles or cords of the neck, and CoolSculpting or Kybella if there is any submental fat under the chin. This combination produces a beautiful long-lasting result in treating the aging neck.”

When considering what is better, Thermage or Ultherapy, it’s important to consider what needs are being addressed by the treatment. Thermage is able to reduce skin laxity almost everywhere on the body, including the face, neck/double chin, décolletage, eyelids, brow area, arms, stomach, buttocks, thighs, and above the knees. Ultherapy is limited to facial regions and the chest area, making it a less flexible treatment option. Additionally, Thermage is more effective for those hoping to reduce the appearance of fine lines and wrinkles on the skin, whereas Ultherapy is more effective for those with fuller faces who are contouring sagging skin.

If you’re wondering is Thermage better than Ultherapyit’s also important to consider the treatment experience. Thermage CPT and Thermage FLX are essentially painless devices that require no pain medication or numbing cream prior to treatment. This means that patients can go back to normal activity immediately after Thermage treatment, whereas  Ultherapy requires pre-medication with oral pain medications which may prevent a same-day return to work or your daily activity.

For these reasons, Thermage is the #1 provider of skin tightening treatments worldwide, used from Singapore to Amsterdam to the US, and is considered the “gold standard” of non-surgical skin tightening procedures.


Dr. Green is an expert in skin tightening and skin rejuvenation in her boutique private practice in NYC. Here are some recent testimonials from her patients who had Thermage for skin tightening in her New York office.

“I got Thermage over the Summer at Dr. Green’s Office. My experience from the initial encounter with her Staff over the phone was one of the best I have had…It’s been five months and my friends and family keep asking me what have I done my face looks great. They told me I would start to see results in three to four months. My skin looks refreshed. I have this glow and the fine lines are no longer noticeable.” –Thermage patient

“Totally trust Dr Green. Her bedside manner, her knowledge of all the new products out there and her ability to make everything painless. Dr Green recommended a wrinkle treatment Thermage for me. I decided to do my face and chin. The applicator gave off a little heat but totally tolerable. I believe there was a cooling spray but my eyes were closed. An hour later I walked out feeling happy because I know everything Dr Green does, works” –Thermage patient

You can refer to our testimonials page for more information.

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Combination Skincare: Can you do Ultherapy and Thermage?

When it comes to combining different skin lighting treatments, it’s important to consider which treatments complement one another. For example, when combining treatments with Thermage, it is more common to combine with a treatment that approaches skin contouring in a different way, such as with a Fraxel laser that can address sun damage or uneven pigmentation, or perhaps a dermal filler that will increase facial volume. Both Thermage and Ultherapy are similar in that they are both have skin tightening technologies so, though the combination can be done, it’s rarely the most effective approach.

Which is more expensive:  Thermage or Ultherapy?

The cost of Ultherapy frequently hovers around $4,000-$5,500 for treatment on the face and neck, which is at the higher end of the spectrum of skin tightening treatments. Thermage has a wider range depending on the size of the treatment area, ranging from around $1,500-$5,000. A single Thermage treatment will have results that last between 1-2 years, though many patients choose to have “tune up” Thermage treatments on an annual basis.

How do I get started with Thermage for skin tightening?

If you’re concerned with fine lines and skin laxity, and are interested in learning more about skin tightening treatment options, Dr. Michele Green is an expert in NYC in laser skin tightening and can create a customized skin rejuvenation treatment plan for you.  Contact the office today or call 212 535 3088 to book an appointment with Dr. Michele Green.

Special offer: Free Thermage consultation if you have a Thermage procedure performed. Offer valid for new patients only.

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