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April 12, 2022


Out of the various anti-aging procedures, Thermage® and Ulthera® have stood out for several years thanks to their proven effectiveness. While both technologies treat sagging skin, they differ in the specific skin characteristics and needs they treat. Which one is right for you? Find out now!

How does radiofrequency and ultrasound work?

Thermage® (radio frequency technology) and Ulthera® (ultrasound technology) both rely on the use of heat to treat sagging skin. The skin is made up of collagen and elastin fibres that build up deep within the skin and together form a mesh that supports various structures in the face. This mesh is called the support tissue. When we are young, the mesh is tight and strong and the skin looks firm and toned, but over time, the fibres become looser, and the skin loses its firmness. Numerous scientific studies and research have shown that by inducting targeted and controlled heat into the skin, two phenomena that impact on skin firmness occur. First, collagen and elastin fibres contract, providing an immediate toning effect on the skin. Then, in response to this unusual contraction, the body initiates a “repair” process, i.e., a renewal of the collagen and elastin fibres in the skin within a few weeks following the treatment. This deep action allows for a gradual firming of the skin, usually over a period of two to three months.

To illustrate the phenomenon of the contraction of elastin and collagen fibres, we can compare it to a wool sweater washed in hot water. Under the effect of the heat, the wool fibres will contract, and the sweater will be tighter when worn. And, as you wear it, the fibres will gradually loosen again. This is basically what happens in the skin when you apply specific heat to the collagen and elastin fibres in the skin and supporting tissue. Of course, these treatments do not stop the passage of time and, eventually, collagen and elastin levels will naturally decrease, and the signs of aging will appear again. This usually happens in about one to three years, after which time a new skin tightening procedure may be beneficial.

What are the differences between Thermage® and Ulthera®?

Thermage® and Ulthera® are similar in some ways, but there are important differences you should be aware of in order to figure out which treatment is right for you.

1-Treatment objectives 

Knowing that we lose 1% of collagen per year from our thirties onwards, Thermage® allows us to work proactively by preventing the natural degradation of collagen. This technology also corrects slight skin sagging by tightening and smoothing the skin. It is the perfect technology to slow down the overall aging of the skin. 

We love Thermage® for its ability to:

› Prevent skin aging
› Smooth out superficial wrinkles
› Give a plumped-up effect to the skin

Ulthera® has a deeper action and allows for a tightening of the skin tissues and to obtain a tightening effect on the contour of the face, the eyebrows, the neck and the décolleté in a single treatment.

We love Ulthera® for its ability to:

› Redefine facial contours
› Firm the skin  
› Give a lifting effect  

2-Type of energy

While Thermage® and Ulthera® both use heat to stimulate collagen production in the skin, they do so in different ways. Thermage® combines unipolar radio frequency (RF) thermal energy with a cooling process that targets more superficial skin tissue from the dermis to part of the subcutaneous fat layer. Ulthera®, with its ultrasound technology (HIFU or High Intensity Focalised Ultrasounds), can penetrate and work on three subcutaneous levels: the deep dermis, the fat layer and the SMAS layer (located just above the muscles). This deep action results in a more pronounced and long-lasting tightening effect on the skin. In addition, the thermal energy of Ulthera® is concentrated in small points, allowing smaller areas to be treated with precision. 

What is the SMAS layer?

The SMAS layer is a fibromuscular layer that lies 4.5 mm inside the skin and covers a large part of the face. It connects the facial muscles to the dermis and its purpose is to transmit, distribute and amplify the activity of all the facial muscles (this is why it is also described as the “facial muscle layer”). As we age, the SMAS layer becomes looser, causing the lower third of the face and jaw to sag, resulting in jowls and wrinkles (e.g., marionette lines) and accentuating the nasolabial folds. This is also the layer that is targeted in a surgical facelift.

3-Treatment areas

Another key difference between the two treatments is the areas they treat. With Thermage® it is possible to treat the entire face, the eyes (including the upper eyelid) as well as several areas of the body such as the arms, the stomach, the thighs, and the buttocks, depending on the needs in terms of skin tightening or improvement of cellulite (from light to moderate). Ulthera® can target the skin of the face, eyes (brow bone), neck and décolleté.

4-Treatment duration and recovery

A Thermage® session generally lasts around two and a half hours. For Ulthera®, depending on the area to be treated, it takes between 1.5 and 3.5 hours. One of the advantages of both treatments is that there is no recovery time. Most people go back to work immediately after their appointment.


Full results are usually seen after two to three months, when the process of elastin and collagen fibre renewal is complete. However, it is estimated that the quality of the skin continues to improve gradually for 6 months (and sometimes more) after a treatment. 

6-Possible side effects

After a Thermage® treatment, slight swelling and/or redness may be observed within 24 hours after treatment. These side effects are quite minor and disappear quickly. With regards to Ultherapy®, bruising, redness and slight swelling may appear immediately during treatment or the day after the procedure. You may also experience inflammation and/or discomfort within 24-48 hours of treatment.

7-Frequency and maintenance care

One Thermage® treatment per year is generally recommended to maintain results. Depending on skin condition and goals, a second session can be scheduled a minimum of six months after the first treatment. Ulthera® results tend to be more long-lasting, so repeat treatments are generally recommended every two to three years depending on skin condition. A Venus Freeze™/Venus Legacy™ treatment at each change of season is also highly recommended to maintain results.


The ideal candidate for Thermage® typically has skin that looks and feels less firm or is loose (mild to moderate skin sagging). The typical Ulthera® candidate generally has skin that looks and feels less firm or is loose (especially under the chin and neck) and/or has fine lines and wrinkles in the décolletage area.

Thermage® or Ulthera®: which treatment to choose?

With its more superficial action and its ability to slow down the loss of collagen in the skin, Thermage® is an ideal treatment to work on preventing skin aging and to treat superficial skin concerns such as very fine wrinkles or dilated pores. It will be a more appropriate treatment for you if you have mild sagging skin and your concerns are to improve the firmness, texture, and quality of your skin.

By targeting deeper subcutaneous layers, the lifting effect is generally more pronounced, and results are more durable with Ulthera® (especially when correcting concerns such as sagging jowls or eyebrows). If you have moderate skin sagging, especially under the neck or chin, and are looking for skin tightening and tightening, Ulthera® is probably a better choice.

In order to make an informed choice between these two treatments, we recommend that you request a consultation with one of our experts. Thanks to their specialized training, they will be able to assess your skin and recommend the approach best suited to your needs.

* Treatment results may vary from person to person depending on the individual’s ability to produce new collagen.

Visit our website or call us at 1 (877) 781-1811 to schedule a consultation with a member of our professional team.

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