Ultherapy is also an anti-aging miracle.
I haven’t talked much about Ultherapy in the past two years, mainly because it has been struggling to meet regulatory standards. So I usually just touched on it briefly when discussing Thermage, without dedicating a separate section to it. Things are different now. Products like Peninsula’s High-Intensity Focused Ultrasound and Pumen’s High-Energy V-Lamer have not only obtained Class III medical device certification, but their indications are no longer just adjunctive treatment for scars, but a legitimate “use of focused ultrasound thermal effects on subcutaneous tissue to improve skin laxity in the mid-lower face, under the chin, and neck.”
The principle of ultrasonic scalpel is a bit similar to using a magnifying glass to light matches that we used to play when we were children. You will find that the match can be lit, but the air in the middle is actually very cold.
Ultrasonic scalpel uses high-intensity focused ultrasound to focus energy on a specific point deep within the body, inducing collagen regeneration and remodeling through thermal damage without affecting the surrounding tissue. You can think of it as hitting a cow through a mountain – that’s perfectly fine.
This is what makes Ultherapy, in principle, uniquely different from anti-aging devices like Thermage—it’s depth-selective, not tissue-selective. Thermage, on the other hand, uses a heating mode that generates heat by flowing electric current, which is based on the logic of current, voltage, and resistance learned in junior high school, similar to the “hot water heater” used in our university days. Therefore, the area where the current penetrates best receives the most heat energy.
Fat has high electrical resistance, so the current tends to flow through areas with lower resistance, such as ligaments and fascia. This is why you’ll find that Thermage is quite effective at tightening ligaments and fascia, but has less impact on fat. However, Ultherapy works differently. It heats everything at that depth—fat, muscle, bone, fascia, collagen—it’s relentless and effective against anything in that area.
Therefore, the power of Ultherapy is actually greater. However, even without thinking, you can vaguely sense that this power is a double-edged sword. Fat, fascia, ligaments, and collagen are not separate entities. It’s not that the fat layer is just fat, the ligaments are just ligaments, or the fascia is just that 3.0mm layer. These things are all mixed together in the body. Collagen and fat are inherently inseparable. When you eat pig’s trotters, can you distinguish which piece is pure fat and which is pure fat? No.
Therefore, if Ultherapy is used too aggressively, especially in areas like the tear troughs and cheeks where fat is easily lost, it may actually worsen facial sagging. Therefore, the indications for Ultherapy are actually stricter than for Thermage, and it shouldn’t be chosen blindly. I’ve mentioned before that for Thermage, if you’re over 30 or have given birth, you can choose it without hesitation. Ultherapy, however, cannot be chosen blindly. Generally speaking, a full-face Ultherapy treatment is more suitable for “young, chubby faces.” Because of their youth, there’s less concern about excessive collagen loss, and Ultherapy effectively removes excess fat, resulting in a perfect outcome. I once treated a 28-year-old woman, and the face-slimming effect was comparable to having her masseter muscles augmented.
However, for older women, or those with thin skin and excessive sagging, Ultherapy alone requires more caution. I prefer a combination of Ultherapy and Thermage—note that this isn’t a combination of Thermage and Ultherapy, which is like mixing strong liquor with 1982 Lafite—too potent and prone to burns. I use Thermage on the face and Ultherapy on the jawline, double chin, and nasolabial folds, thus leveraging the advantages of both devices—avoiding the painful areas of Thermage in the lower face while specifically reducing lower face fat, achieving two goals at once. Another option is to combine Ultherapy with Botox injections. “Baby Face” is a collagen regeneration stimulant, a skin-tightening injectable material that effectively compensates for potential volume loss after Ultherapy, providing lifting and tightening, and further preventing facial sagging.
A research paper on animal experiments published earlier this year demonstrated that combining Ultherapy with “Baby Face” injections can achieve a collagen regeneration effect greater than the sum of its parts (1+1>2). I’ll elaborate on this later. As for whether the Peninsula Ultherapy or Pumen’s high-energy V-Lami is better, that’s a matter of opinion. There’s no specific comparative study yet. From my own experience, they’re roughly comparable. The equipment is just a tool; the doctor’s skill in performing the procedure is crucial.
Therefore, if you’re considering a firmer, lifting effect, Ultherapy is a good option, but don’t get it done haphazardly. Consult a doctor first to assess your individual needs.