Ulthera (Ultherapy) Questions Answered by Steven Weiner, MD, Facial Plastic Surgeon

Q: Is it okay to use hand held tightening devices for the face after ultherapy?

A: Hand held tightening devices can be used after Ulthera, but waste of time and money

Hand held devices for skin tightening do very little. You are better off to save the money for skin care products, dermal fillers, or other treatments. The energy the FDA allows for the home devices is so low that they don’t work.

Q: If you currently have fillers like Sculptra can you have Ulthera?

A: Combining Ulthera with Sculptra is the bomb!

Absolutely, you can combine the 2 treatments, Sculptra and Ulthera. You obviously recognize that the 2 do different things, Sculptra fills volume loss and Ulthera tightens loose skin. When done together, they are synergistic, meaning 1+1=3! My blog goes into details about doing both of these, please read. Steve Weiner, MD, Destin, Florida.

Q: Ultherapy Vs. Refirme Vs. Accent XL for Thin Face

A: Don’t bother with Refirme or Accent XL for the face, Ulthera is much more reliable

All the RF devices which try to transmit their energy through the skin are unreliable with very inconsistent or no results. These include: Thermage, Refirme, Accent XL, Pelleve, Venus Freeze, Exilis. The only one worth using from the RF family, at the present time, is the Infini by Lutronic. Please see my blog which goes into more depth on the technology. (I also have another blog about the benefits of Ulthera plus Sculptra.) Ulthera is a very reliable device, placing the right amount of energy at a given level, at all times. No, it does not affect the natural fat of the face. Steve Weiner, MD, Facial Plastic Surgeon.

Q: Which is more effective thermage or ultherapy for tightening skin?

A: Ulthera is far superior to Thermage for skin tightening results

Ulthera reliably places energy in the dermis and SMAS layer. The energy is always above the critical temperature to cause tissue contraction and collagen formation. Thermage is very unreliable in it’s placement of energy through the skin and therefore it’s results are very unreliable (some have results, while most do not). There is a new device called Infini, which uses RF energy like Thermage, but it places the energy very reliably in the dermis and is therefore much more effective than Thermage as well. I consider the Ulthera for tightening the jawline, turkey neck, raising the cheeks and the brows. Infini would be better for the superficial fine lines, lip lines, necklace lines, cheek lines. I used to have Thermage but sold it the same month that I bought Thermage – 3 years ago. I have much happier patients. See my blog below. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.

Q: Are these results of Ultherapy really true?

A: Ulthera is not a surgical result, but some people don’t want surgery

There is no debate whether or not the energy is delivered by Ulthera to the precise location that the device is made for. Most people, 8-9 out of 10 get noticeable improvements from the procedure. Are they the results similar to which surgery can give? Most of the time the answer is no. But, if you want little or no downtime, want a result that doesn’t leave scars, and has minimal risks (no long term risks), it is the procedure for you. Surgery has it’s inherent risks: bleeding, infection, scarring, anesthesia, need for redo, poor cosmetic results, nerve injury, as well as downtime (up to a month for a facelift). I have written a blog about why I believe that Sculptra and Ulthera are better than a facelift. Steve Weiner, Facial Plastic Surgeon. Destin, Florida.

Q: How Often Can Ultherapy or Thermage Be Applied? Do Repetitive Applications Have Any Side Effects or the Opposite?

A: Ulthera can be repeated in 4-6 months; Don’t bother with Thermage

Repeat treatments with Ulthera will help you keep up with the aging process.  There is no exact right answer as to when you should do this.  Getting more treatments will only improve the results and won’t be harmful.  I have given up on Thermage 3 years ago when I got the Ulthera because results are so much better and more consistent with Ulthera.  Read my blog about RF devices and see why Thermage doesn’t work well.  Infini is a good skin tightener too and it’s full ability has yet to be determined.  Steve Weiner, MD, Facial Plastic Surgeon, Panama City Beach, Fl.

Q: If I Have a Plate in my Neck Can I Still Have Ultherapy?

A: Ulthera can be performed on someone with a plate in their neck

Because the penetration of the energy is only 4.5mm deep, the plates will not be a factor.  You can safely have the procedure.  Steve Weiner, Destin,FL

Q: 1. Can This Procedure Affect/injure/change the Thyroid? 2. Why is Thyroid Area Avoided During Ultherapy Precedure?

A: Ulthera will not affect thyroid nodules

The thyroid area is avoided because of the cartilage that is close by.  It has nothing to do with the thyroid gland.  In fact, I could see the Ulthera technology being used to treat thyroid nodules in the future.  You have nothing to worry about.  Steve Weiner, MD, Destin, Florida.

Q: Can I Get Ultherapy ?

A: Ultherapy for someone who gets cold sores and shingles is ok with prophylaxis

We have done many treatments on patients like you.  It just requires taking a dose of Valtrex before and a few doses after to prevent the problem.  If you sense that there is an outbreak coming on despite this, take a therapeutic dosing for the recommended time by your doctor.

Q: Can an Ultherapy Side Effect Be Burning and Tingling on Scalp?

A: After Ulthera there is some burning and tingling of scalp, this can be related and will go away quickly

There are nerves in the forehead which travel to the scalp. During Ultherapy, it is possible to bruise these nerves and the result can give you abnormal sensations of the scalp and forehead.  To my knowledge, there have been no reported long term issues with Ulthera.  This should go away within a few weeks I suspect.

Q: Can Ulthera Be Done on the Neck Only, or is the Lower Face with It Necessary?

A: Ulthera can be done on neck only but not what I would recommend.

Ulthera was recently FDA approved to be done on the entire neck. Best result for the jawline would include the lower face as well to get some lifting above the jawline.

Q: Can Ultherapy Reduce the Size/appearance of Large Submandibualr Glands?

A: Ulthera won’t improve appearance of large submandibular glands

Ulthera won’t get deep enough to hit the submandibular glands.  One thing you might consider is having them injected with Botox. I have seen at meetings that Botox reduces the size of enlarged parotid glands so there is no reason why it shouldn’t work for the submandibular glands.

Q: Nurse Squeezing and Tapping Foot During Ulthera?

A: Distracting during Ulthera treatment can decrease pain

The Gate theory goes back to the 1950s which states that the brain has trouble processing two stimuli at once. So when there is a competing sensation, the brain will block out one partially.  This leads to less discomfort. We add vibration and cold air so the brain gets really screwed up.  Steve Weiner, MD, Destin, Florida, Facial Plastic Surgeon

Q: Thermigen Vs Ultherapy?

A: I have the Ulthera and have seen Thermigen. Please read my discussion to get a better idea.

My clients have been very happy with the results they have seen with the Ulthera.  They can walk in and do anything they want to do afterwards.  Thermigen is quite similar to the new Precision Tx laser.  It requires tumescent anesthesia and requires a chin strap afterwards.  It goes under the skin and heats up the fat and skin to dissolve the fat and tighten the skin.  It has thermal controls so the skin doesn’t heat up to a dangerous level.  I have seen it performed and the patient was comfortable during the procedure.  It all boils down to results, and I haven’t seen the “wow” results that would convert me from Ulthera to Thermigen.  Thermigen is not FDA approved for this procedure either.  The cost of the device is a lot less to the physician than the Precision Tx laser so the procedure should be less to the patient.  It depends how invasive you want to be as to which you do.  I’m staying with Ulthera for now.  If you want more aggressive results, also look at the Precision Tx, which is the same technology as the Cellulaze laser.

Q: Should I Stop Taking Supplements (Eg. Fish Oil, Ubiquinol) After Ultherapy?

A: There is theoretic concern with anti inflammatories after Ulthera

There are no studies to suggest that anti inflammatories decrease the effect of Ulthera but some docs suggest not taking them after the procedure. The risk they say is that the healing process is subdued and therefore you are not getting the full effect of the treatment. I think this idea started with Thermage as an excuse when they weren’t seeing results. I don’t tell my patients to stop these supplements.

Q: Can Have Ultherapy Done Under my Chin and Neck if I’ve Had Cystic Acne Before?

A: Ulthera in patients with prior cystic acne is no problem

Ulthera can safely be performed in patients which have had cystic acne.  As Dr. P has said, we don’t do it in the case of an active infection.  In the long run, it might actually help the acne by partially destroying the sebaceous glands which are the source of the acne problem. There is an active clinical trial to see if Ulthera can actually be used for acne treatment.

Q: Now That They Have Had the Benefits of Experience Behind Them, Does Ultherapy

A: There have been improvements since Ulthera first came out about 3 years ago.

The changes which have occurred are:

  1. There are now 3 different depths for treatment, 1.5, 3, and 4.5 mm.
  2. There are about twice as many treatment lines being laid down as to when it was first introduced.
  3. Topical lidocaine is being used and having an effect in improved comfort.
  4. Lowering the intensity of the treatment lines give better comfort but same results.

All the above results in more comfort and/or better results (more aggressive treatments).  It only makes sense that over time, everyone learns more about the potential of the technology and becomes more comfortable at trying new protocols.

Q: Can You Get Ultratherapy with a Titanium Piece in Your Cheekbone?

A: Ulthera cannot be done in face with Titanium plates

The ultrasound waves will bounce off the metal and scatter unpredictably.  This is one of the only reasons someone can’t have an Ulthera treatment.

Q: Had Ultherapy on Upper Face, Had Little Pain, Will It Be Less Results?

A: Very little pain with Ulthera for upper face is a good thing, not bad.

Several measures have been done recently to reduce the discomfort with the Ulthera.  A new protocol uses less energy but more treatment lines and seems to have equal results.  We also use topical numbing creams and cold air, both seem to help as well.  Because protocols are fairly standardize, at least the minimums are, I wouldn’t worry about your treatment.  We tend to stay at the upper end of the protocols and give more treatment lines than the norm, but that doesn’t mean it should hurt.

Q: Ulthera After Peel?

A: When Peeling is done after a Peel, it’s ok to have Ulthera

You could probably do the Ulthera immediately after the peel, but because there is liberal use of ultrasound gel, it’s better to wait til the skin is done peeling.  It really does nothing to the outer skin, so don’t worry about affecting results of the peel.

Q: Could Ultherapy Be Performed on a Person’s Neck, if That Person Has Some Nodules on the the Thyroid?

A: Ulthera on the neck can be performed on patients with thyroid nodules

The Ulthera (Ultherapy) penetrates 4.5 mm into the skin.  The thyroid is much deeper than that, with a layer of muscle between the skin and thyroid as well.  There is no worry whatsoever.  Dr. Steve Weiner, Panama City Beach, Florida.

Q: How Long After Ultherapy Do I Need to Wait Before Getting Lip Waxing?

A: Waxing after Ulthera (Ultherapy) can be done immediately after treatment

There is no reason to stop doing anything you normally do after Ulthera. There is no downtime.  If you use Retin-A or similar, you should wait about 4 days after stopping to get waxed, but this has nothing to do with Ulthera.

Q: Can I Drink Wine the Same Day As Having Ultherapy?

A: Wine after Ulthera is perfect, there are NO RESTRICTIONS

The beauty of Ulthera is that it is a no downtime, fairly risk-free procedure.  No long term complications have been reported to my knowledge.  Having wine afterwards is quite alright and we encourage people to do their daily routine after Ulthera.  There is no data to support this, but some doctors recommend not using anti-inflammatories for about 6 weeks, but we don’t.  Steve Weiner, MD, Santa Rosa Beach, FL

Q: Does Ultherapy Work for a Brow Lift?

A: Ultherapy is a noninvasive FDA approved method for Brow lifting

If you desire no downtime and  a very low risk procedure to raise your brows, Ultherapy (Ulthera) is a great option.  It won’t give a surgical result, but will give a natural look.  If you want more results, a second procedure can be done.  It takes about 15 minutes to do with only mild bruising or temporary numbness as a side effect.

Q: Aftercare for Ulthera on Lower Face and Neck Yesterday?

A: Aftercare following Ulthera is NOTHING

After having Ulthera, there is no need to do anything special.  It is recommended not to use steroids or other anti-inflammatories, but this has yet to be proved to be detrimental to your results (its theoretic).  That’s the beauty of Ulthera, no downtime, no aftercare!  Please see my video too.

Q: Can I Take a Steroid Medicine (Methyprednisolone) After Ulthera?

A: Taking steroids for a brief period after Ulthera has a theoretical risk of decreasing the effectiveness of Ulthera

Although there are no studies, and it would be very difficult to do a study, there is the feeling amongst some doctors that anti-inflamatories after Ulthera can decrease it’s effectiveness.  This is based on the fact that you need the inflamatory factors to produce the collagen and tissue tightening.  This would include steroids, motrin, advil, aspirin, but not tylenol.  If they can be avoided, it’s advisable but not absolutely.  This is a gray area, so don’t worry too much about it.

Q: Does Ultherapy Work for Upper Cheeks?

A: Ultherapy is great for lifting the cheek area

Yes, Ulthera is perfect for lifting the cheek area.  Ulthera works by laying down very precise lesions in the skin at 4.5, 3, and 1mm, which over time, leads to collagen stimulation and tightening. Results take about 3 months to fully appreaciate, and some people will want a second treatment.  You can see lifting of the brows, improvement in wrinkles around the eyes, lifting of the cheeks, firmer jawline, and tightening of the upper neck.

Q: Ultherapy for Excessive Sweating (Hyperhidrosis Treatment)?

A: Ulthera does work for hyperhidrosis in one study by Dr. Nester

There was a poster presentation at a conference I was at describing very significant improvement in the sweating scores after 2 treatments of Ulthera for axillary hyperhidrosis.  The proposed way it works is by destroying the sweat glands with the ultrasound from the Ulthera.  It requires lidocaine injections to numb the area treated, just as the Miradry device does.  The study was done by Dr. Nester from South Florida.

Q: Can Ultherapy Be Done on the Eyelids? Or is It Not Safe? Or Just Not Tested?

A: Ulthera is not to be used on the eyelids

The company has been evaluating the Ulthera treatment on the eyelids, but as of today, they have not found a good way to shield the eyes from the energy of the treatment.  Therefore, it is not recommended to treat the eyelids.  Who knows what the future holds though.

Q: What Risks Are Involved with Ultherapy?

A: The risks from Ulthera are mainly some mild bruising and discomfort which is short lived.

Ulthera has been proven to be an extremely safe procedure.  According to the company, and our 2 years of experience backs this up, there have been no long term side effects.  Some people might experience some mild swelling and bruising right after the procedure, but this subsides rather quickly. Very rarely, some people experience some temporary numbness.  With new treatment protocols which are more aggressive, there is slightly more discomfort during the procedure.  With topical anesthesia, this has been reduced.

Q: Is It Safe To Do Ultherapy One year Later?

A: Repeat Ulthera treatment is safe and is going to give longer and improved results.

Ulthera is a very safe procedure and there is no risk of repeating treatment after 1 year.  In fact, several of my clients have a planned second treatment at 3-6 months after their initial one.  The results will be better than just having one, and longevity will be increased.

Q: Ulthera – Are Welts a Normal Side Effect?

A: Swelling / Welts after Ulthera can happen but go away quickly

Occasionally, a person which has Ulthera can have overall swelling which is very short lived.  Sometimes bruising can occur and present with firmness under the skin.  Visible dermal swelling/welts can occur if the ultrasonic skin injury occurs too superficial.  It can occasional have a little fluid like a cyst or pimple, but will resolve within about 5 days.


  1. Sheridan Lorenz

    I have scheduled Ultherapy based on advice from derm. But the comments online are pretty frightening–are these just the few disgruntled patients who possibly had the procedure before the technology improved? There is a lot of discussion about pain, longer down time than anticipated, bruising, swelling, no results, cysts, etc! So, I am considering canceling. I am 64 years old and have had great skin and only now seeing a little sagging n the jaw and neck areas (had a brow and neck lift 15 years ago). I have maintained youthful features longer than average due to those procedures and some pretty wonderful genetics from my mom. Also, surface skin quality has been maintained with lots of dermabrasion, good products, sunscreen for life, etc., people ask what I am doing. But now I am seeing changes–a significant difference in sagging since age 62. I do not want a surgical facelift–so Ultherapy seemed like the answer. But a little worried. Let me know your professional opinion.

    • There is nothing to be worried about Ulthera. It is an extremely safe procedure. I have done this procedure since 2010, and to my knowledge, there are no long term side effects. No one has complained of downtime. Results will vary and I would recommend 2 procedures for you. You will find stories on the internet about any procedure (Botox, Fillers, Lasers) and you have to take them with a grain of salt. The most important choice is the provider/doctor. One that is experienced and will give you honest opinion about expectations. Surgery is going to give you the most noticeable results, but comes with MUCH more risks. My experience has been that people who haven’t had much done (aesthetic procedure wise), expect too much from nonsurgical procedures.

      • delan

        please dr Stevenfweinermd you said that ultherapy recently approved for entire neck do you mean can be use for even middle of neck ?

      • Infini is a superior treatment for all areas. Much more coagulation points than Ulthera.

      • Not over thyroid gland or cartilage

      • delan

        thank u

      • delan

        hello dr .Stevenfweinermd—the only concern about this treatment loss fat it is very important to me because as we age we loss volume ..i know we can replace volume with fillers but i need to make sure there is no loss fat in my face thank u vary much for answering .

      • It is possible, that’s why I now recommend the Infini. It places the coagulation zones in the dermis, not below.

  2. Kymm

    I just had Ulthera done by a korean aesthetician, how come she called it HIFE, notice it’s e clip written on the equipment. How come I didn’t feel any pain at all.

    • You didn’t get Ulthera. You got a knock off. Don’t know what HIFE means but HIFU means High Frequency Ultrasound.

  3. Kymm

    So what is the difference between HIFU and ultherapy ?

  4. Kymm

    Language support (3) :
    HIFU(High Intensity Focused Ultrasound)

    E-CLIP strongly penetrates deeply into skin and superficially at the same time, creating a heat congealing section. The state of the art ultrasonic lifting treatment promotes the generation of collagen and elastic fiber for more effective lifting results.

    1. HIFU system
    – High Intensity Focused Ultrasonic Surgical Unit, HIFU
    HIFU is an equipment to treat various cancers like liver cancer, uterine cancer and breast cancer throught thermal energy which created in the focal point of supersonic wave collected through ultrasound transducer.

    * How HIFU is functioning?
    Emit High Intensity Focused Ultrasound → Induce Vibration among the tissue particles in the target area → Generate Thermal Energy caused by friction → Form Coagulation Necrosis Zone

    2. Effects
    – Skin lifting through promotion of collagen contraction and elastic fiber regeneration
    – Care for deep and fine wrinkles
    – Pore tightenning and skin care effects

    3. Features
    – Because strong energy is delivered deeply into skin without affecting the epidemis, the treatment is safe.
    – Minimization of treatment affects because facial cleasing and makeup is possible even immediately after treatment
    – Short period of treatment for immediate and visible effects

    * Inducement of collagen formation → Wrinkle diminisihng effect Skin → firming effect

    Thermal Injury zone

    4. Specifications

    AC 100-240V, 50/60 Hz
    3.2 MHz
    0.2 ~ 1.8 J/c cm
    1.2, 1.5, 1.8 mm
    3 mm & 4.5 mm
    42 x 48 x 108 cm (carton size)
    25 kg

    Standard Acc

    3 mm of cartridge & 4.5 mm of cartridge

    • The technology looks similar to Ulthera but it should not be sold to the consumer as Ulthera.

      • delan

        please doctor,, explain what is difference between ultherapy to (hifu) i need clear answer which one better & which one more long lasting? thank u

      • HIFU is similar technology but a knock off and is not FDA approved. It is unknown what you are getting unapproved devices. These can be dangerous. Unable to tell you anything about them.

      • Lorraine bevis

        Just curious Doctor if you have changed your mind on any of the hand held home devises . I have a hand held mono polar with massage from project E .Had it for about 2 weeks now using it pretty much everyday and seeing some results .says the output frequency is 90khz which means nothing to me.

      • Don’t know your device. In general they are underpowered and give minimal results, even when using them more than recommended.

      • Lorraine Bevis

        Thanks for your feedback ….well I have it now so I must well give it a go and see what results I can get from it . :)I’m using a DMAE moisturizer first then using a aloe Vera Gel as a conductor .what are your thoughts on this?

        Sent from my iPad

      • Not familiar with those

  5. Marie

    If I’ve already had treatment with HIFU, can I still make use of Ultherapy?

    • They are similar technology. I assume you are talking about a knock off. So yes you can have both.

  6. joey

    I have had bells palsy still some minor drooping is ulthera an optyion

    • I prefer the Infini now for noninvasive tightening.

  7. This is a great blog. According to me Ulthera skin tightening is better than thermage as Ultherapy is the natural choice for a nonsurgical way to lift, tone and tighten your skin using safe, time-tested ultrasound technology.
    It provides a number of unique benefits to patients and physicians, by non-invasively heating tissue with ultrasound to provide lifting and skin tightening.

  8. Diana Ayguabibas

    Can a person who has had some facial skin cancer be given Ultherapy????

  9. Tina Woolston

    I have to say, your blog is the most helpful one I have read thus far. I have been reading up on various non surgical treatment for the face and neck for very long time. I just want to thank you for your informative and more straight forward approach to answering the questions. Is there, and if so what is the difference between Ulthera and Ultherapy? What ever treatment I get, I always have it done by licensed cosmetic surgeon, even botox.

  10. Would Infini or ulthera be good for a 60 year old postmenopausal woman with paper thin redhead’s skin. There aren’t many lines but scarring from acne on the chin and skin laxity of the face.

  11. Margarita Wilson

    I had a face lift about 10 years ago ( am 61 nos) and I am beginning to see some sagging in my jaw line and neck.Can I have Ultherapy to help with the sagging even if I suffer from Rosácea?

    • Yes you can. However, we now recommend Infini for better results than Ulthera.

    • Yes, doesn’t affect rosacea.

      • Margarita Wilson

        I do not know of anyone on Puerto Rico who does Infini. I do know someone who does Ulthera. So I think I will go for this procedure then. Thanks.

  12. Sarah R

    This is a great post, very thorough, thank you! I’m almost 39 and people usually think I’m about 8-10 years younger. I’m fair and grew up on a farm and we didn’t use sunscreen back then but I think good genetics from my Italian mom have helped. I’m not wrinkled and hardly any fine lines but I’m starting to see some texture issues (pores, fine marks from sleeping on my side). Also, I have some hollowness in the cheeks and a little laxity starting in jawline area. I have lost 40 lbs since having 3 babies back to back so I’m sure that plays a part, but I’ve always tended to overly to thin out in my face compared with the rest of my body. I like my face best when I’m about 20 lbs overweight, but I feel too good at my ideal body weight to go back to overweight. Also, I have some broken capillaries and redness around my nose that I would like to address, as well as cosmetic leg vein concerns. I’ve been considering Ulthera and fillers for some time. I also have read about so many different lasers for facial redness, texture, and capillaries. What would you suggest?

    • For reds – Excel V, for volume – Sculptra, for tightening, texture – the Infini.

  13. Melusina

    In 2006 while living in Paris, I had a light lift on my cheeks with gold threads . Is it posible to to do Ulthera ?

  14. I had a surgical facelift 11 years ago and the doctor did a string lift on the cheeks among other stuff but not a brow and eye lift.. also, I have rosacea and have been having photo facial treatments for that. Can I have Ultherapy on my brows, upper and lower face and chin? I am 72 years old and do not want a surgical face lift again and I understand it can be painful so was recommended to take 3 advil and 1 valium.

    • If there is metal in the threads, can’t do Ulthera over them. Most don’t but I would check, otherwise ok.

  15. thank you…. I will check with the doctor before I do anything.

  16. delan

    i realy realy upset i spent lot of money 4 days ago for utherapy for loss fat? i hate it if happen to me you always encourage people bast tretment for non invasive procedure ,,i hate bony face i like plump face do think this is going to happen for everybody who get treatment under ulthera ..please understand how i am feeling i hardly tried to gathered money for this ;;;;((((

  17. Filler is needed for volume. Ulthera will mostly only tighten.

  18. Eve

    Can someone with cheek implants that use the tiny titanium screws in one spot (each cheek) still have the Infini treatment? Would a 3 D xray help to see? Can those 2 spots just be avoided? Will the implants do alright with the treatment?

    • I wouldn’t do it directly over implants. Don’t bother with xrays, you can feel them.

  19. David

    Had HIFU in India from a tech subtracted by a known dermatologist. After 10 days, I could see my jowls drooping, almost overnight. Horrible experience and I am frightened to look in the mirror.

    • That’s not Ulthera. Can’t make any connection to Ulthera. There are numerous copy cats that aren’t studied well and not accurate.

  20. Jill Harris

    Is it recommended to have the Ulthera done by a nurse, or should I spend more and have a doctor perform the work?

    • It can be done by either. Results will probably not be better with a doctor for this.

  21. dana

    Regarding the use of Ulthera VS Thermage for the buttocks/ back of thighs area. Is it advisable to be used there? I went in to see a top nyc dermatology group to have the Cellfina celullite treatment performed, but they told me I don’t have cellullite, its more of an issue of sagging, and fibers not being strong enough or supporting anymore. Anyway, im very thin and super fit, and am 30 years old.No matter what i do to work out, i still have these sagging dents/irregularities under my buttocks area. Which of the two procedures would work best on this area? Also, if I did ulthera on the face (I would probably do lower face to lift jowls), is there a specific level or depth the machine has to be set at? I do a lot in general-for “prevention” but i do see some sagging in my face so i would be interested in preserving and keeping my skin lifted. Am I a good candidate at this age? I think most older women keep overfilling their face not realizing that its just adding more weight to an already sagging face. They don’t realize gravity is pulling them downwards. I am look for something that will plump and lift, so that when I am 50 i will still look 30. What do you advise?

    • Dents need to be filled, Sculptra can be placed there. Filling is necessary in most people, it doesn’t add to sagging. I stopped Ulthera and use Infini now for facial laxity, it’s much better. Don’t do Thermage or Ulthera on legs/buttocks. Loose skin on extremities does better with Vanquish, Exilis, Venus.

  22. Lisa

    I had ultherapy done two days ago. I paid $3,750 for face and neck, and it also included one syringe of Voluma. While I was being treated, I experienced slight discomfort but I did take one valium and 1 painkiller, so it was completely tolerable. The nurse also gave me a hand vibrator to press if it was getting a little painful. It went very smoothly. While I was getting the procedure, I asked if they would do the NFL area because I noticed they didnt get that area, and the nurse practioner said that it would be an additional $175 to do that area and it would include the upper and lower lip as well. I agreed and she proceeded to change the head of the transformer to a 1.5. The procedure took approximately 1.5 hours – When we were finished I asked if she did my neck (as I paid for face and neck) she responded that she really targeted the jowl area and used a lot of the energy there, and that to do the “entire” neck would be “a lilttle more” cost involved. I let that slide. She also said that she saved some of my energy to use in three months at my consultation, because she would be able to hit some stubborn areas. I guess that made some sense, right? I asked her how many “swipes” or whatever terminology she used was going to be used on my face and she said 1,000. However, when she stepped out of the room to get a different transformer, I quickly added the “swipes” that were on the computer and it maybe came out to 600. I’ve read a lot of information on ultherapy, but I have not come across any of these questions. My question is if any of this makes sense to you or if you have any suggestions as to any questions I may ask them. I feel that I was nickel and dimed and to me when somebody says face and neck, it means just that and if it didnt then they should have been more specific. They also told me that I was getting a “phenomenal deal” and that they usually charge $6,500 plus $1,000 for voluma. (meanwhile, I’ve yet to see anybody pay $6,500 for face and neck – I’m in Scottsdale by the way.) Thoughts??

    • The charge seems reasonable, I agree with them. There are usually 800 lines when doing the face. I would just clarify what the neck part included. Sometimes upper neck is what was meant. 1000 is a bit high for Voluma, 850 to 900 is avg.

  23. Dr Weiner I can’t express my gratitude adequately for your “thumbs up” now for Infini. I know you’ve been a proponent of Ultherapy for a number of years now so to have you add Infini to recommendations for skin laxity (in some ways superior) shows your high level of ethics in practice and concern for patient outcomes. I looked at Ultherapy for a long time, was initially very excited, but after many reports of loss of facial volume, pain, and nerve issues I started getting consults for Infini. Very happy to have your opinion on its value and efficacy vs Ultherapy, I have my first treatment in 2 weeks. Thanks!

  24. Carol

    Can I have Ulthera if I have a titanium marker in breast?

  25. Ulrike Borchert

    My nurse said to get the best result I should do a second Ulthera Hifu treatment four weeks later again. Is there any risk? Why should I have to wait 3 month in your opinion?
    Could I do anything wrong if I would do the next treatment too early. And what could happened?
    Thank you for your serious answer.

    • No problem doing it earlier than 3 months. There is nothing bad that could happer.

  26. Kendra

    I have noticed that my normal pretty skin is more lax and not as vibrant or full after this procedure. I had ultherapy about 3 1/2 months ago on my lower face. It was noted by a plastic surgeon at ultherapy that it looks like dehydrated skin due to the sweat glands. They said its temporary. I’m wondering if my skin will get worse and if the sweat glands are destroyed. Or are they dormant? And will they wake up and start hydrating my skin again? It looks a little better from a month ago but still not what it used to be. Does this get better over time? I would never have done this if I knew it would ruin my beautiful skin.

    • It wouldn’t be sweat glands most likely but sebaceous glands. Sebaceous glands come back. I like Infini better now and have sold Ulthera. More control on depths and more coagulations points.

      • Kendra

        Thank you for your quick reply! I’m relived to hear that. I haven’t noticed much fat loss. And I’m hoping that after this amount of time that damage would have shown itself already. The operator said she was rally careful to avoid that layer since it was my concern. Glad to know the sebaceous glands come back. I’ve started derma rolling too.
        And fortunately only the cheek area was done. I don’t think I’m going to do the heating thing anymore. Even the infini makes me nervous at this point. I’ll stick to fillers and skin care and dermatology.

  27. Beemo

    Dear doctor,
    I have one clear question and want please an honest clear answer: does Ultherapy cause fat loss of the face ? Yes or no ?

    • I think it can. It is too deep for dermis and in the right level to affect fat. I haven’t seen it but it can happen based on the depths it goes.

      • Beemo

        Then should i consider it? I dont want to lose the fat in my face, it will look worse and more sagging!
        How can ultherapy imrove skin tone if it causes fat loss and thus volum loss?

      • You took me out of context. I didn’t say Ulthera caused fat loss. I said it theoretically could. I have moved on from Ulthera. Infini is my skin tightening device. I have about 6 blogs on Infini

  28. Kendra Bauser

    What about the Profound procedure? Would this have a better effect on tightening wout the risk of volume loss?

    • Don’t do Profound. I have seen many complications. Infini is the best right now. I don’t do Ulthera anymore.

      • Beemo

        Thank you doctor for your reply.
        My freind did Ultherapy 2 days ago, but she is freaked out when she herd of this possible side effect. Is there anything she can do to PREVENT fat loss That might happen? I know if it happens she will have to go for fillers and fat injection, but is there any preventive measures she can take? Thank you again

      • Nothing. Don’t worry though.

  29. Marie

    Should an aesthetician be using ulthera, HIFU, or infini or a Doctor/nurse or dermatologist instead? I want to look up where I can get treatments in Missouri? Does it have to be a Doctor or are aestheticians qualified enough? Maybe at a spa or something? I would think Doctors cost a little more? There are spas everywhere.

    • I feel it should be a nurse or Doctor but not is not what the laws say. These are not highly regulated and vary according to state.

  30. Marie

    You said according to state? Do you know if in Missouri I could get treatments by an aesthetician and if it’s cheaper but still safe that way?

    • I don’t know about Missouri and I don’t know training of person you are asking about. You have to discuss with your provider and decide if they have the experience to treat you.

  31. Marie

    Ok, Thanks!

  32. Angela

    I had the treatment a week ago and now have pimples all over my forehead and round flat pink marks on my face near eye as well as bruising . Coincidence or not I also developed severe conjunctivitis in one eye . Have to see acute eye specialist and dermatologist .

    • Sounds like the treatment wasn’t given properly. The handpiece wasn’t flush so I areas treated superficially. Also eye might have been treated.

      • Beemo

        Dear Dr.
        I had Ulthera done for lower face and neck one month ago. Until now i haven’t noticed any improvement. When should I see the improvement?
        Also, if Im interested in Infini, how long should I wait before doing the infini?

      • No waiting for Infini. You should see final results at 3 months

      • Beemo

        Thank you doctor for your reply. Let me get this right, do you mean I can do infini now, although i just had Ultherapy last month?

      • You asked when can you get Infini and you can get now. If you want to wait 3 months to see results from Ulthera you can.

      • Beemo

        Thank you again very much for your reply.

      • Beemo

        Can infini be applied on hands?

  33. Don’t recommend hand treatment, CO2 laser is better.

  34. ritz

    i am 38 & planning to get a HIFU in india. any long term side effects??? will my skin become more loose & sagging after 1.5 or 2 years???

    • HIFU is a knock off of Ulthera and the results and side effects are unknown to me.

  35. sally marshall

    How soon after getting ulthera can you get accent XL treatments?
    I like to do both cause I see differnt results.

  36. Yada

    Dear Dr,
    Can ultherapy improve blemish? I have been thinking to get a treatment done on my facel very soon. Thanks.

    • Ulthera does nothing to blemishes, pigmentation, or other superficial skin problems.

      • Beemo

        I had ulthera 3 months ago mainly to lift my jawline. Unfortunately I noticed more sagging now. I think i had some fat loss although i did it in one of the premium centers. Can infini reverse this effect?or improve the sagging? Im not considering fillers.
        Another question: what is the difference between infini nd thermi , And what is more effective in lifting the sagging jawline?
        Finally: where us your office?

      • Infini won’t improve fat loss. It improves sagging. Thermi is more invasive, goes under the skin, and I don’t do it. I’m in Destin area.

      • Beemo

        Thank you doctor for your reply. I live in Los Angeles. How can I find a trustworthy Infini provider here? I dont want to loose fat from my face again

      • I don’t know who has Infini in LA. Google it.

      • Beemo

        Do u have any reservations on Thermi ?
        I’m asking because it seems we don’t have infini here in LA. If you don’t recommend it as an alternative to infini i wont do it. I trust your opinion.
        Thank you

      • Thermi is good and should work.

      • Beemo

        Is intracel the same as Infini?

      • It looks similar. Don’t think approved in the US. I wouldn’t use.

      • Beemo

        I had radiesse filler in my cheeks. Is it safe to have infini?
        If yes, when after the filler can i have the infini treatment?

      • Radiesse is not affected by Infini. OK to go right away.

  37. susie

    I had gold threadlift on my face about 9 years ago & i had a granuloma where one thread is.
    I also have bumps n long dents where the threads were positioned over the years. What an i do about it?
    Recently I had some restylayne fillers done & my face itches so I think i may develop some granulomas as it was the same itchy feeling that i had when my first granuloma formed. What can i do to make my face smoother & rid my scarring , dent & bumps?
    I think i am one of those people who scar when a cut heals.

    • Itching doesn’t mean granuloma. This is too complicated to just answer via a question over the internet. Please see a board certified aesthetics doctor.

  38. RM

    I am only 29 years old, however due to weight loss my breasts have acquired loose and wrinkled skin. I also have some stretch marks but it’s the loose skin that bothers me the most and is ruining my self-esteem. A surgical breast lift is not something I would consider at this stage for a number of reasons including scarring and the fact that I am yet to start a family. Please could you advise me on whether any of the procedures you have discussed here or otherwise would be suitable for the tightening of skin on the breast area. Thank you.

  39. RM

    P.S. It might be worth noting that I am aiming to lose a further 28lbs. Should I have skin any recommended tightening procedures done after I’ve reached my target wait or would the collagen stimulation prevent the situation getting worse as I lose the remaining weight?


    • Without seeing you, I am going to guess that the loose skin problem is beyond the capabilities of skin tightening devices. The best current device is Infini. It can be used on small areas (face, chest, neck), but not on extensive body areas due to limitations related to the size of the footprint of the device.

  40. Arwen Tang

    Your blog is so informative and very clear. If I live near your clinic,I will definately visit your clinic. I am thinking about having Ulthera treatment. The clinic that I consulted recommended that if I cant take the pain whilst undergoing the treatment,they can put iv for me to sleep through. I am not sure if this is a safe thing to do. Thank you for your time.

    • We are doing the Infini now for skin tightening. For pain control, we do a superficial skin block which numbs the skin completely with no need for oral or IV medications.

      • Beemo

        I had bad experience with Ulthera.. It caused some fat and collagen loss which adversely affected my face. I want to use infini for tightening my mildly sagging jowls but very worried that it might cause the same problem of fat and collagen loss because it uses the same RF technology. Is there a possibility that infini might cause that side effect ?

      • Infini’s depth is dermis only. Ulthera goes deeper. Ulthera is not RF, it is ultrasound. Volume is needed in most patients and that’s probably needed in your case too.

      • Beemo

        Thank you for your reply
        So you think I would benefit from fillets not from infini?
        How about combinig both for better results?
        Also, can infini be combined with PRP?

  41. I don’t know and can’t give you advice about anything without a formal consult. Infini is fine to combine with PRP. I can comment on what I know about Infini and Ulthera.

  42. Keely Nixon

    Hello can you have ultherapy if you have had breast cancer 4 years ago ? And are on 3 monthly zoladex injections plus daily anatrozle?
    Thank you

    • If the drugs impair the healing process, collagen stimulation might be less and therefore results wouldn’t be as beneficial.

  43. Thanh ngo

    I want to know how much cost for hifu treatment on face?about total ?

    • I don’t have the device anymore. Ulthera tends to run about 3500.

  44. Karen

    Your blog is most informative. Thanks for responding to these questions even though you don’t provide Ulthera service any longer. My question – I have vitaligo and wonder if Ulthera or Infini are appropriate for somebody with this condition?

  45. Candice Dionne

    Just an opinion on Thermitight on lower face and next as opposed to Ultherapy. I’m 60 years old and wonder if all these treatments are on younger people?

    • I think the best skin tightening is now Infini. It is not Ulthera. I haven’t seen the results from Thermitight at meetings that I thought it should show.

  46. Nnadira

    My friend did Hifu yesterday and got burnt .has superficial lesion burnt marks on the face .any advise why it happen

    • Remember Hifu is not ulthera. It is similar technology and I don’t know it exactly. If the handpiece is not flat on skin, a burn can happen with Ulthera.

  47. LAC

    What about the reports of facial fat atrophy with Ultherapy?

    • I do believe this is possible and likely. I haven’t used Ulthera for over 3 years. The depth of the zone of coagulation is in the sub q fat for the 3 and 4.5mm transducer. I have switched to Infini which has coagulation depths within the dermis.

  48. Lisa

    I had a pdo thread lift about a month ago. Can I get Ulthera as a follow-up treatment? If so, how long do I have to wait before treatment? Thanks!

  49. must be 5-6 months after PDO thread lift

  50. Ilsa

    Dear Dr. Werner,
    I had the most unusual thing happen during my Ulthera threatmenr, just when the second pass part was about to begin the machine partly broke. My therapist would not proceed because she could not visualize the tissue and wanted to make sure she was tesgeting properly. I respect that, of course. I have to go back when it is resolved. Will it affect my results? I appreciate her commitment to accuracy and the treatment was very painful for me as I know they used the older protocol. Having a break was not all bad for me! What is your opinion? I want the best results, after all it is quite expensive and it was very hard on me. My return date is scheduled and my face is very, very swollen. Any tips? Much thanks. I would love to maximize what I can.

    • You results should not be compromised. Proceed with the follow up retreatment.

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