Ulthera (Ultherapy) Questions Answered by Steven Weiner, MD, Facial Plastic Surgeon
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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
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.
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.
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.
A: There have been improvements since Ulthera first came out about 3 years ago.
The changes which have occurred are:
- There are now 3 different depths for treatment, 1.5, 3, and 4.5 mm.
- There are about twice as many treatment lines being laid down as to when it was first introduced.
- Topical lidocaine is being used and having an effect in improved comfort.
- 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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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