Ultherapy vs Thermage: Which Is Better? A Split-Face Look

This is an English adaptation of a clinical article by Dr. SangYoul Yun — board-certified dermatologist and Medical Director of Delight Dermatology in Gangnam, Seoul — originally published in Korean. Read the Korean original on Naver. It has been restructured and translated for international readers.

What did the split-face trial find? In 20 participants, both monopolar radiofrequency (MRF) and microfocused ultrasound with visualization (MFU-V) improved several face-and-neck laxity measures through 180 days, and the study did not establish overall superiority of either modality. Its small sample and modality-level design mean it is not a Thermage FLX-versus-Ultherapy Prime verdict.

This page explains that one study. For a broader choice based on mechanism, recovery, visit time, evidence limits, and an itemized Seoul plan, use the Thermage FLX vs Ultherapy Prime decision guide.

How the randomized split-face trial was designed

The evaluator-blinded study enrolled 20 women aged 30–60 with broadly symmetrical facial laxity. One side of each participant's face and upper neck received monopolar RF; the other received MFU-V. Evaluators assessed the cheek, nasolabial fold, jawline, and upper neck at baseline and at 30, 90, and 180 days.

This design helps control for between-person differences because each participant acts as her own comparator. It does not remove every limitation: the sample was small, the protocol was specific, follow-up ended at six months, and the paper compared modalities used at the time rather than proving that today's Thermage FLX or Ultherapy Prime is universally superior.

What improved at 30, 90, and 180 days

Cheek, nasolabial-fold, and jawline scores improved on both sides after 30 days and remained improved at 90 and 180 days. The upper-neck assessment also improved on both sides; one regional analysis favored MFU-V, but the study's overall comparison did not show a statistically significant difference between the modalities.

That distinction matters. A finding in one region is not the same as an overall winner, and “no statistically significant difference” does not prove that treatments are identical for every anatomy or treatment plan.

Patient ratings and pain scores

Reported six-month and treatment-time measures in the 20-person study

Measure	MFU-V side	Monopolar-RF side
Patient GAIS at 6 months (1 = best)	2.43	2.31
Observed treatment pain score	2.35	1.4
Overall superiority established?	No

The pain measurement came from this study's protocol and participants. It should not be converted into a fixed pain promise for a different device generation, setting, pain-control plan, or patient.

What this study cannot decide

• It cannot prove that Thermage FLX and Ultherapy Prime are equivalent or that one is better for every patient.
• It cannot establish a universal one-to-two-year result duration; the study followed participants for 180 days.
• It cannot set one full-face session time, because areas, Ultherapy lines, Thermage REPs, settings, preparation, and pain control vary.
• It did not test a combined protocol, so it cannot support one standard sequence or fixed interval between the modalities.
• Response rates from separate older studies should not be placed beside one another as though they came from this randomized comparison.

How to use the result in a consultation

The practical takeaway is not “both are the same.” It is that a small direct trial did not find an overall winner, so the decision still has to follow the assessed concern, tissue, treatment area, exact platform, proposed lines or REPs, material risks, recovery, and written quote. Ask what finding makes one modality more relevant to your plan and what would make the clinician defer either treatment.

Reference

1. Alhaddad M, et al. A Randomized, Split-Face, Evaluator-Blind Clinical Trial Comparing Monopolar Radiofrequency Versus Microfocused Ultrasound With Visualization for Lifting and Tightening of the Face and Upper Neck. Dermatol Surg. 2019. PMID: 30531187.

Medical disclaimer. This article explains one small study and is not individualized medical advice. Suitability, settings, risks, and any combination plan require an in-person assessment by a qualified physician.