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

This is an English adaptation of a clinical article 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; all references are the author's own.

Aging shows up across the bone, the subcutaneous fat, and every layer of skin. The firmness of the dermis breaks down and the skin begins to stretch and sag. Two of the most common ways to restore elasticity — both with relatively short recovery and a good track record for effect and safety — are Ultherapy, a microfocused ultrasound with visualization (MFU-V) device, and Thermage, a monopolar radiofrequency device. So which is better? Here is what a split-face study found.

The study — one side Ultherapy, the other Thermage

In this study the face and neck were treated on one side with Ultherapy and on the other side with Thermage, and the changes were compared over time. The subjects were women aged 30–60 with balanced elasticity on both sides of the face. Facial elasticity was assessed with the FLR (face-and-neck laxity grading scale) at baseline and at 30, 90, and 180 days, across four regions — the cheek, the nasolabial fold, the jaw line, and the upper neck.

Improvement in the cheek, nasolabial fold, and jaw line was clear after 30 days and remained markedly improved on both sides at 90 and 180 days. Upper-neck elasticity also improved at 30, 90, and 180 days — and here Ultherapy showed somewhat more significant improvement. Overall, though, there was no statistically significant difference between the two procedures; both improved.

Satisfaction and pain

Patient-rated outcomes told a similar story. Using the Global Aesthetic Improvement Scale (GAIS) — where (1) is much improved, (2) improved, (3) no change, (4) worse, (5) much worse — at 6 months the Thermage side averaged about 2.31 and the Ultherapy side about 2.43 (both in the "improved" range). Pain was rated with a VAS (visual analog scale) based on the patient's expression during treatment: Thermage 1.4, Ultherapy 2.35 — the Ultherapy side was felt to be somewhat more painful.

Earlier studies had reported that operators judged Ultherapy to produce an effect in about 66–84.4% of patients over 3–6 months, and Thermage in about 80–83.2%.

So which should you choose?

To summarize: aging causes loss of elasticity across bone, fat, and skin, leading to sagging, and both Ultherapy and Thermage were effective in the cheek, nasolabial fold, jaw line, and upper neck, with good patient satisfaction. Both were effective enough that the difference was not statistically significant. In actual practice, the choice tends to fall along these lines:

Combining the two — Ultherapy for the contour and Thermage for skin quality — is an effective way to address both at once. For a fuller look at each procedure on its own, see our companion articles: what to know before Ultherapy and a clinical update on Thermage.

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 is general information and does not replace individual consultation. Both procedures suit most people but not everyone, and the right choice — Ultherapy, Thermage, or a combination — should be decided after an in-person consultation with a dermatologist.