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Thermage vs Ultherapy: How it Works?

Ultherapy and Thermage: What are the Differences?

I get asked “Ultherapy or Thermage” so often, and I hope that this article covers some questions you may have and can help you decide better.

Thermage utilises radiofrequency (RF) energy to help tighten the skin mainly in the under-eye area. On the other hand, Ultherapy utilises ultrasound energy to tighten the skin on the brow, cheek, chin and neck areas. Both are non-invasive treatment procedures that work effectively to tighten skin and treat wrinkles.

The reason why these two devices are always compared is that they are both US FDA approved devices with more than ten years of history and 1 million treatments performed worldwide. The debate has been on-going since.  

Until Jan 2019, a randomised controlled trial, split-face study published by The Dermatology Surgery Journal, one of the most trusted peer-review journal in Dermatology and Aesthetics, showed that both Thermage and Ultherapy are effective in skin tightening and face and neck lifting with visible results from 1 month and up to 6 months after 1 treatment. 

Interestingly, there is NO significant difference between Thermage and Ultherapy in terms of visible results, patient satisfaction and side-effects. 


Let’s dive deeper.

Similarities between Thermage and Ultherapy

While there’s a lot to talk about when it comes to ultherapy vs thermage, both treatments use heat as a mechanism to stimulate collagen production. However, the technology used to achieve this is different.

Type of Energy Used

Ultherapy vs HIFU vs Thermage

Thermage uses patented monopolar radiofrequency waves to induce heat while Ultherapy uses mircofocused ultrasound waves with direct visualisation.

Procedure and Goal of Treatment

Both Thermage FLX and Ultherapy treatments take approximately 1-2 hours long. Numbing cream is applied prior to treatment to ensure more patient comfort.

Treatment Areas

Thermage and Ultherapy Treatment Areas

Depending on the area of concern, you may choose one over the other. 

Ultherapy has 3 major treatment area:

  • The brow
  • The (double) chin and neck
  • The chest

The ability to target the SMAS layer is the reason why these areas are FDA approved for a non-surgical facelift. If you are looking for skin tightening and facelift, ultherapy would be your preferred treatment.

Thermage treats several specifically

  • The face
  • The upper and lower eyelids
  • The abdominal area

Thermage is FDA approved for wrinkles but not for skin tightening. 

Thermage is the ONLY energy device that is FDA approved to treat the upper eyelids. If your concern is droopiness of the upper eyelids, you would probably choose thermage over Ultherapy.

If you are treating the body, thermage has a bigger applicator for the body. However, in my experience, it can cause a lot of discomforts, and I would sometimes use the face tip for the body. In comparison, Ultherapy can target deeper, potentially into the fat layer; therefore you might choose this over Thermage for body treatments.

Depth of Penetration

Ultherapy aims to treat deeper into the dermal layer, and even down to the fat and the SMAS layer, which is located 4.5mm under the surface of the skin. There are different transducers which precisely targets the different depths. Ultherapy can be said to treat your skin from “inside out”.

Thermage is bulk heating of the skin from the superficial layer up to 3.0mm. Thermage treats your skin from “outside-in”.

With that said, Thermage treats more superficial wrinkles and lines, while Ultherapy is able to target deeper layers that is designed for a non-surgical facelift.


Objectively speaking, Ultherapy has an imaging function that is US FDA approved. This means that your doctor can visualise the treatment area before delivering a ‘shot’.

Thermage does not have an imaging or visualisation function.


In the past, when Thermage was first launched in 2002, it was definitely more painful. However, over the years, generations of Thermage have developed, and a lot of improvements has been made to minimise discomfort. We are now into the 4th generation, and the discomfort is reduced by cooling the skin before each shot is delivered. There is also an in-build vibration mechanism that helps to distract the patient from the heat when energy is delivered. 

With Ulthera, as the energy is precisely delivered to the deeper layers of the skin, leaving the epidermal skin unaffected, the discomfort is minimal. The rhythmic sounds of the machine allow the patient to anticipate when the energy is delivered, and the use of a vibrator is commonly found useful. 

I would say the discomfort experienced with the newer versions of Thermage and Ultherapy are comparable.

Side Effects

It is proposed Thermage, which delivers energy from the surface of the skin, is capable of removing impurities on the skin surface, improving skin problems like acne and freckles. However, these ‘added benefits’ are not well studied. Besides, heat on the epidermis could potentially aggravate melasma. 

Ultherapy is very safe as energy is targeted into the deeper layers of the skin, bypassing the skin surface. While there can be potential ‘fat loss’ with energy delivering to the deep foundation of the skin, it can be an advantage for heavy jowls and body treatment, but it can work against individuals who are already very slim.

Duration of Treatment

Ultherapy treatments can be customised depending on the area of concern by adjusting the number of shots needed. The duration and cost will correlate to the number of shots deem necessary for you. It is common in our practice to do only the lower face and double chin. And treatment can be as short as 30min.

Thermage is somewhat restricted as the ‘tip’ has a fixed number of shots to be used within a stipulated time of 2-3hours. The tip will not be able to deliver fresh shots after this stipulated time. As such, it is uncommon to do only the lower face. Henceforth, the price of treatment is quite fixed. It will take about 90 – 2 hours to deliver all the shots.


You should not experience much downtime with either treatment. Temporary redness and swelling are common, and this should be self-resolving within a day or two. Bruising is uncommon and can be further avoided by scanning the treatment area before delivering each shot in Ultherapy. As ultherapy targets the SMAS layer, it is normal to experience an ache over the treatment area for up to two weeks. It is as if you have just gone to the gym.

How long does the result last?

Generally, both procedures recommend repeat treatment every year. While results generally can last for up to a year, some of our patients see the need to touch up in 6 months. 

Number of treatments required

Most patients would do only one session as recommended. However, I feel that some of our patients will require more than one session to achieve the desired effect. A patient’s biological response to each treatment and the degree of skin laxity will determine the number of sessions required. This applies to both Thermage and Ulthera.

Although in this article, we are comparing the differences between the two treatments, I believe that the two treatments do, in fact, complement each other very well by targeting the different layers of the skin with different mechanisms! 

Who is a good candidate for Ultherapy and Thermage?

Both Thermage and Ultherapy rely on your body’s ability to produce collagen, and this process takes time. One will take 2-3 months to see the results of either treatment. Just like Thermage, Ultherapy does not promise permanent results and repeated treatments are required to maintain its results.

If you expect a dramatic change, or if you have significant sagginess, you are probably better off with facelift surgery.

Can you do both Thermage and Ultherapy?

Yes. Both Thermage and Ultherapy treatments target various aspects of skin aging. Ultherapy up to 4.5mm whereas Thermage up to 3.0mm. Both non-surgical skin tightening treatments can be spaced 6 months apart.

Ultherapy vs Thermage: How to Choose your Treatment?

Ultherapy vs Thermage: How to Choose your Treatment

1. Proven Effectiveness

Why waste your money on treatments that do not yield results? Choose a procedure that is approved by major health regulatory bodies with multiple research studies that back up its effectiveness. 

2. Price

Skin tightening is not a one-off treatment. For optimal results, you might need to repeat treatments every 6 to 12 months, depending on your age and skin condition. 

In order to budget wisely, pls research the price of Thermage and Ultherapy in Singapore before making your decision. 

3. Doctor/ Clinic

Thermage and Ultherapy are medical treatments that should not be trivialised. This is because they carry risks of complications too. 

I suggest going to a clinic that has multiple types of skin tightening devices and anti-aging lasers so that you have more options.

Often times, you might need more than 1 type of treatment or laser to get optimal results. 

Unsure which is the most suitable treatment for you? A face-to-face consult will help.


Medical Director

After graduating from the National University of Singapore, Dr Boey’s journey in aesthetics brought him to esteemed institutions such as Harvard Medical School, American Academy of Aesthetic Medicine and Queen Mary University of London in diverse cities like Seoul, London, Boston and New York.