Ulthera is a lifting procedure that, without opening the skin surface, focuses ultrasound at a set depth and heats only those points to create tightening. Rather than on the day of treatment, collagen and elastic fibers are described as being remodeled over weeks to months.
3-line summary
1. Ulthera is a single treatment that uses focused ultrasound to create thermal points at a set depth in the skin, after which collagen and elastic fibers are remodeled.
2. In blinded photo scoring, brow height rose by a mean of 1.7mm at 90 days after treatment, and self-scores from those treated were lower than physician scores.
3. Pain is moderate; temporary muscle weakness and paresthesia, and burns from incorrect technique, have been reported, so pacemaker, metal, open wounds, and severe acne are disclosed before the appointment.
Focused ultrasound creates thermal points at a set depth
Ulthera delivers energy while viewing the layers on an ultrasound screen during treatment. Without surface cooling, it leaves small thermal points only at the depth set by the transducer. A U.S. regulatory agency permitted this device to be marketed for lifting the brow, lax tissue of the submental area and neck, and improvement of décolleté wrinkles.
In a tissue study with manufacturer employees among the authors, thermal points formed at the 1.5·3.0·4.5mm depths indicated by the transducer; at day 90, collagen-producing cells gathered at those sites and new collagen and elastic fibers increased. The numbers are transducer markings; actual depth differs from person to person. The procedure sequence is consultation and cleansing, confirming bone and layers with ultrasound, delivering energy along lines, then checking the skin immediately afterward. How shot count and treatment area are reflected in the estimate can be read further in the dermatology pricing comparison guide.
| Item | What was confirmed |
|---|---|
| Energy | Focused ultrasound, no surface cooling, layer confirmation during treatment |
| Marketed uses | Brow, submental area and neck, décolleté wrinkles |
| Number of treatments the studies looked at | Course after a single treatment |
| Photo-scoring time point | Mainly 90 days; self-scores through 1 year |
| Sensation during treatment | Moderate pain; studies that used cream anesthesia |
| Common reactions | Redness, swelling, tenderness |
| Rarely reported reactions | Bruising, paresthesia, temporary muscle weakness, burns from incorrect technique |
The range of use can be reviewed further in Ulthera treatment information, and differences from the method that broadly heats the dermis with radiofrequency are covered separately in the Ulthera and Thermage comparison guide.
90-day changes were measured at the brow and submental area
In a study that treated the forehead, temple, cheek, submental area, and neck once, blinded scoring of 90-day photographs judged the brow to have risen in eight or more out of ten people. Mean brow height rose 1.7mm, and more than 90% of participants were women. Immediate reactions are recorded as temporary redness and swelling.
In a literature summary that collected only single-treatment studies, tightening and wrinkle improvement on physician scores at 90 days was at the level of nine out of ten people; self-scores from those treated were four out of ten at 90 days and five out of ten at 1 year, lower than the physician scores. That summary collected only studies in women, and the last time point covered was 1 year. It summarized that the response was weaker in more lax skin.
In a 22-person data set with manufacturer funding and employee authors, elasticity values fell at 4 weeks after a single treatment, then rose at 12 and 24 weeks. In a marketing summary that expanded the submental area and neck, the submental area decreased in 51 of 70 people, and among those, the share in whom a blinded evaluator saw change exceeded four out of five. In another study of the lower face, lax skin looked improved in six out of ten on blinded evaluation, and pain during treatment was around six out of ten.
| Time point | Confirmed change |
|---|---|
| During treatment to the same day | Moderate pain, redness |
| Hours to days | Swelling, linear edema, tenderness |
| 4 weeks | Record of elasticity values falling temporarily |
| 90 days | Mean brow height 1.7mm, blinded scoring |
| 12~24 weeks | Record of elasticity values rising |
| 1 year | Self-scores slightly higher than at 90 days |
※ The 4-week, 12-, and 24-week elasticity values are from a 22-person data set with manufacturer funding. One year is the last time point in the collection of self-scores.
Delivering heat to the collagen layer is also covered in the guide to methods for increasing collagen, and when looking at neck wrinkles alone, continue with the neck wrinkle care guide.
Pain is moderate, and nerve symptoms have also been reported
A literature collection recorded treatment pain as moderate. Pain scores in a pooled analysis with manufacturer funding were around five out of ten. The instructions for use record momentary discomfort during treatment, discomfort between 2 hours and 2 days afterward, and tenderness between 2 days and 2 weeks. Redness is guided as settling over hours, swelling from 3 hours to 72 hours, and linear edema within a week. Bruising occurs occasionally and lasts 2 days to 2 weeks.
The same instructions for use record a course in which temporary muscle weakness from motor-nerve inflammation, and tingling or numbness from sensory-nerve inflammation, settle within 2 to 6 weeks, and there were 0 records of permanent facial-nerve injury in clinical trials. A safety summary with a manufacturer employee as first author divided common reactions into tenderness, redness, and mild swelling, and uncommon reactions into bruising, linear edema, paresthesia, and muscle weakness, and grouped burns that occurred when the transducer was tilted or gel had pooled with incorrect technique. Post-market spontaneous reports also include fat reduction, nerve symptoms lasting several months, blisters, and pigment change.
What the instructions for use list as contraindications are open wounds, severe cystic acne, functioning implanted devices such as a pacemaker, and metal implants at the treatment site. Directly over filler or mechanical implants, over existing keloids, inside the eye, eyelid, or orbital rim, and the thyroid and large vessels are written as sites where energy is not delivered. Evaluation data in pregnancy and breastfeeding have not yet been made public. General handling of adverse reactions can also be confirmed in treatment safety information.
Confirm today's transducer and sites to avoid
The following five items are things to have answers for before treatment.
- □ Whether the device used today is genuine Ulthera, or another focused-ultrasound device
- □ Which of the brow, submental area, neck, and décolleté will be treated, and whether bone is avoided on the screen
- □ The criteria for lowering energy when pain increases
- □ Whether pacemaker, metal, filler locations, severe acne, and open wounds were disclosed before the appointment
- □ Whether the next schedule will be reviewed after comparing 90-day photographs from the same angle
Frequently asked questions
Q1. Does Ulthera hurt?
Discomfort comes at the moment energy is delivered. In the brow study, treatment was done after applying cream anesthesia.
Q2. How many sessions?
The data that measured the brow and submental area looked at the course after a single treatment. Whether to repeat is decided after comparing 90-day photographs from the same angle.
Q3. How long do the effects last?
The last time point covered by the collection of self-scores is 1 year. Those scores were slightly higher at 1 year than at 90 days, and lower than physician scores.
Q4. Can it be received together with filler or Thermage?
The instructions for use exclude delivering energy directly over filler from the recommended list. Thermage uses a different type of energy, so sequence and sites are decided first, and history is disclosed following the consultation guide for filler, botulinum toxin, and lifting history.
Q5. Who should postpone the appointment?
Open wounds, severe cystic acne, functioning implanted devices such as a pacemaker, and metal implants at the treatment site are contraindications in the instructions for use. Energy is not delivered around the eyes or to the thyroid.
Results, duration, and suitability vary with individual skin condition, age, and lifestyle, and the same outcome cannot be guaranteed.
Procedures may cause temporary redness or swelling, and contraindications may apply, so please confirm these during your consultation.
This article is general information and does not replace individual medical care. Please confirm diagnosis and treatment suited to your condition during a consultation.
Sources
- U.S. regulatory agency, Ulthera brow-use classification letter — PDF text confirmed. Marketing classification for nonsurgical aesthetic use of lifting the brow. A substantial-equivalence and classification document, not a document that guarantees individual aesthetic results.
- U.S. regulatory agency, submental area and neck marketing summary — PDF text confirmed. Added lax tissue of the submental area and neck to the brow. In a public trial, submental area decreased by 20 square millimeters in 51 of 70 people; among those, blinded-evaluation improvement 84.3%. Adverse reactions were mild and short, with 0 serious device-related events. Document numbers are kept only in footnotes.
- U.S. regulatory agency, décolleté-wrinkle marketing summary — PDF text confirmed. Added improvement of décolleté wrinkles to the uses. Thermal points confined to the focal zone, no surface cooling. Substantial-equivalence marketing document.
- Manufacturer instructions for use (Ulthera System) — PDF text confirmed. Marketed uses; contraindications (open wounds, severe cystic acne, functioning implanted devices, metal); cautions for filler, keloids, and the periocular area; time windows for facial, neck, and décolleté adverse reactions; post-market spontaneous reports (including fat reduction and months-long nerve symptoms). Manufacturer document.
- Prospective blinded brow evaluation (PMID 20115948) — Abstract confirmed. 36 enrolled (34 women), 35 evaluated, 90 days. Brow change in 30/35 by 3 blinded evaluators, mean height 1.7mm. Temporary redness and swelling. Cream anesthesia. Transducer focus 4.5mm·3.0mm. No retraction or expression of concern. Full text and funding language are not in the abstract.
- Single-treatment literature collection (PMID 36674277) — Abstract confirmed. 16 papers, subjects were women. Brow 0.47−1.7mm, submental area reduction 26−45 square millimeters. Physician-score 90-day improvement 92%(337 people), self-scores 42% at 90 days · 53% at 360 days (81 people, mild). Moderate pain, temporary erythema±edema. Other adverse events 2% (paresthesia, bruising, chin burns, etc.). Reduced response in groups with greater laxity and higher body-size index. Declared no conflict of interest. No retraction. Full text is available on PMC, but claims in this article are limited to the abstract.
- Tissue study of collagen and elastic fibers after thermal points (PMID 39545626) — Abstract confirmed. Thermal points at 1.5·3.0·4.5mm, gathering of collagen-producing cells and new collagen and elastic fibers at day 90. Majority of authors were manufacturer (Merz) employees. No retraction.
- Skin physiology and elasticity after a single treatment (PMID 30666145) — Abstract confirmed. 22 women, 24 weeks. Barrier and water loss stable; elasticity decreased at 4 weeks then increased at 12 and 24 weeks. Edema resolved without sequelae, pain decreased immediately afterward, 0 adverse events at 24 weeks. Manufacturer funding and employee authors. No retraction.
- Safety-profile summary (PMID 25399626) — Abstract confirmed. First author a manufacturer (Ulthera) employee. Common reactions tenderness, redness, mild swelling; uncommon reactions bruising, linear edema, paresthesia, muscle weakness. Superficial thermal injury from incorrect technique. No retraction.
- Efficacy and safety pooled analysis (PMID 39540440) — Abstract confirmed. 42 papers. Investigator-assessed improvement 89%, self-improvement 84%, mean pain 4.85 (moderate). Common adverse events erythema, edema, bruising, tenderness. Manufacturer (Merz) funding. The authors noted that classifying neutral responses as positive can inflate the effect. 1 commentary. No retraction.
- Prospective lower-face trial (PMID 24990884) — Abstract confirmed. 103 enrolled, 93 evaluated, 90 days. Blinded-evaluation improvement 58.1%, instrumental improvement 63.6%. Higher no-change rate in the group with higher body-size index. Pain cheek 5.68 · submental 6.09 · submental angle 6.53. Wheals in 3 people. No retraction.
Related reading
- Ulthera treatment information
- Ulthera effects and duration
- Comparing Ulthera and Thermage energy methods
- Changes remaining after a single Thermage treatment
- Consultation guide for filler, botulinum toxin, and lifting history
- Facial sagging, choosing Ulthera and thread lifting
- Treatment safety and adverse-reaction information
Sources
Discuss options for your current needs
We review your current health and prior procedures before explaining appropriate options and their limits.
