Ultherapy, Sofwave, or Thermage: which skin tightening treatment is right for you?

The question we hear most often about non-surgical skin tightening is which device to get. That question comes too early. Each device reaches a different layer and tissue, so what it can improve is different as well. No device is better across the board. There is only the device that fits your situation.

How deep each one goes

The face is made of layers: the skin, the fat beneath it, and beneath that the SMAS, a sheet of muscle and connective tissue that a facelift tightens. Sagging develops in several of these layers at the same time.

Focused ultrasound creates small points of heat at a set depth and leaves the skin surface and upper dermis in between untouched (Fabi 2015, PMID 25709486). Monopolar radiofrequency spreads heat fairly evenly through the deep dermis and the upper fat, which makes collagen contract and then regenerate (el-Domyati 2011, PMID 21315951; Suh 2020, PMID 32319176).

Take the three devices our clinic uses. Ultherapy Prime, a focused ultrasound device, mainly reaches the fat and the SMAS. Sofwave is also ultrasound, but it heats the middle of the dermis. Thermage FLX is similar to Sofwave but aims a little deeper in the dermis. All three are sold as skin tightening devices, and they reach different depths and different tissues. For how Sofwave works, see How Sofwave tightens skin: parallel ultrasound heat at 1.5 mm. For how Thermage FLX works, see How Thermage FLX tightens skin: broad heat below a cooled surface. For how Ultherapy PRIME differs from the original, see Ultherapy PRIME vs. the original: a new console, the same ultrasound.

So what they can improve differs too

If the problem is the deeper layers coming down, you need a device that reaches that deep. If the problem is loss of firmness and fine lines in the dermis, a device that treats the dermis is the right one. The answer changes with the change you want.

If the skin and soft tissue have sagged a long way, surgery may suit you better than any device (Fabi 2015, PMID 25709486).

Turn the question around

So the first question is not which device is good, but what change you want. Once that is settled, the method follows. That is the order we work through at a consultation.

References

1. Fabi SG (2015). Noninvasive skin tightening: focus on new ultrasound techniques. Clin Cosmet Investig Dermatol. PMID 25709486 (opens in new window).
2. Suh DH, et al. (2020). Monopolar radiofrequency treatment for facial laxity: histometric analysis. J Cosmet Dermatol. PMID 32319176 (opens in new window).
3. el-Domyati M, et al. (2011). Radiofrequency facial rejuvenation: evidence-based effect. J Am Acad Dermatol. PMID 21315951 (opens in new window).