As Facebook ads for non-surgical facelifts abound, it can be hard to discern the efficacy of injectibles, thread lifts to HiFU—especially where seductive promotional rates are concerned. Yet not all face sculpting treatments are created equal, and in determining the right face lifting programme for you, one needs to take into account your own budget, downtime, after-care maintenance and more. One treatment that stands head and shoulders above them is Ultherapy, a non-invasive ultrasound treatment that harnesses the body’s own regenerative response to gradually lift skin on the eyebrows, under the chin and on the neck, while smoothing lines and wrinkles on the décolletage.
Ultherapy first hit Singapore in 2009 and remains the only non-invasive treatment that is cleared by the US Food and Drug Administration (FDA), to lift the skin on the neck, under the chin, and on the brow, as well as to improve the appearance of lines and wrinkles on the décolleté, say Merz Aesthetics.
What is Ultherapy?
Ultherapy delivers microfocused ultrasound energy directly into the specific layers of the skin to stimulate collagen production for a lifted and tighter face. Through proprietary real-time ultrasound imaging, Ultherapy-trained doctors directly see target tissue layers in real time, enabling them to direct the energy to where it’s most beneficial—be it around a sagging cheek area or lax neck area. “When we’re young, healthy collagen resists the forces of gravity but with ageing, the skin stretches and sags downwards partly because of collagen loss,” shares Dr Sylvia Ramirez of Cutis Medical Clinics.
“We also have loss of volume which includes loss of fat, muscle and bone. Skin quality also changes and our muscles create pulls that can aggravate sagging. All of these factors contribute to the appearance of ageing, the degree to which varies from person to person,” says Dr Ramirez.
Ultherapy targets the first of these factors, precisely focused ultrasound waves lead to collagen formation in various layers of our facial tissues. Skin and underlying fibrous tissue (known as SMAS or superficial muscular aponeurotic system, an important structure that connects the skin to deeper tissues) can be treated resulting in collagen building and lifting,” says Dr Ramirez, who likens Ultherapy as a means of depositing collagen in to the skin’s bank. “Like depositing money, we don’t want to keep withdrawing then become ‘bankrupt’.
“By the age of 40, we are breaking down more collagen that we are creating. We need to deposit back that collagen to prevent laxity and other changes that occur rapidly as we age. Very few procedures can do this—not even surgery, and Ulthera is one of the leading treatments that does this as shown in clinical studies.”
What are the benefits of Ultherapy?
Ultherapy remains the only US FDA-cleared non-invasive ultrasound procedure to naturally lift and tighten skin on the neck, brow, and under the chin. There have been over 1.75 million Ultherapy treatments performed worldwide with results supported by numerous peer reviewed studies in major medical journals and clinical trials.”Studies show over 70 per cent of patients note a visible improvement in skin laxity and marked improvement in collagen stores with Ultherapy,” says Dr Ramirez. Ultherapy is most effective for those with mild to moderate skin laxity or those looking to firm and tighten areas of the face that may appear to be saggy, with common spots being a lowered eyebrow line, loose or crepey skin under the chin and neck, or wrinkles in the upper chest area.
Is Ultherapy as good as a facelift? And can it replace Botox or fillers?
In short: No. While it treats the deep, foundational layer or SMAS layer of the skin, which is also addressed in cosmetic surgery, it would be unrealistic to expect as dramatic results as a facelift. It is however, great for those looking for a gradual, natural looking lift. While Ultherapy treatments can lift and tighten mild to moderate skin laxity, it is unable to duplicate the results of a surgical patients especially in patients with severe laxity. “Also, Ultherapy cannot replace lost volume which would be the job of facial fillers, nor eliminate excess fat and destroy fat cells.” For this reason, CoolSculpting may be a good option. “It is, however, a good alternative if you’re not ready or willing to go under the knife. Ultherapy can also be used to extend the effects of a surgical procedure since surgery does not improve skin quality.”
How long before I see the results of Ultherapy?
It’s not an overnight solution: expect gradual results with improvements appearing within two to three months of treatment, which is when the process of neocollagenesis or “the period when the new collagen begins to lift and tighten the skin” takes place. Further improvements can be seen up to six months after the treatment. As collagen is produced on the inside, it’s important to remember that your natural ageing process also dictates how long that translates to visible results on the outside.
How often should I do Ultherapy?
Most patients need only one treatment every 12 to 18 months. This however, according to Dr Ramirez, is based on the degree of skin laxity, the biological response to ultrasound energy and the individual’s collagen-building process, some patients may benefit from additional treatments. Because the skin continues to age, future touch-up treatments can help patients keep pace with the body’s natural ageing process.
“Published clinical studies of Ultherapy demonstrate that neocollagenesis continues up to a year after treatment,” says Dr Ramirez. “Nevertheless, we generally suggest multiple treatments within a year for older patients who need more tightening and collagen building. Multiple treatments may also be recommended for post-menopausal patients who have not done prior treatments in the past as menopause is a sentinel’ event, which triggers acceleration of our ageing curves.”
Is Ultherapy painful?
When it comes to Ultherapy, the adage of ‘no pain, no gain’ rings somewhat true. Comfort levels vary from person to person, but the heating sensation only lasts while the ultrasound energy is being delivered, and is an indication that the procedure is working. While there may be a significant degree of discomfort for some, Dr Ramirez’s unsurpassed warmth and bedside manner of the nursing team mean they’ll work diligently at icing and applying several layers of numbing cream before the procedure, as well as implementing comfort measures such as using a cold ultrasound gel, sensory distraction with vibrational tools and blowing cool air to help anxious patients get the support they need during the Ultherapy session.
How does Ultherapy differ from lasers and radiofrequency?
While Ultherapy bypasses the skin’s surface to stimulate collagen production deep in the skin for a lifted and tightened countenance, lasers use light energy which superficially treats the skin and unlike Ultherapy, are not FDA-cleared to lift the skin. Ultherapy targets three specific depths in the skin without affecting intervening tissue layers while radiofrequency ‘bulk heats’ the skin, with the highest amount of heat deposited at the skin’s surface and less so into the deeper layers, according to Merz Aesthetics.
“Ultherapy, unlike other HIFU treatments, has dozens of clinical studies in both Asians and Caucasians demonstrating clear benefits to skin tightening,” says Dr Ramirez. “Another critical element that sets Ultherapy apart from other HIFU devices is that it is the only one that uses real-time visualisation to allow us to target the right layers in the skin. There is no ‘one size fits all’ with Ultherapy. Sometimes, the SMAS layer, or the layer that holds the skin in place is shallow. The treatment for such a patient will need to be different because a ‘standard’ protocol will be too deep, potentially increasing risk without maximising collagen building. The imaging with Ultherapy, which is missing with HIFU enables physicians to identify collagen building layers for each person and hence, perform a more precise and highly personalised treatment.”
As HIFU doesn’t offer real-time imaging, there’s always the “risk of targeting non-collagen building layers of the skin. There is also no evidence that other HIFU machines can consistently heat and target these essential layers for neocollagenesis to happen.”And finally, another fundamental difference is the temperature of the ultrasound system. “We know that Ultherapy is able to consistently heat tissues to 65-70 degree Celcius, which is the optimal temperature for collagen building. This has not been tested with HIFU. Too low, and the result is suboptimal, too high and the risk of complications such as burns increases.”
Simply put, unlike Ultherapy, “HIFU does not have this track record for safety and effectiveness. Ultherapy has also received the European CE mark for non-invasive dermatological sculpting and lifting of the upper and lower face, neck, and décolletage.”
Do the results of Ultherapy vary amongst Asian and Caucasian skin?
Dr Ramirez who regularly sees a mix of both Asian and Caucasian patients in her practice, says: “Caucasians on average have greater skin wrinkling and loss of volume, this is because the skin is thinner and facial volume is typically less than among Asians, as shown in clinical studies. Asians may have thicker skin with higher sebum content, a greater volume of buccal fat, so that ageing may present more as a gradual descent of the tissues on our faces. Because of these differences, it is plausible that Caucasians, given the finer skin, may have greater visible lifting effects of Ultherapy. I should note that these differences have not been studied but this may be a theoretical difference across our patients. Regardless, collagen building will be of benefit in all of us given the inevitable collagen loss from environmental, ageing and hormonal changes of time.”
Why is it crucial to find the right doctor or Ultherapy provider?
“Because it is important to target the correct layer in order to maximise results while minimising complications, have the treatment with a doctor who does Ultherapy procedures regularly,” cautions Dr Ramirez. “This is technique dependent, how you apply the device, the depth of the treatment and the number of pulses or ‘lines’ makes a difference. In a full face and neck treatment, there are typically over 16,000 coagulation points or points where collagen is being built. Ask about the number of lines that the doctor will administer you will be getting. All clinical studies are based on a certain number of lines to ensure an effective treatment result.”
In your search for an Ultherapy provider, look for a licensed doctor in an Ultherapy-certified clinic. Ensure the doctor and their team take their time in addressing your concerns prior to treatment, and remember that you do get what you pay for: “Suspicions should also be aroused when patients encounter Ultherapy treatments that are too cheap, or when expensive packages get pushed to you,” recommends a spokesperson at Merz Aesthetics. “Ultherapy shows consistent and reproducible results, and does not need patients to commit to a course of treatments. If they are too cheap, patients need to ask about the number of lines they are receiving. A standard full face Ultherapy treatment should entail at least 500 to 800 lines.”
How else can we prevent collagen loss?
Collagen production starts to decline at around 25 years of age and lots of creams on the market promise younger skin but in truth we know topicals can only do so much with ageing.
“It is important to note that combination treatments are more effective than individual treatments as ageing is not only due to collagen loss. The best and most natural results for rejuvenation and to combat ageing changes require a combination of skin quality treatments, collagen building treatments, and dermal fillers. Reducing negative vectors or downward pulling of muscles also needs to be minimised with the use of botulinum toxin,” says Dr Ramirez.
“Apart from regular diet and exercise, it is also important to use skincare products with vitamin C, which helps to fight signs of ageing. Importantly here in Singapore, be sure to always use a sunscreen with broad spectrum to avoid premature skin ageing and sun damage. “Oral collagen supplements can also be considered. While collagen’s effectiveness as a supplement is still uncertain, there are early evidence to suggest its benefits. Studies suggest that those who took collagen supplements experienced improvements in skin hydration, elasticity, and better dermal collagen density. Just be sure to be diligent about product control and choose a brand that provides your collagen of interest.
“There are also other nonsurgical aesthetic procedures to keep the skin firm and more youthful. Infrared or Radio Frequency treatments also promote collagen production on a more superficial level to improve fine lines and mild laxity.”