Ultherapy vs Thermage: focused ultrasound or radiofrequency
Medically reviewed by Dr Sin Yong · Last reviewed · 8 min read
Published 9 October 2026 · Reviewed by Dr Sin Yong
Ultherapy and Thermage are the two most widely discussed non-surgical tightening treatments, and they work in different ways. Ultherapy focuses ultrasound energy into small points at set depths, down to the muscle-and-fascia layer, while watching on an ultrasound image. Thermage heats the deeper dermis in bulk with monopolar radiofrequency. Two randomised trials have compared them directly.
Short answerUltherapy uses microfocused ultrasound with visualisation to heat points at about 1.5, 3.0 and 4.5 mm; Thermage uses monopolar radiofrequency at 6.78 MHz to heat the dermis broadly. In two small randomised split-face or comparative trials, both improved laxity with no significant difference between them; in one, ultrasound was more painful. Which suits you depends on where the laxity sits and how much facial fat you have.
Ultherapy focuses ultrasound energy into tiny points beneath the skin, the way a magnifying glass focuses light, at depths chosen by the transducer: about 4.5 mm for the muscle-and-fascia layer, 3.0 mm for the deep dermis and 1.5 mm for the superficial dermis. An image on screen helps the operator see the layers. Thermage passes radiofrequency current through the skin to a return pad, heating the deeper dermis and its fibrous septa broadly while cryogen cools the surface. Focused points against a broad field is the core distinction.
Focused ultrasound places heat in points at set depths; monopolar radiofrequency heats the dermis broadly.
What do head-to-head trials show?
In a randomised split-face trial of 20 patients followed for six months, monopolar radiofrequency and microfocused ultrasound both improved laxity with no significant difference between them (Alhaddad, Dermatol Surg 2019). In a trial of 20 patients treated on the neck, results were again not significantly different, and ultrasound was more painful (Jones, Dermatol Surg 2017). Across 42 studies of microfocused ultrasound, 89% reported investigator-assessed improvement, with mean pain of 4.85 out of 10 (Amiri, Aesthet Surg J 2025); in an earlier lower-face study, outcomes were weaker in patients with a body-mass index above 30 (Oni, Aesthet Surg J 2014).
Where the laxity sits, and how much facial fat there is, decide the tool.
Thermage vs Ultherapy: a verdict by situation
Thermage vs Ultherapy comes down to which layer has loosened. Ultherapy places focused ultrasound at set depths down to the SMAS, with imaging, so it suits laxity that sits deeper along the jaw, under the chin and at the brow. Thermage FLX heats the deeper dermis broadly with monopolar radiofrequency, so it suits crepey skin and early softening of the skin envelope, including the eyelids with its eye tip. Dr Sin Yong performs both Ultherapy Prime and Thermage FLX himself, and the assessment decides which one, both, or neither fits.
Your situation
Usually leans to
Why
Early jowling, a softening jawline, laxity under the chin or on the neck
Broad dermal heating suits skin quality more than deep laxity
Crepey eyelid skin with a reasonable brow position
Thermage FLX eye tip
A dedicated small tip with shields; heat does not raise a low brow
Laxity at two depths: deep jawline plus crepey skin above it
Sometimes both, as separate steps
They act on different layers; order and spacing are set at assessment
Lean or hollow face
Usually neither
Heat into fat that is not the target can hollow the face; the VF Lift on Volnewmer is considered instead
Puffy or heavier lower face
Usually neither as the main step
Fullness is a fat question; Time Freeze Laser LCLR® is generally used
Heavy jowls with redundant skin
Neither
Beyond energy devices; referred for a surgical opinion
Two small randomised trials found no significant difference between the two for laxity overall, which is why the decision is made on anatomy rather than on reputation. Comfort differs: focused ultrasound is felt as brief, deep heat that is most noticeable over bone, and radiofrequency as heat pulses with cooling bursts. Recovery for both is usually redness and tenderness that settle, with swelling more likely after eye treatment. The Thermage suitability and HIFU suitability guides set out who should wait for each.
Comfort, recovery and risks after Ultherapy or Thermage
Both treatments are usually done without an anaesthetic injection. Ultherapy pulses are felt as deep, brief heat and are more noticeable over bone. Thermage pulses are felt as heat followed by a cooling burst. Redness after either usually settles quickly. After Ultherapy, tenderness on chewing or touch, mild swelling and occasionally small bruises or temporary numbness are recognised, and they are reviewed if they persist.
Uncommon risks for both include:
Burns where energy concentrates at the surface.
Small depressions from fat loss when heat reaches fat that should have been spared, which is why a lean face is planned more conservatively.
Temporary nerve weakness, rarely, after deep ultrasound lines.
These are the reasons the energy, the depth and the number of lines are set by the doctor for each zone rather than by a standard package. The fuller lists are on the Ultherapy side effects and Thermage side effects pages. A blister, a new dent over the cheek, temple or jaw, numbness that does not settle, or any change in facial movement should be reported the same day, wherever the treatment was done; the complication care page explains which signs need a doctor the same day.
Volnewmer by CLASSYS is also monopolar radiofrequency at 6.78 MHz, with continuous water cooling rather than cryogen spray. It is the platform behind the VF Lift – Vertical Facelift protocol, and it is not focused ultrasound. How the two radiofrequency platforms differ is set out in Thermage FLX vs Volnewmer.
Who suits which?
Where laxity sits deeper, along the jawline and under the chin, focused ultrasound reaches the deeper layer directly. Where the concern is skin quality and fine crêpiness, broad dermal heating is often the better fit. In lean or hollow faces, heat placed into fat that is not the target can make the face look more hollow; hollowing after Ultherapy, HIFU or Thermage is a recognised risk, which is why Dr Sin Yong does not prefer HIFU-type treatments for lean patients and uses the VF Lift – Vertical Facelift on Volnewmer instead. For puffier or heavier faces, he generally uses Time Freeze Laser LCLR®. His fuller comparison is on Ultherapy vs VF Lift vs Time Freeze.
“The question is not ultrasound or radiofrequency. It is where the laxity sits, and how much fat the face can afford to lose.”
Both are monopolar radiofrequency at 6.78 MHz, so the energy is the same kind. They differ in the cooling system and the treatment tips. Volnewmer is the platform behind the VF Lift – Vertical Facelift protocol. Which suits you depends on the zones and the tissue, and that is decided at assessment.
Sometimes, because they treat different layers: Ultherapy reaches the SMAS and deep dermis at set depths, while Thermage heats the dermis broadly. Whether to combine them, in what order and how far apart is decided at assessment. In a lean face, adding more heat is not the answer, and a different route such as the VF Lift on Volnewmer radiofrequency may be proposed instead.
Neither is better for every neck. Where the laxity is in the platysma and the tissue under the chin, Ultherapy reaches that layer directly and was cleared for lifting lax neck and submental tissue. Where the concern is crepey skin quality, Thermage FLX broad dermal heating may suit better. Fat under the chin is a separate problem that neither device is designed to reduce.
No honest answer applies to everyone. Both work by heating collagen so the body remodels it, and that change develops gradually and then fades at a pace set by age, skin quality, weight change and sun exposure. The two head-to-head trials found no significant difference in laxity improvement. Whether and when to repeat either is decided at review, not promised in advance.
Neither has been shown to be better overall. Two small randomised trials comparing microfocused ultrasound with monopolar radiofrequency found no significant difference in laxity improvement; in one, ultrasound was more painful.
In a neck trial, microfocused ultrasound was more painful than monopolar radiofrequency. Comfort varies with settings, area and the individual.
Hollowing after Ultherapy, HIFU or Thermage is a recognised risk, particularly in lean faces where heat reaches fat that is not the target. This is why the plan depends on how much facial fat you have.
Yes. Dr Sin Yong performs Ultherapy Prime and Thermage FLX personally. He also uses the VF Lift – Vertical Facelift on Volnewmer for lean or hollow faces and Time Freeze Laser LCLR® for puffier faces, and the assessment decides which fits.
References
US FDA 510(k) K260618 — Ulthera System (Merz), 2026: indicated to lift the eyebrow, lift lax submental and neck tissue, improve lines and wrinkles of the décolleté, and improve skin laxity on the abdomen, arms and knees. source
US FDA 510(k) summary K170758 — Thermage FLX (Solta Medical), 2017: 6.78 MHz; indications include non-invasive treatment of wrinkles and periorbital wrinkles. source
Alhaddad M, et al. Randomised split-face comparison of monopolar radiofrequency and microfocused ultrasound with visualisation for laxity (n=20). Dermatol Surg. 2019;45(1):131-139. doi:10.1097/DSS.0000000000001653. source
Jones IT, et al. Subsurface monopolar radiofrequency versus microfocused ultrasound with visualisation for neck laxity (n=20). Dermatol Surg. 2017;43(12):1441-1447. doi:10.1097/DSS.0000000000001216. source
Amiri M, et al. Microfocused ultrasound with visualization (MFU-V) effectiveness and safety: a systematic review and meta-analysis. Aesthet Surg J. 2025;45(3):NP86-NP94. doi:10.1093/asj/sjae228. source
Oni G, et al. Evaluation of microfocused ultrasound with visualisation for lower-face laxity (n=93 evaluated). Aesthet Surg J. 2014;34(7):1099-1110. doi:10.1177/1090820X14541956. source
