Thermage vs Ultherapy, why people in their 30s and 40s

should choose differently

"They say I should get both Thermage and Ultherapy,

do I really need both?"

A lot of people ask that.

Today, I’ll walk you through the answer step by step.

Thermage and Ultherapy,

their names may seem similar, but in fact

Thermage uses RF (radiofrequency) energy to

warm the entire dermis

and induce collagen contraction.

Unlike Ultherapy, Thermage

works on a "plane".

In contrast, Ultherapy uses HIFU (high-intensity focused ultrasound)

to coagulate the SMAS layer at a depth of 4.5 mm

as if piercing it with a "point".

They’re both in the anti-aging category,

but the layer they target and the way they work are completely different.

Why is it Thermage for some people with sagging,

and Ultherapy for others?

Director Wi Young-jin’s

key insight

Thermage heats the entire dermis with RF heat,

and Ultherapy uses HIFU ultrasound

to target the 4.5 mm fascia layer point by point.

For people in their 30s who have lost skin elasticity, Thermage,

and for people in their 40s whose sagging has started,

Ultherapy takes priority.

This may surprise you a little.

Last week, a 53-year-old client

came in saying, "I want the full 1,500-shot Thermage."

But after touching the face and looking at the photos,

it was clearly visible that the fat had sagged downward

from below the cheekbones to the corners of the mouth.

In cases like this, no matter how many Thermage shots you do,

the results won’t be very good.

So I recommended Ultherapy first.

That’s because Thermage targets the dermis, the inner layer of the skin,

heating the 1.5~3.0 mm depth over a wide area,

which makes it strong for improving the skin’s own elasticity.

But if the SMAS layer (fascia) has already started to sag,

the foundation is collapsing, so tightening only the dermis

can only have a limited effect.

Ultherapy, on the other hand, uses a 4.5 mm cartridge

to directly coagulate the fascia,

so it’s better for lifting sagging itself.

However, because it doesn’t heat the entire dermis as a plane,

improvements in skin texture and fine wrinkles

may be a bit weaker than with Thermage.

Adding InMode to the comparison makes it even easier.

InMode is strong for local areas, such as submental fat

or defining the line of a double chin.

In other words, Thermage handles overall plane-wide elasticity,

Ultherapy handles fascia sagging,

and InMode handles localized lines and contours.

Director Wi Young-jin’s key summary

Thermage is specialized for a feeling that "the skin itself has loosened,"

while Ultherapy is specialized for a feeling that "the face is sliding downward."

You need to honestly identify which one applies to you

to make the treatment choice easier.

Who Thermage is right for

vs. who Ultherapy is right for,

it comes down to depth

A recent 45-year-old client had little sagging, but

as the skin became thinner, fine wrinkles stood out,

so I recommended Thermage before Ultherapy.

In the end, it’s not age, but whether your face has

a "plane" problem or a "point (sagging)" problem

that becomes the most important criterion.

The three questions I get most often in the exam room,

let me answer honestly

Q1. They say it works better if you get both,

can I get them on the same day?

A. To put it simply, I don’t recommend it.

You need to give the skin enough time

to recover from the heat energy.

Usually, we first lift sagging with Ultherapy,

then apply elasticity with Thermage 4 to 6 weeks later.

That sequence is the most ideal.

Q2. How long does the effect last?

Do I need it every year?

A. Both generally last about 12 to 18 months.

However, it’s less about the effect “disappearing”

and more about slowing the pace of aging.

I usually recommend full treatment every other year,

with lighter maintenance treatments in between

as a combined approach.

Q3. Are there any side effects or precautions?

A. Ultherapy can cause temporary sensory dullness,

and Thermage may rarely cause fat atrophy

if the output is excessively high.

So rather than blindly increasing the number of shots,

precise design based on your skin thickness

is essential.

If you take just one thing away today,

— choose the treatment not by age, but by whether it’s a plane or a point.

In the next article,

I’ll show specific cases of the

results depending on the interval between Ultherapy and Thermage treatments.

This was Wi Young-jin.

Read more

• Ultherapy 300-shot effect, just on the cheekbones [Seoul National University specialist]

• Ultherapy for the cheekbones: does it work only if you treat the whole face?

• "Thermage has no effect?" An honest lifting story from the clinic - Hongdae Thermage

Frequently asked questions

Q. I heard that getting both is more effective, but can I get them on the same day?

A. To get straight to the point, I don’t recommend it. You need to give your skin enough time to recover from the heat.

Q. How long does the effect last? Do I need to get it every year?

A. Both are maintained for an average of 12 to 18 months.

Q. Are there any side effects or precautions?

A. Ultherapy may cause temporary numbness, and Thermage may rarely cause fat atrophy when used with excessive output.

Q. When choosing between Thermage and Ultherapy, is there a standard I can use to decide on my own?

A. Don't just think about your age—look at whether you need to treat an 'area' or a 'spot.' If your skin feels loose and lacks elasticity, Thermaqe is your go-to treatment, as it warms the dermis over a wide area. If your skin feels saggy and droopy, Ulthera should be your first choice, targetting the 4.5mm deep SMAS layer spot-by-spot.