Ultherapy or Thermage: how the two differ, and how the choice is made
Two non-surgical tightening treatments, often described as interchangeable. They use different energy, reach different depths, and suit different problems.
October 22, 2026
What does each one actually do?
Ultherapy uses focused ultrasound. The energy converges at set depths and leaves discrete points of coagulation, including in the SMAS — the layer a surgeon lifts in a facelift. The handpiece carries an imaging window, so the practitioner can see which layer is under the probe before each line is placed.
Thermage uses monopolar radiofrequency. Tissue resists the current and that resistance makes heat — not at one depth, but through the full thickness of the dermis and into the fibrous strands running down through the fat beneath it. The surface is cooled before, during and after each pulse, and every tip is loaded with a counted number of pulses.
The ending is the same for both: controlled heat injury, then months of repair. Neither removes tissue. Both are judged at three to six months rather than on the day, which is why the photographs taken before you leave matter more than the mirror on the way out.
Different energy
Focused ultrasound against monopolar radiofrequency. Not two brands of the same machine.
Different depth
Ultrasound places points at set depths including the SMAS. Radiofrequency heats a volume of tissue, more broadly and less deeply.
Different thing improved
Descent along the jaw and neck tends toward ultrasound; skin quality, crepiness and overall tightening tend toward radiofrequency.
The same patience
Both build as collagen repairs over months, and both are reviewed with standardised photographs rather than memory.
Which problem points to which?
In most consultations the answer follows from one question: is the complaint that tissue has dropped, or that skin has thinned and lost its texture? Descent points one way, surface quality the other. Where both are present, the assessment decides which to treat first rather than treating both at once.
- Skin & body
Ultherapy — when tissue has descended
Mild to moderate laxity of the jawline, brow or neck, in skin that still has elasticity. The energy reaches the layer a facelift addresses, which is why it is the one of the two that speaks to descent.
- Downtime
- None
- Typically lasts
- Commonly about a year, varying with age, skin quality and sun exposure
- Skin & body
Thermage — when skin quality is the complaint
Crepey texture, a loose overall feel, and areas where the problem is the skin rather than its support. Radiofrequency is not absorbed by pigment, so the settings do not have to be dialled back for darker skin.
- Downtime
- None
- Typically lasts
- Commonly one to two years, with the same caveats
- No treatment needed
Neither, for now
If the skin no longer retracts, no energy device changes that, and a surgical consultation is the more honest conversation. If the complaint is volume rather than laxity, tightening does not do what filling does.
This is a real outcome of the assessment and not a rhetorical device. Both devices are in the building; neither is the answer to everything.
Which one is appropriate — and whether either is — is decided by examination at the Lonsdale Avenue clinic in North Vancouver, not from a photograph. Current prices for each sit on their own pages and are read live from the clinic's booking system.
What actually decides it?
Six things, and the brochure is not one of them. These are the factors that change the recommendation in the room, which is also why the answer cannot be given reliably by email or over the phone.
- Whether the problem is descent or surface quality — the single question that separates the two most often
- How much elasticity the skin still has: neither device works on skin that has stopped retracting
- Where the laxity sits — jaw and neck behave differently from the midface, and the brow differently again
- Implanted electronic devices: a pacemaker, defibrillator or neurostimulator rules out radiofrequency outright, and metal in the treatment field does the same
- What has already been done — fillers, threads or neuromodulator in the area change the sequence and the interval
- How long you are willing to wait before judging: three to six months, or neither treatment is the right purchase
Questions we get about the two
The three asked most often, answered first: the difference is the energy and the depth, not the quality; neither hurts in a way most people need medication for; and the cost of each depends on the area and the number of lines or pulses it takes to cover it, which is why both are quoted after an assessment rather than from a list.
In one sentence, what is the difference?
Ultherapy places discrete points of heat at set depths, including the layer a surgeon lifts; Thermage heats a volume of tissue through the full thickness of the dermis, more broadly and less deeply. Descent tends toward the first, skin quality toward the second.
Which one hurts more?
They are uncomfortable in different ways. Ultherapy is a brief deep heat along each line, sharper over bone; Thermage is a brief deep heat with each pulse, spread over a wider area. Most people manage either without medication, and the setting is adjusted from what you report during the treatment, not from a default.
Why is one more expensive than the other?
Neither is priced as a session. Both are priced by the area treated and the number of lines or pulses it takes to cover it, so a jawline and a full face and neck are different figures on the same device. The current ranges are on the Ultherapy and Thermage pages, and you have an exact quote before anything begins.
What are the side effects of each?
Both: redness, mild swelling, tenderness and sometimes numbness or tingling for days to weeks. Ultherapy adds the possibility of temporary weakness or an uneven smile if energy reaches a nerve. Thermage adds the possibility of blistering or a burn where heat has been excessive. Both can cause loss of fat in the treated area, producing a hollow rather than a lift.
Can I have both?
Sometimes, and not on the same day. Where descent and skin quality are both part of the picture, they are sequenced with an interval rather than stacked, and the second is planned once the first has been reviewed.
How soon will I see something, and how long does it last?
Some tightening may be noticed early with either. The change that matters builds over three to six months as the heated tissue repairs. After that, Ultherapy commonly holds about a year and Thermage one to two, varying with age, skin quality and sun exposure. Your skin keeps ageing; neither treatment stops that.
I have had filler. Does that rule either out?
Usually not, but tell us what you have had and when. Heat can affect some products, so it becomes a question of sequence and interval. It needs to be known before the appointment rather than discovered during it.
Who is not a candidate for either?
Significant loose skin, where surgery is the honest answer; pregnancy or breastfeeding; open wounds or active infection in the area; and for radiofrequency specifically, any implanted electronic device or metal in the treatment field. An assessment that ends in "not this" is a normal outcome.