Thermage vs Ultherapy: Which Tightens Skin Better?
Neither clearly wins on current evidence. The only head-to-head trial found (20 people, split-face, 6 months) compared monopolar radiofrequency, the category Thermage belongs to, with microfocused ultrasound, the category Ultherapy belongs to. Both improved laxity and the trial found no statistically significant difference. That study is small, so a real difference can’t be ruled out. Results vary; consult a qualified provider.
What’s the difference between the two technologies?
Thermage (made by Solta Medical) is monopolar radiofrequency: electrical current heats the skin’s deeper layers, which is thought to contract existing collagen and prompt new collagen over the following weeks (see Collagen Denaturation). Ultherapy is the best-known brand of microfocused ultrasound with visualization (MFU-V), which delivers focused ultrasound energy while the clinician views the tissue on an ultrasound image. The systematic review used below calls the device “the Ulthera system” and does not use the brand name, so the brand-to-category match here is ours, not the review’s.
Has anyone compared them head to head?
Once, as far as this site’s sourcing shows. Alhaddad et al. (2019) treated 20 people with mild to moderate laxity using monopolar RF on one side of the face and MFU-V on the other, with an evaluator who didn’t know which side was which. Both sides improved on a standard laxity scale from day 30 through day 180, and the authors report no statistically significant difference between the sides in laxity scores, patient satisfaction, or adverse events. We could read only the abstract: the funding and author disclosures were not visible, and the study did not name brands, so it is evidence about the technologies and not a brand test.
What does the evidence show for each?
| Radiofrequency (Thermage-type) | Microfocused ultrasound (Ultherapy-type) | |
|---|---|---|
| Strongest evidence sourced | A 6-patient biopsy study showing more collagen and 70–75% tightening improvement at 3 months (El-Domyati 2011); a 15-study review (1,230 patients) with an industry conflict of interest (Kumar 2025) | A systematic review of 16 studies (Contini 2023) |
| Measured lift | Not measured in millimetres in the sources here | Brow lift about 0.5–1.7 mm at 90 days; 1.2 mm at 6 months in one study |
| Rated improvement | Texture improvement in 71–100% of patients (Kumar 2025, COI) | 92% of patients showed some improvement per investigators, but 47% mild and 36% moderate (day 90) |
| Pain | Not quantified in the sources here | Average about 3.8 out of 10 even with pain relief |
| Safety | 2.7% temporary side effects in 600+ treatments, none permanent (Weiss 2006; early-generation device); rare tip-failure burns | Redness nearly universal; about 2% less common effects such as bruising, numbness, burns |
| FDA | Thermage FLX cleared as K170758 (September 2017) | Not sourced on this site |
Who might respond less well?
The ultrasound review notes that excessive laxity and a BMI over 30 appear to reduce efficacy, and several of its studies excluded such patients. Both approaches target mild-to-moderate laxity; neither source supports them as substitutes for surgery in significant sagging. See Loose Skin After Weight Loss (Including GLP-1): What Helps and What Needs Surgery for the weight-loss context.
What does each cost, and how long do results last?
No pricing was sourced for this page. The ultrasound review evaluated single treatments and says long-term follow-up is lacking; the RF studies here measured outcomes at around 3 months. How long results last is not established for either.
What’s still missing from the evidence
- A larger or independent head-to-head trial (the one trial found had 20 people and we could read only its abstract).
- Disclosures and funding for the head-to-head trial.
- Brand-specific data: the studies describe technology categories and, in the ultrasound review, the “Ulthera system” by name only.
- Cost, durability beyond about 6 months, and body (not face) applications.
FAQ
Is Thermage or Ultherapy better for sagging jowls? The sources here don’t separate jowls from other areas. The head-to-head trial assessed overall face and upper-neck laxity and found no significant difference between the technologies.
Which one hurts more? Not established here. The ultrasound review reports average pain of about 3.8 out of 10 even with pain relief; the head-to-head trial recorded pain, but we only saw its abstract, which reported no significant differences in adverse events.
Can I have both? This site has not sourced evidence on combining them. Ask a provider about their reasoning.
Does either replace a facelift? No source here supports that. Measured lifts were small, in the millimetre range for the ultrasound studies.
This page is educational, not medical advice. Results vary; consult a qualified, licensed provider.
Sources
Alhaddad M, Wu DC, Bolton J, Wilson MJ, Jones IT, Boen M, Goldman MP. “A Randomized, Split-Face, Evaluator-Blind Clinical Trial Comparing Monopolar Radiofrequency Versus Microfocused Ultrasound With Visualization for Lifting and Tightening of the Face and Upper Neck.” Dermatologic Surgery 45(1):131–139, 2019. doi:10.1097/DSS.0000000000001653. ⚠️ Abstract only.
Contini M, Hollander MHJ, Vissink A, Schepers RH, Jansma J, Schortinghuis J. “A Systematic Review of the Efficacy of Microfocused Ultrasound for Facial Skin Tightening.” Int J Environ Res Public Health 20(2):1522, 2023. doi:10.3390/ijerph20021522.
El-Domyati M, et al. “Radiofrequency facial rejuvenation: Evidence-based effect.” J Am Acad Dermatol 64(3):524-535, 2011.
Weiss RA, Weiss MA, Munavalli G, Beasley KL. J Drugs Dermatol 5(8):707-712, 2006.
FDA 510(k) K170758, Thermage FLX, cleared September 22, 2017.
Kumar N, Suh DH, Lee SJ, Ryu HJ. Aesthetic Surgery Journal Open Forum 7:ojaf159, 2025. ⚠️ industry COI.