Skin-Tightening

I Tried Ultherapy to Fight Sagging and Look Less Tired — This is My Honest Review

ultherapy facial treatment

I’m one of those people that, despite having access to the best brightening eye creams and shadow-reducing concealers Sephora® has to offer, manages to look perpetually exhausted on a daily basis. Nothing squashes your confidence more than someone looking at you with concern in their eyes and asking the dreaded, “Are you OK? You look tired.” 

As I hit my mid-thirties and my skin slowly started to lose its natural tautness, that tired appearance joined forces with the first hints of sagging for a double whammy. While that downward skin migration is an inevitable part of aging, it made someone like myself — who has naturally deep-set, downturned eyes — look long overdue for a power nap . . . or 20. Topical treatments weren’t going to cut it — it was time for a dermatological intervention. 

Which brought me into the office of board-certified Manhattan derm, Patricia Wexler, MD. I had done my research and knew there were quite a few devices on the market to choose from, ranging from resurfacing lasers to radiofrequency and microneedling. When I asked Dr. Wexler which would work best to stop my specific slow crawl towards saggy city, she answered with zero hesitation: “Ultherapy®.” In fact, she went so far as to call it “the gold standard” of non-surgical lifting and skin tightening devices. 

Editor's Note

As always, talk to your doctor before starting any new treatment.

Ultherapy is a device that uses micro-focused ultrasound, a type of heat energy, to penetrate the layers of the skin for multi-level benefits. There are two treatment tips to address different skin depths — a superficial one that helps stimulate collagen production and smooth skin’s surface, and a more concentrated tip that reaches the deep dermis layer and all the way down to the fascia (the fibrous tissue surrounding the muscles of the face). By targeting and tightening that tissue, Ultherapy is able to also provide a lifting effect — it gives the benefits of a facelift, but as an alternative to surgery.

“It’s a two-phase treatment,” Dr. Wexler explains. “People [may start to] see improvements after two weeks from the fascia getting tightened — something I call the shrink-wrap effect — but then there’s three- to five-month improvement where your collagen is being remodeled.” As we get older, our collagen loses its structure, which leads to wrinkles and sagging. With Ultherapy, “microscopically, we see organization in new strands of collagen and elastin tissue, making it more structured and firmer,” she says.

Now, you might be asking yourself: What the heck is a 36-year-old doing getting a treatment that’s billed as a facelift alternative? (Fair enough.) According to Dr. Wexler, Ultherapy can be both preventative and reparative. “When you are doing it in your thirties, you are doing it to prevent skin from laxity,” she says. “When you are doing it in your forties and up, you are doing it to recover from the existing laxity.” Adds her husband, Gene Wexler, MD, “The younger you are, the better Ultherapy works — younger cells stimulate the new collagen production much better. In an older person, we always tell them that although it can be an effective treatment, it might take more than one treatment.” That said, he does note that he has treated patients in their seventies who have still seen improvements. One key factor as to how much of a tightening effect you are going to see, says Dr. Wexler, is the amount of sun exposure your skin has. She notes that those who have significant sun damage will most likely not see the same level of results with Ultherapy.

After my chat with the doctors Wexler, I left the office with an appointment for the following week and conviction that Ultherapy was the tightening treatment for me. When I excitedly mentioned to some industry friends that I was going to have it done, the topic immediately turned to pain. Every person I spoke to had heard from someone or read something about how excruciatingly painful Ultherapy is. Uh-oh.

I am not someone with a high tolerance for pain, so to say I went into Dr. Gene’s treatment room nervous is the understatement of the year. As he came into the room and the machine booted up, I started stammering about how much it would hurt. “Ultherapy is variably mildly uncomfortable,” said Dr. Gene. “Some people sleep through it, some people have areas where it’s more uncomfortable than others.” I strongly suspected I wouldn’t be the sleeping type.

When I arrived at the office, a topical numbing cream was applied. I then waited (with growing dread) for it to kick in before Dr. Gene got to work. Ultrasound gel was also slicked all over my face to form a barrier to transmit the ultrasound energy into my skin.

Editor's Note

As always, talk to your doctor before starting any new medication.

The Ultherapy treatment is done section by section, starting at the jawline with the deep tip, followed immediately by the superficial tip, before moving on to the next area. However, the deep tip is only used on the cheeks and neck, as the rest of the face doesn’t have enough muscle to warrant it; my forehead and orbital area were only done using the superficial tip. 

I have tried a lot of different non-invasive treatments in my day — from a microneedle radiofrequency facial to laser hair removal — and, in my opinion, this by far was the least painful of the bunch. That’s right: Ultherapy was actually less intense than having my bikini line zapped into oblivion. For each area that the applicator touched, my skin began to feel warm and got progressively hotter. Just before that heat became unbearable, the applicator was removed and placed on the next section. It was kind of like sitting in direct sunlight on a hot summer day. Not pleasant, but tolerable for a short period of time. The deep tip felt a bit achy, while the shallow tip had a bit of a stinging sensation, but I’ve had chemical peels that were more painful. 

Editor's Note

Individual experiences may vary.

The entire treatment took about 30 minutes, and once Dr. Gene finished, I was put in front of a red light device for 45 seconds “for redness reduction and faster healing.” I left the office a little puffy and red, still feeling goofy from the pain meds. That night, after everything had worn off, my face felt warm and the areas that had been treated with the deep tip ached, but it was tolerable. I rinsed my face with some warm water, applied a mild cream, and headed to bed. The next morning, my skin was still a bit red, but the aching and warmth had faded. By day two, my skin was back to normal. And that was it — no special follow-up instructions or restrictions. I was back to my regularly scheduled skin routine on day two.

One of the more complicated parts of writing about treatments with long-term benefits like Ultherapy is that it’s very hard to “see” results. I look at my face every day in the mirror, so gradual changes over time don’t really register. Throughout this process, I didn’t have one particular moment where I thought, “Gee, my face does look tighter.” Thankfully, that’s what before and after photos are for. 

At my follow-up with Dr. Gene five months later, we snapped an identical shot of my face to compare to the pre-treatment photo. Looking at them side-by-side you can see the difference. My brows are higher, my eyes aren’t quite as shadowed, my jawline is more pronounced, and my laugh lines are softer. Fast forward to the eight-month mark (when I snapped this street selfie), and you can see those changes became even more pronounced. I look — for the first time in a very long time — well-rested.

In my case, Ultherapy was likely a one-and-done procedure for now. However, for some, it can be a treatment done every year or more, depending on the results you are trying to achieve. Dr. Gene also suggests boosting treatments for the brow area — a 10-minute session using just the superficial tip around the forehead and brow bone — for an extra lifting zhush. The minute my face starts looking the same when I get eight hours of sleep as it does after an all-nighter, you can bet I’ll be knocking at the good doctor’s door. 


Dr. Patricia Wexler is a paid Allergan® consultant.

Complimentary treatment was provided to the author for the purpose of writing this article.

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