Anxious about going ‘under the knife’?

July 11, 2013 by
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Sagging facial features are a common reason people see their dermatologic surgeons. Some of these patients, however, aren’t ready to go “under the knife” or have anxiety about needles or anesthesia. Other patients have medical concerns or take medications that preclude them from having surgery.

Those patients may want to consider a non-invasive technology such as Ultherapy, which exists to help tighten facial tissues.Ultherapy1

Ultherapy first received FDA clearance to lift facial tissue in 2009. It involves deeply penetrating, focused ultrasound energy that heats the deep tissue, causing immediate contraction of the connective tissue layer. This induces collagen production that can last for months after the procedure.

Ultherapy is not considered to cause down-time as there is no wounding of the surface of the skin. Microscopic swelling that distends the facial skin, smoothens some lines and lifts the skin can occur immediately after treatment, but this quickly diminishes. The real effect is just beginning as the stimulated fibroblasts start producing more collagen in the dermis – the supporting layer below the epidermis.

Even though Ultherapy has a very high patient satisfaction rating, it is not expected to provide nearly as much lifting as a surgical facelift. It is more of a global re-contouring and rejuvenation procedure. The slight contraction of each small area adds up cumulatively across the face, often providing a refreshed appearance.

While slight swelling that may last a few days has been reported occasionally, it’s rare. Small welts have been noted after the procedure, but these typically resolve spontaneously in a few hours. Since bruising has been reported infrequently, it wouldn’t be prudent to have this procedure immediately prior to a big social function.

There also could be temporary skin or nerve sensitivity, but this resolves within several days to a few weeks. On very rare occasions, nerve irritation has caused asymmetry in facial expression, but these cases typically resolve over time without treatment. Because Ultherapy generates heat in the deep dermal tissues that can be painful, many providers prescribe pain medication for their patients to be taken prior to the procedure.

Many people ask how long the effects of the procedure last. While the amount of surgical facial lifting decreases as the patient ages, the improved skin tone resulting from Ultherapy is not thought to disappear. These procedures, which allow us to stay ahead of the aesthetic aging curve, may be repeated six to 12 months later. As always, though, patients should discuss the treatment thoroughly with their physicians before undergoing any therapy.

Other non-invasive technologies such as Pelleve and Thermage also might be non-surgical answers to help you tighten those facial tissues. Thermage, one of the first radiofrequency devices designed to tighten tissue, is used by many physicians for facial treatment. It has similar, albeit rare, risks like Ultherapy. Meanwhile, Pelleve is a more comfortable treatment, delivered as a series of three or four treatments every three weeks or so.


Ron M. Shelton, MD, is a board-certified dermatologist and a member of the American Society for Dermatologic Surgery. Dr. Shelton served as the Chief of the Dermatology Service at Langley Air Force Base Hospital and studied cosmetic dermatologic and Mohs micrographic surgery at the University of California, San Francisco. In 1993, he created the Division of Dermatologic Surgery at the Mount Sinai Medical Center in New York City and served as its first director. Dr. Shelton entered private practice in 1998 and co-founded The New York Aesthetic Consultants, LLP, a premier cosmetic dermatologic and plastic surgery facility in NYC. Visit his website:

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