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Sagging skin affects everyone eventually. But if combated early, during a woman’s late 20s, 30s or 40s it’s much easier and less invasive to treat, says Beverly Hills, CA based board certified facial plastic surgeon, Sarmela Sunder, M.D. “When a woman hits her late twenties collagen production starts to decrease and continues nose diving into her 30s and 40s,” she says. This is when you start to see sagging eyelids, drooping brows, skin laxity around the jawline and descending cheeks. Decades ago the only two options were to either deal with it or go under the knife. Thankfully, the past decade has ushered in a new era of noninvasive anti-aging treatments including the industry’s current anti-aging darling – skin tightening laser, Ulthera, known as Ultherapy.


How does it work?
The ultrasound based technology, similar to ultrasounds done during pregnancy, but seriously amped up, works similarly to other lasers by harnessing the body’s natural healing mechanism. “The laser leaves little coagulation points that irritate under the skin and at the muscle layer with heat. Because of this irritation your body thinks there is an injury and tries to repair it by laying down new collagen. The new collagen creates a tightening and plumping effect,” explains Dr. Sunder, “But unlike typical lasers that burn or ablate the superficial layer of skin Ultherapy goes under the skin at 1.5, 3 and 4 millimeter levels and lays down the energy by-passing the top layer making it safe for darker skin tones predisposed to hyper or hypo pigmentation.”

Face, body, both?
“Ultherapy can be done on different sections of the face and the neck area. A lot of my patients in their 30s who see a brow droop or notice little lines around the eyes, may opt for just the forehead and around the eyes. While patients in their 40s, which is when you start seeing your jawline sag, want to do the upper face and jawline. You can also do it on the brow bone to lift the eye lid, or around the mouth. It depends on what the patient’s concerns are and what we are trying to accomplish,” says Dr. Sunder, “It also works great on the décolleté, arms, or above the knee where some people have sagging skin. Pretty much anywhere you are hoping to see skin and muscle tightening.” 

Results
Since the body is producing new collagen, results aren’t seen until around the three month mark and progress as time goes on lasting up to two years with accumulative effects if done yearly. While drastic improvements can be seen in women of all ages, Dr. Sunder says, “I definitely recommend it as a preventative tool for women in their 30s and 40s. When you are in your 30s and 40s your collagen response is much better than when you are in your 50s and 60s. You are almost guaranteed to have a better response than if you were to wait until you’re older when it’s more difficult for your body to produce collagen.”

Ultherapy neck treatment before-afters
Can this affect my hyaluronic acid filler?
“Normally, with hyaluronic acid fillers I say if you know you are going to do Ultherapy and fillers – do the Ulthearpy first. Or if you have to do the filler first wait a month and then do the Ultherapy so we don’t have to worry about it dissolving. The deepest Ultherapy can go is 4.5mm and a lot of the hyaluronic acid fillers are placed deeper than that so in those cases it doesn’t matter as much. But when we are injecting the hyaluronic acid into fine lines where it’s placed more superficially I would recommend waiting a month.”

How does Ultherapy compare to say, a brow lift or face lift?
“Surgery is always going to be the gold standard. You are always going to get a better result and a longer lasting result with a surgical procedure. With a brow lift you can get the brows to lift higher and the brow lift is going to last longer, same with a face lift; it’s going to last longer. A  mini lift lasts around 5 years and a full face lift will last 10 years. You are going to get a more dramatic improvement with surgery and a lot of patients who are older or have more skin laxity are going to do much better with surgery than Ultherapy because it just doesn’t have the power to do what surgery can do. But a lot of patients don’t want the downtime of surgery and a lot of patients don’t necessary need the surgery. Most patients use this from a preventative stand point.”

Safety and associated risks
While the risk of negative side effects is very low when conducted by a board certified plastic surgeon or dermatologist, Dr. Sunder points out two to be aware of, “Ultherapy is an ultrasound device. And just like when you have an ultrasound when you are pregnant and you see the level at which the ultrasound waves are coming back at you, when you do Ultherapy you can see the layers you are treating. You can see the fat, skin and muscle layers. One risk is the potential to dissolve fat if you are at the wrong layer and aren’t paying attention to which layer you are in. On the body it’s fine if you want to dissolve fat, but in the face you don’t want to dissolve fat since you want to maintain volume in the face. Nowadays, the whole goal of facial rejuvenation is putting volume back because we realize volume is what gives the face a youthful appearance, so if you start to get rid of volume, you make someone look older. Secondly, if the treatment is performed by someone who doesn’t truly understand facial anatomy they could hit a nerve or irritate it. This could cause temporary facial weakness. It’s really rare but I always reiterate you should go to a board certified plastic surgeon or dermatologist who knows facial anatomy for this treatment.”

-by Amy Chang
Image source: ulthera

For more:

Thinking about getting fillers? Read this guide to fillers – which one is best and goes where…

And if you’re in NYC, check out this spa for THE BEST FACIAL in the city.


Disclaimer: Any information in the publications, messages, postings or articles on the website should not be considered a substitute for consultation with a board-certified dermatologist or plastic surgeon to address individual medical needs. Your particular facts and circumstances will determine the treatment which is most appropriate for you. And the outcomes.

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