Ultherapy PRIME® vs Thermage® FLX: Which Is Right for Your Skin?

If you have little facial fat and are on the thin side, the radiofrequency method Thermage® FLX is generally considered a safer option. This is because HIFU Lifting creates strong thermal coagulation points in deep layers, and heat can also be transferred to the fat layer, so you need to consider the possibility that cheeks may appear more hollowed in a face with little fat.

Thermage® FLX works by contracting and regenerating collagen in the dermal layer to boost the skin's own elasticity, so it carries relatively less risk of volume loss and is suitable for addressing fine lines and sagging in a thin face. Even if a person with little fat receives HIFU treatment, it is possible to design the procedure to avoid the fat layer by increasing the proportion of 3.0 mm and 1.5 mm cartridges instead of 4.5 mm, so a precise skin assessment before treatment is important.

The moisture-oil type itself, such as dry or oily skin, is not a decisive criterion for distinguishing between the two procedures. What matters in choosing a lifting device is skin thickness, amount of fat, depth of sagging, and degree of elasticity loss, because sebum production has little direct relation to the dermal and fascial layers where the energy acts.

However, there are points to consider. People with dry and thin skin tend to experience temporary dryness and sensitivity after thermal stimulation, so the energy intensity and post-treatment moisturizing care should be designed more carefully. People with oily and thick skin often have concerns about pores and sebum, so the plan may differ by combining a texture-improving procedure. In other words, skin type is a factor that influences 'how' you receive the treatment rather than 'what' you receive.

If sagging is pronounced and originates from deep layers, the ultrasound method is often advantageous. Skin sagging largely stems from structural weakening of the SMAS layer. Ultherapy PRIME® is known to create thermal coagulation points in this layer at about 4.5 mm depth, inducing immediate tissue contraction and collagen regeneration simultaneously. In that it targets the 'root' of sagging, it has strengths in lifting itself.

However, the more severe the sagging, the harder it is to solve everything with a single device. Even if you pull the deep layers with ultrasound, if dermal elasticity is insufficient, surface laxity may remain, so a stepwise approach that also tightens the dermal layer with radiofrequency may be necessary. The solution differs depending on whether the cause of sagging is fat ptosis, decreased skin elasticity, or bone loss, so diagnosis comes first.

When deep sagging and reduced surface elasticity occur together, combining the two procedures can be a good option. This is because ultrasound (Ultherapy PRIME®) lifts the 4.5 mm SMAS layer, while radiofrequency (Thermage® FLX) tightens the dermis to subcutaneous layer and improves fine wrinkles, so their layers of action do not overlap and they complement each other. A typical example is when sagging, elasticity loss, and fine wrinkles have progressed simultaneously, as in the 40s and beyond.

When combining, the common sequence is to perform the ultrasound that treats the deep layer first, followed by radiofrequency. Whether to do both on the same day or to space them out is determined based on the skin condition. Since accurately understanding the cause of your sagging and the amount of fat is the starting point, please design the sequence and combination through a consultation with a dermatologist.