Ultherapy
Ultherapy uses focused ultrasound. The handpiece is moved along the jawline and neck in lines.
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Dermapedia / CompareProcedures
Ultherapy vs Fraxel
Ultherapy is for sagging. It focuses ultrasound to a point deep under the skin, never breaks the surface, and firms the brow, jawline and neck over a few months. Fraxel is for the surface. It puts columns of controlled heat into the skin to treat texture, acne scars, sun damage and lines, and it costs you several days of peeling. They do not treat the same problem, so plenty of people end up having both at different times.
At a glance
| The difference | Ultherapy | Fraxel |
|---|---|---|
| What it does to your skin | Ultrasound focused to a point beneath | Columns of controlled heat injury |
| What it is best at | Mild sagging at brow, jaw and neck | Texture, acne scars and sun damage |
| What it feels like | Deep, sharp pulses of heat | Hot snaps, then a sunburnt face |
| Downtime | None, but you may be sore | About a week of redness and flaking |
| How long until it works | Two to three months | A week for glow, months for the rest |
Fraxel
Fraxel treats the skin in tiny columns and leaves the skin between them alone. Eye shields are worn.
Side by side
The differences that matter
What it does to your skin
Ultherapy
Ultrasound focused to a point beneath
The energy passes through the surface untouched and concentrates deep down, like sunlight through a magnifying glass. Tissue at that point heats and contracts.
Fraxel
Columns of controlled heat injury
The laser treats a fraction of the surface and leaves the skin between the columns alone. That untouched skin heals the rest.
How deep it goes
Ultherapy
Down to about 4.5 mm
The deepest setting reaches the sheet of tissue below the fat that a surgeon tightens in a facelift.
Fraxel
The surface and the layer under it
Depth varies with the setting, but it works in the skin rather than beneath it.
What it is best at
Ultherapy
Mild sagging at brow, jaw and neck
It firms tissue that has started to drop. The change is real and modest.
Fraxel
Texture, acne scars and sun damage
Sunken acne scars, rough or crepey skin, fine lines and surgical scars.
Conditions treated
Ultherapy
Wrinkles and Fine Lines
Focused ultrasound heats a deep layer to tighten it, aimed at the jaw, neck and brow rather than at lines. The change is modest and takes three to six months to show, and it is nothing like a surgical lift. It can be uncomfortable, and results vary enough that it is worth seeing a provider's own before-and-after photographs.
Fraxel
Stretch Marks
The best-evidenced device for mature white marks, and useful on red ones too. It puts columns of controlled heat into the supportive layer to force a fresh round of collagen remodeling, over three to six sessions spaced weeks apart. Expect partial improvement in texture and how noticeable they are, not removal. On deeper skin tones it is used at conservative settings after a test patch, because of the pigment risk.
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Wrinkles and Fine Lines
Heats columns in the dermis without removing the surface, so it improves fine lines, texture and pigment with a few days of redness and swelling instead of a week of raw skin. It takes three to five sessions to match a fraction of what one ablative treatment does. It is the more sensible starting point on deeper skin tones.
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Sun Spots (Solar Lentigines)
Treats the sun-damaged skin as a whole rather than targeting individual spots, so it improves texture and fine lines alongside the pigment. That makes it a reasonable choice when the spots are only part of what is bothering you. For clearing spots alone it is slower, dearer and less precise than freezing or a pigment laser.
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Acne Scarring
Resurfaces without removing the surface, so recovery is a few days of redness and swelling rather than a week of raw skin. It gives less improvement per session than CO2 and needs more sessions to get there. It is the sensible middle option when the downtime of ablative laser is not workable.
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What it will not do
Ultherapy
It does nothing for the surface
Nothing breaks the skin, so there is no way to treat scars, pores or roughness.
Fraxel
It will not lift a jawline
Resurfacing changes the surface. Slack tissue underneath is a different problem.
Related topic illustrations
Ultherapy
Botulinum toxin
Strong evidence for lines caused by movement, and no effect on laxity. Frequently done alongside rather than instead.
Fraxel
Microneedling
Moderate evidence. Aimed at the same acne scar and texture problems, without light or heat, so the pigment risk is lower, which matters on deeper skin tones. Generally cheaper per session and gentler, and generally slower to show the same amount of change.
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Chemical peel
Strong evidence for surface pigment and clogged pores. Much cheaper and available almost anywhere. It works on the surface, so it does not reach indented scars and does far less for texture.
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Clear + Brilliant
Limited evidence, from the same manufacturer. A far gentler version of the same idea, with about a day of downtime and a much smaller result per session. A reasonable choice for early texture and dullness, not a substitute for a course of Fraxel on scars.
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What it feels like
Ultherapy
Deep, sharp pulses of heat
This is the well-known drawback. Reports range from mild to the worst treatment a person has had, and the brow and neck are the worst of it.
Fraxel
Hot snaps, then a sunburnt face
Numbing cream first. The heat lingers for hours afterwards.
Downtime
Ultherapy
None, but you may be sore
Swelling, tenderness and sometimes bruising for a few days. Tingling or patchy numbness along the jaw can last a week or two.
Fraxel
About a week of redness and flaking
Swelling and a bronzed, rough look for five to seven days. The strongest version removes surface skin and needs one to two weeks of wound care.
How many sessions
Ultherapy
Usually one
Repeated for maintenance rather than to finish the job.
Fraxel
One strong, or three to five gentle
The gentler setting is a course, four to six weeks apart.
How long until it works
Ultherapy
Two to three months
The lift is collagen rebuilding, so nothing much shows on the day.
Fraxel
A week for glow, months for the rest
Skin looks brighter once the peeling ends. Scars and texture keep improving for months.
How it works, illustrated
Ultherapy
Fraxel
How long it lasts
Ultherapy
About a year, sometimes longer
Ageing carries on underneath. Most people who like it repeat every one to two years.
Fraxel
Years, for texture and scars
New collagen is real change. Sun exposure brings new pigment back sooner.
Skin tone
Ultherapy
Ultrasound ignores pigment
It heats tissue rather than aiming at colour, so it is reasonable across skin tones.
Fraxel
Light and heat both raise the risk
Any laser can leave a patch that heals darker. That is more likely on deeper skin tones, and it is managed with lower energy and longer gaps.
Cost
Ultherapy
Priced per area, usually one visit
Ask for the price of the areas you actually want treated.
Fraxel
Priced per session, often a course
Ask what a full plan costs rather than one visit.
The at-home or drugstore version
Ultherapy
There is not one
Home ultrasound wands sold for tightening put a small fraction of the energy into the surface. They never reach the layer this device heats.
Fraxel
A retinoid cream is the honest version
Home fractional wands reach only the very top of the skin at a fraction of the power. A nightly retinoid is slower than resurfacing and it genuinely works on texture and fine lines.
Who each suits
Ultherapy
- Best for — Jowls, a heavy jawline, a loose neck, dropped brows.
- The trade — An uncomfortable hour, then months of waiting.
Fraxel
- Best for — Acne scars, rough texture, sun damage and lines.
- The trade — Real time off for a visible change in the skin.
Lift or resurface
Ultherapy
Ultherapy works below the skin and cannot touch the surface. The energy skips past the epidermis on purpose, which is exactly why there is no wound and no visible healing. It also means scars, pores and roughness are untouched.
Fraxel
Fraxel works in the skin and cannot lift. It remodels the layers where texture and scarring live. Slackness sits deeper than it reaches.
Pain and downtime trade places
Ultherapy
Ultherapy hurts during, and costs you nothing after. Most people go back to work the same day, sometimes swollen and sore. The discomfort is concentrated in the appointment itself.
Fraxel
Fraxel is manageable during, and costs you the week after. Numbing cream handles most of the session. The peeling is the part to plan around.
Common questions
Questions Patients Ask
What is the main difference between Ultherapy and Fraxel?
Ultherapy heats tissue deep under the skin to firm sagging, and never breaks the surface. Fraxel puts heat into the skin itself to treat texture, scars and sun damage.
Which one has more downtime?
Fraxel. Expect about a week of redness and flaking, and one to two weeks if the strongest, surface-removing version is used. Ultherapy leaves no wound, though you may be swollen and sore for a few days.
Which one hurts more?
Ultherapy, by a distance. The sensation is a deep, sharp pulse of heat repeated hundreds of times, and the brow and neck are the worst of it. Ask what pain relief the clinic offers.
Can I have both?
Yes, and many people do, at different times. They treat different problems, so they are not really rivals. Leave weeks between them so the skin is not healing from two things at once.
Which is safer for deeper skin tones?
Ultherapy uses ultrasound, which heats tissue without aiming at colour, so it carries no pigment risk. Fraxel is light-based and needs lower energy, longer gaps and strict sun protection on deeper skin.
Has anyone compared them in a trial?
No published trial has put the two against each other. They treat different problems, so the choice comes down to which one describes your complaint.