[Doctor Bellvue Column 86.] Comparing Ulthera (HIFU), Thermage (RF), and Onda Lifting, Newly Introduced at Bellvue

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The modern lifting market is not an exaggeration to call an ‘energy battlefield.’ Patients are no longer fixated on “trendy procedures” and seem to be carefully examining the skin layers each device targets and the characteristics of its energy.

From a medical perspective, we have taken an in-depth look at the medical differences and clinical uses of the three major lifting treatments: Ulthera (HIFU), Thermage (RF), and Onda (Microwave), newly introduced at Bellevue. We hope this article helps you make the best choice for your own skin condition.

1. Ulthera

A powerhouse of “vertical lifting” that rebuilds the fascial layer. Ulthera uses High-Intensity Focused Ultrasound (HIFU) technology. Like using a magnifying glass to concentrate sunlight and burn paper, it forms thermal coagulation points (TCPs) deep within the skin. Its main target is the SMAS layer (the fascial layer), which is the root cause of skin aging. It delivers thermal energy of about 60 to 70 degrees to a depth of 4.5 mm to contract the sagging fascia. It is easy to think of it as lifting similar to rebuilding an old building foundation. It offers the strongest “lifting” effect for cheeks and a double chin that have drooped downward due to gravity. However, if there is too little facial fat, caution is needed because hollowing of the cheeks may occur, so precise design is essential.

Ulthera

2. Thermage FLX (Thermage)

It is the representative treatment for “horizontal tightening” that makes the dermis feel firm and taut. The most distinctive feature of Thermage is that it uses radiofrequency (RF) energy to deliver heat evenly throughout the skin layers. If Ulthera feels like a procedure that “drives nails in” one by one, Thermage is closer to “flat ironing” the skin. The core target layer of Thermage is the dermis, which is central to skin elasticity. Monopolar radiofrequency induces denaturation and regeneration of collagen fibers. It immediately contracts aging, loosened collagen pillars and then promotes new collagen production over the following months. Rather than lifting sagging skin upward, it specializes in “tightening” and improving skin texture by making the loosened outer layer of skin adhere more firmly. It is the optimal choice for thin skin with many fine lines.

3. Onda

A “shaping lifting” treatment that organizes fat and refines the facial line. Onda is the only lifting device that uses microwaves. Its biggest feature is that the 2.45 GHz frequency reacts selectively to fat cells and connective tissue rather than water. Its core targets are the subcutaneous fat layer and fibroblasts in the lower dermis. Through dielectric heating, it delivers energy deep into the tissue without resistance from the epidermis. While promoting the metabolism of unnecessary fat cells to induce cell death, it also helps remodel collagen in the lower dermis. Onda’s defining feature is its exceptional efficiency in reducing unnecessary volume such as a double chin or jowls with almost no pain. It can be described as the peak of “shaping” lifting, refining the face as if sculpting a line.

Ulthera vs Thermage vs Onda: Choosing the Best Option

Lifting achieves its greatest synergy when used as a “combination treatment” rather than as a single procedure. Since the degree and pattern of facial sagging differ from person to person, it is very difficult to recommend only one treatment. A proper diagnosis must come first for both treatment recommendations and results to be successful.

If you have a lot of facial fat and significant sagging	Ulthera + Onda	Ulthera supports the fascia, and Onda reduces unnecessary buccal fat to reduce the facial area.
If you have thin skin and are concerned about overall elasticity	Thermage + Ulthera (Ulthermage)	This is the most classic combination. Ulthera works in the deeper layers, and Thermage fills in elasticity layer by layer on the surface.
If you are afraid of pain and want immediate line refinement	Onda alone or combined with LilliD	It reduces fat with almost no pain and replenishes moisture with a skin booster to complete a smoother facial shape.

The patterns of skin aging are all different, like each person’s unique fingerprint. Which energy will work most efficiently on your skin layers should be decided through consultation with an experienced medical professional. Bellevue Clinic will first analyze your skin thickness and fat volume rather than the name of the device, and then propose the most reasonable plan. Thank you.

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The Mark-Vu skin diagnosis test can identify various skin concerns at once that are difficult to confirm with the naked eye, including skin texture, pigmentation, pores, wrinkles, skin tone, dark circles, radiance, redness, melanin, sebum, and acne bacteria.

At Bellevue, we use this to scientifically analyze your skin and make a final diagnosis for the necessary procedures. Through detailed consultation, we will do our best to provide each patient with the most effective treatment.

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