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Lip Fillers. The perfect way to enhance your smile

Lip Augementation

Lip augmentation using fillers is increasingly more common and is one of the most sought after filler treatments. With celebrity endorsement and many media fuelled horror stories, it is paramount that aesthetic practitioners develop their skill and knowledge in this procedure

The Perfect Lip 
Lips are the central hallmark of the lower face and when they are full and well-defined, they impart youth, health, attractiveness and sexuality. Wider, fuller curved lips with a high vermilion and a short upper white lip are all signs of female attractiveness . One of our greatest challenges is to achieve natural results after lip augmentation

Treatment Strategy
– Lip augmentation consists of the reshaping and/or enlargement of the visible portion of the lip, the vermilion. Alteration of the shape of the Cupid’s bow and of the relationship between the vermilion and the skin underlying the nasal columella also falls within the category of lip augmentation.
It is also important to consider the relationship between lip height and incisor shown in the anatomic analysis, to evaluate possible maxillary hypoplasia and protrusion, and to consider the patient’s occlusion status.

Assessment and technique
To achieve natural results it’s important to understand patient’s anatomy, and just as important to assess the lips before , so as to be able to appreciate what is and isn’t possible.
Fashion Styles of Lip fillers
1. Caucasian Style  : like Kylie Jenner,Kim-Kardashian,Angellina Jolie,Julia Robers,Scarlett Johansan . The characteristic types are full lips  or Heavy lower lip .

2. Asian Style like Jeon Ji Hyun,Kim Tae Hee,Yoon Eun Hye ,Lee Ji Eun(IU), Song Hye Kyo .The characteristic types Heavy lower lip,Bow Shaped lips ,Wide lips
How much face and lip fillers cost
–  The cost of dermal fillers is 15,000-20,000 bahts /CC of Restylane of Juvederm , depending on things like the type of product and number of syringes used, and the complexity of the area being treated

Side effects are typically mild and include temporary bruising, swelling or redness at the injection site. Serious complications are extremely rare when treatment is performed by a qualified provide

How long last for lip fillers? Hyaluronic acid fillers, such as Juvéderm and Restylane products, are a popular non-surgical option, offering temporary lip enhancement at an affordable cost. When administered by an experienced provider. Lip filler can last 8 to 12 months d and achieve soft, natural-looking results. Depending on the product, fillers can boost lip volume, enhance lip shape, and smooth vertical lip lines (peri-oral rhytids).
Benefits of dermal lip fillers
– A skilled cosmetic dermatologist can adjust the amount of filler used to achieve results with precision
– Little to no downtime is needed
– Improvements are usually noticeable immediately after treatment
– Results are final within 2 weeks
– Side effects are typically mild and include temporary bruising, swelling or redness at the injection site. Serious complications are extremely rare when treatment is performed by a qualified provider


  • Treatments must be repeated periodically to maintain results
  • Beautiful, natural results require a provider with immense skill and experience
  • The affected area may be a bit red, sore and swollen. Any swelling or bruising should settle down in a few days.
  • This includes not wearing make-up immediately after the procedure and avoiding alcohol, coffee and the sun.
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Mint PDO Thread Lifting for Facial Rejuvenation

What is MINT PDO Thread

MINT PDO is from South Korea, and it is a safe & effective absorbable suture made from a biocompatible material called PDO, polydioxanone. With a decade worth of safety track record in surgery,
PDO is a safe raw material that has been used for orthopedic and cardiovascular surgery for wound closure. Starting 2004, PDO’s use has evolved so that it is applied for minimally invasive procedure such as for soft tissue approximation in MINT PDO’s procedures.  Additionally, MINT PDO’s safety is further validated from its 510(k) clearance from the FDA and is currently being used in 14 other countries worldwide.
MINT PDO is used to pull and approximate soft tissues of the sagging skin to a desired position. MINT’s bi-directional and helically positioned barbs strongly anchor onto the soft tissue and then approximate it to the desired position. The procedure is simple and done through local anesthesia. Patients will experience minimal pain, minimal scarring, and a rapid recovery.

Who can be a good candidate for MINT PDO? MINT PDO procedures are safe for adults who keep up with healthy lifestyles and have maintained their weight for at least three months.
How does MINT PDO procedure works?
MINT PDO thread is a minimally invasive procedure that does not require general anesthesia nor big incisions. It is introduced into the deeper layers of the skin, and the helically molded barbs on the MINT PDO anchors onto the sagging tissue, and the thread is lifted upwards to achieve an instant, rejuvenating & contouring effect.
What is the recovery time for the MINT procedure? After the procedure, patients may immediately return to daily lives, but they should consult with their physicians before resuming exercise and other intense activities.

Are there any risks or side effects associated with MINT? Although minimal, side effects may include but are not limited to bruising, dimpling, and swelling.
How long do the results last? Patients will see immediate results after the procedure that can last up to 1 year. Despite being relatively new to the US market, MINT has a stronger lifting power and better specification designs in comparison to other PDO threads. By restoring the patient’s lost youth with a sharper jawline and V-line, MINT procedures address signs of aging caused by gravity, such as sagging skin.
Additional benefits to MINT PDO Not only that, MINT PDO procedure promotes collagen stimulation and neovascularization to improve skin texture, fine lines, and elasticity. As a result, after about 6-8 months when MINT PDO is completely absorbed by the body into water and carbon dioxide, the results will last for about 3-6 months more due to the collagen stimulation. With minimal scarring and downtime, it is an amazing option for patients looking into achieving instant and natural-looking results.

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V Beam: Vascular laser and Pulse Dye laser for reddness skin

What is the V-Beam laser

This is a laser treatment that uses a built-in cooling cryogenic spray mist onto the skin to help decrease the mild discomfort associated with the treatment, and decrease the possibility of blister or scab formation.
This laser produces an intense but gentle burst of light that selectively destroys the blood vessels of spider veins, or other vascular lesions, without damaging the surrounding tissues, leaving them intact and allowing normal pigmentation to occur.
This treatment can improve the look and feel of most scars and stretch marks by stimulating collagen production in the deeper layers of the skin.
This is an USA-FDA accredited treatment procedure. This has a remarkable level of safety and effectiveness.

What are the indications for the V-Beam laser treatment?

1. Acne redness
2. Rosacea
3. Redness on face (telangiectasia)
4. Red birth marks (hemangiomas, Port-wine stains)
5. Angiomas
6. Red stretch marks
6. Keloid scars
How many treatments are recommended to achieve optimum results?
-For acne redness, multiple treatments every 2 weeks is the recommendation while other treatments may be given every 4-6 weeks.
– For angiomas, 1-2 treatments is the recommendation.
– For keloid, acne redness, and birth marks, 4-8 treatments is the recommendation.
Contraindications of this procedure:
1.Darkly pigmented patients, as skin pigment will make laser less effective in decreasing blood vessels of vascular lesions
2. Lesions with blood vessel depth of more than 1.5mm

The Procedure:

This is a simple 5-20 minute procedure.

  1. The face is properly cleansed.
  2. The dermatologist will assess the patient’s pain tolerance and if required, he may apply some numbing cream to the area 40 minutes before the laser treatment is started.
  3. The dermatologist directs the V-Beam laser towards the area in the patient’s face, where the lesion is located, keeping it still for several minutes.
  4. After the procedure a slight redness may be noted so a mild moisturizing cream will be applied to the skin.
  5. The patient is allowed to go home with special instructions.
    Instructions for the patient after going through the V-Beam treatment procedure:
    There may be a transient redness or a slight bruise noted on the treated area for about 2-4 hours or 1-7 days, depending on the treated area. There may also be a very mild pain likened to the sting of sunburn. The treated area is very delicate and should be handled with care.
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Blunt Blade Subcision : An Evolution in the Treatment of Atrophic Acne Scars


Subcision is the mainstay of atrophic acne scar treatment but the efficacy and safety of the procedure is controversial.
Various instruments (such as Nokor and conventional needles, cataract blades,and wires) and techniques have been advocated but their effectiveness is indispute.

Moreover, subcision has lost overall popularity given the high risk of needlesticks for surgeons, moderate patient satisfaction,and the possibility of neuro-vascular injuries and also complications such as permanent discoloration.

Blunt Blade Subcision
this novel technique of subcutaneous undermining using a blunt subcision blade seems to be a safe and effective method for atrophic acne scar treatment. The technique is associated with a short recovery time and a low rate of serious complications.In addition, the technique’s simplicity and low cost could make it a suitable first step in the treatment of most cases of atrophic acne scars.
Paper Review: Eighteen patients with bilateral atrophic acne scars considered eligible for subcision were enrolled. Before subcision, a tumescent solution was injected subdermally to anesthetize the treatment area and aid the dissection of the dermal-subcutaneous tissue. Patients underwent treatment using the blunt subcision blade, a long metal blade with gradually narrowing edges, and a rounded blunt tip. Early postoperative complications, overall aesthetic improvement and persistent discoloration, or lumpiness were assessed 7 days after subcision and at a 6-month follow-up visit.
Moderate to marked improvement of atrophic scars was observed in 15 cases (83.3%). Mild to moderate tenderness, periorbital ecchymoses, and swelling were reported by some patients, but resolved completely within 1 week after the procedure. No cases of persistent discoloration or lumpiness were observed at the final visit.

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Chronic Migraine : Prevention and Treatment with Botulinum toxin type A (Botox) injection

How does botulinum toxin work in chronic migraine?
The simple answer is that we don’t know fully. A recent US study by Rami Burstein et al using animal models suggested that botulinum toxin inhibits pain in chronic migraine by reducing the expression of certain pain pathways involving nerve cells in the trigeminovascular system. The trigeminovascular system is a sensory pathway thought to play a key role in the headache phase of a migraine attack.Unlike many of the other conditions in which it is used, it is not thought to work by relaxing overactive muscles. Botulinum toxin has been shown to reduce pain in a number of disease states, including cervical dystonia, neuropathic pain, lower back pain, spasticity, myofascial pain, and bladder pain.More research into the mechanism of action of botulinum toxin will hopefully shed light into all the pathways that it acts upon.
Is Botox® right for me?
  Only patients with chronic migraine are eligible for treatment with Botox®. Chronic migraine is defined as headaches occurring on 15 or more days each month, at least half of which have migrainous features. There are, however, other treatments available to patients with chronic migraine, and it is important that patients have an informed discussion of their headaches and the options for treatment with a practitioner experienced in the diagnosis and management of headaches before a decision to use Botox® is taken.

Who can inject Botox® for chronic migraine?
At present the use of Botox® is restricted to a few specialist headache centres, but as time goes on there should be increasing numbers of trained injectors available. In all cases, however, you should ensure that the person injecting has received appropriate training, both in the diagnosis and management of chronic migraine, and in the delivery of Botox® according to the proven PREEMPT schedule. Please note that the referral process differs for each location.  In the first instance, patients who are struggling to manage their symptoms should discuss this with their general practitioner (GP) and if appropriate, seek referral to a specialist with an interest in headache disorders.  Read more about seeking medical advice.On visiting a migraine clinic a detailed history of the patient’s condition will be taken, including symptoms, frequency of attacks and any medication tried in the past or currently taking.  Keeping a diary can help with this.
Availability of Botox® for treating chronic migraine on the NHS

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Plexr Plasma : Non-Surgical Blepharoplasty

Plexr is definitely one of our most interesting developments, a real revolutionary and patented innovation in the field of aesthetic medicine and surgery.

PLEXR represents a new and exciting frontier in surgery: it offers both the doctor and the patient an alternative approach to procedures that were, until now, highly invasive due to pre- and post-operative complications such as anesthesia, surgical resection, sutures and post-operative recovery in hospital.

This completely wireless device is extremely handy, ergonomic and well-performing, created from the need to operate on conditions where it is difficult to use other instruments such as a laser or a radio-frequency scalpel.

Plexer uses the fourth state of matter: Plasma. Tissues treated “Sublimate” avoiding spreading unwanted heat to surrounding areas. The principle is to ionise gases in the air to create a small electrical arc, similar to a tiny lightning bolt, with which dermal and epidermal areas affected by aesthetic problems may be treated, without spreading unwanted heat to surrounding areas.

Key uses:

  • Eyebag/Eyelid Correction
  • Acne – active spots AND scarring
  • Stretch marks, scars
  • Lines & Wrinkles eg smoker’s lines
  • Skin Lesions eg warts, xanthelasma, moles (flat or raised), age spots

Advantages Vs Surgery:

  • No injectable anaesthetic required
  • No cutting of skin
  • No stitches required
  • Very low risk procedure (NO risk of blindness as there is with surgery)
  • Minimal side effects and far less downtime
  • Quick & easy procedure
  • Most patients can return to work the same day
  • No thinning of the skin
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Dutasteride : New drug used to treatment male baldness

Dutasteride (Avodart), , is a dual 5-α reductase inhibitor that inhibits conversion of testosterone to dihydrotestosterone (DHT). It is used to treat benign prostatic hyperplasia. It increases the risk of erectile dysfunctionand decreased sexual desire.
Mechanism of action
Dutasteride belongs to a class of drugs called 5-alpha-reductase inhibitors, which block the action of the 5-alpha-reductase enzymes that convert testosterone into dihydrotestosterone (DHT).
Medical uses
Avodart (dutasteride) 500 µg soft capsules.Dutasteride is useful for treating benign prostatic hyperplasia (BPH); colloquially known as an “enlarged prostate”.
In those who are being regularly screened, 5-alpha-reductase inhibitors such as finasteride and dutasteride reduce the overall risk of being diagnosed with prostate cancer; however, there is insufficient data to determine if they have an effect on the risk of death and may increase the chance of more serious cases
Dutasteride versus finasteride
Finasteride is also approved for the treatment of benign prostatic hyperplasia, or BPH. The medications belong to the same class of drugs.
Dutasteride inhibits two of the three isoforms of 5-alpha reductase, I and II, whereas finasteride only inhibits type II, and has a much shorter half-life. Bexlosteride is an isoform I selective inhibitor,albeit with limited commercial availability

Adverse effects
1. Sexual effects This class of medications increases rates of erectile dysfunction (with between 5% and 9% developing problems after starting their use).This is linked to lower quality of life and can cause stress in relationships.There is also an association with lowered sexual desire.It has been reported that these adverse sexual side effects may persist even after discontinuation of the drug.
2. Prostate cancer The FDA has added a warning to dutasteride about an increased risk of high-grade prostate cancer.While the potential for positive, negative or neutral changes to the potential risk of developing prostate cancer with dutasteride has not been established, evidence has suggested it may temporarily reduce the growth and prevalence of benign prostate tumors, but could also mask the early detection of prostate cancer. The primary area for concern is for patients who may develop prostate cancer whilst taking dutasteride for benign prostatic hyperplasia, which in turn could delay diagnosis and early treatment of the prostate cancer, thereby potentially increasing the risk of these patients developing high-grade prostate cancer.

Children and women who are or may become pregnant, and people with known significant hypersensitivity (e.g., serious skin reactions, angioedema) to dutasteride or finasteride should not take dutasteride. Exposure to dutasteride and other 5-alpha reductase inhibitors during pregnancy can cause birth defects. Since these medications are readily absorbed through the skin, women who are or may become pregnant should not handle them and if they come into contact with leaking capsules, the contact area should be washed immediately in soapy water. People taking dutasteride should not donate blood and, due to its long half-life, should also not donate blood for at least 6 months after the cessation of treatment.

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Exilis: Monopolar RF Machine 2 in 1 for Skin Tightening and Body Contouring

The Exilis® Elite is a non-invasive face and body contouring device designed to tighten skin while reducing fat and signs of fine lines and wrinkles.
It uses a combination of monopolar radio frequency (RF) energy, ultrasound to stimulate fat lipolysis (the breakdown of fat cells) and collagen remodelling (for skin tightening), alongside skin cooking, helping to contour the body and face.
How does it work?
The Exilis Elite uses a combination of radiofrequency energy (3.4Mhz up to 120 Watts), ultrasound and skin cooling to deliver controlled heating to target deep tissue, addressing deeper wrinkles, sagging skin and jowls, as well as the superficial skin layer, treating finer lines.
License status
The Exilis Elite was granted European CE Mark certification in 2011.It has also been approved by the U.S. FDA (Food & Drug Administration) and cleared for the non-invasive treatment of dermatologic wrinkles and rhytids
What is it used to treat?
The Exilis Elite is used to treat everything from superficial, fine lines to deep wrinkles within the deep tissue on the face, neck and body. Skin becomes smoother and lines are reduced, while the body and face are reshaped and recontoured.
– Fat deposits in hard-to-reach areas can be reduced, all with long-lasting results provided that you continue to maintain a healthy diet and lifestyle.
It is suitable for those with stubborn, mild to moderate fat deposits, and can postpone or even eliminate the need for more invasive treatments, like liposuction, in the future.It is not a weight loss solution.
Exilis Elite is used to treat love handles, bingo wings (flabby arms), saddle bags on hips and thighs, post-baby tummies, turkey necks and jowling in the face



About Exilis Elite Body Contouring & Tightening Technology
The new Exilis Elite offers improvement with the delivery of cooling and heating that dramatically improve results. Key benefits of the Exilis Elite is that the RF energy is able to penetrate up to 4cm deep into the fat and deliver to the fat a temperature greater than 44.2 Celsius. Why is that important? Clinical research has proven that not only can you cause a fat cell to lose its lipids through heating, but if you maintain a temperature of 44.2C for 4-5 minutes, fat cell destruction can occur as well.
How long does it last?
According to clinical data, Exilis Elite results are generally permanent, provided that you maintain your weight following the treatment. Its use to treat cellulite is not-permanent, however, as this can easily reoccur over time.
A European study demonstrated significant circumferential reduction in all 58 trial volunteers after 4-5 treatments. Another study demonstrated longevity of results up to at least 18 months.
The longevity of the results will depend on your genetic predisposition to ageing and your lifestyle; you may need top-up treatments to maintain the results
Side effects & risks

Side effects are generally minimal. You may notice some pinkness or redness to the skin immediately following the treatment but this typically subsides within 15-30 minutes. Skin may be slightly tender to the touch for a little time afterwards, but this is not always the case. Very rare risks reported include numbness, swelling (oedema), blistering, scarring, allergic reactions and nausea.

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Ulthera (Ultherapy®) : non-surgical face lift indication

About Ulthera
Ulthera, Inc. is a global medical device company focused on developing and commercializing technologies for aesthetic and medical applications using its therapeutic ultrasound platform technology.
The Ulthera® System is the first and only energy-based device to receive U.S. FDA clearance for a non-invasive aesthetic lift indication. It is used in a procedure known as Ultherapy®, which is an FDA-cleared treatment to lift skin above the eyebrow, on the neck , under the chin ,on the upper chest,etc
How is Ultherapy different from other cosmetic procedures
Ultherapy targets deep tissue below the skin, an area typically reached with cosmetic surgery. Ultherapy also provides ultrasound imaging, which allows  doctors to actually see the layers of tissue that are targeted during the treatment, and thus ensure the energy is delivered where it will be most effective.
Who is a good candidate for Ultherapy?
Someone with skin that has “relaxed” to the point of looking less firm. A lowered eyebrow line or sagging skin on the neck or the jowls, is often the first sign of “maturing” skin. Typically, those in their thirties and older who have mild to moderate skin laxity are candidates. Ultherapy is also a good option for people who want to “stay ahead of the game” as well as those looking to prolong the effects of cosmetic surgery.
What results can be expected?
Ultherapy addresses mild to moderate loose or sagging skin by reconditioning and renewing the collagen underlying the skin. Ultherapy can lift the brow, which in turn reduces excess skin on the lids, opens up the eyes, and gives a more refreshed look overall. It can also improve the appearance of loose skin in the jowls or neck.

How does Ultherapy work?
Before we can delve into why Ultherapy works so well, we’ll need a quick anatomy lesson. The skin is composed of layers, not unlike an onion. Peel away the top epidermal layer, and you’ll find the dermal layer – beneath it is a layer of subcutaneous fat. Between the bones and the fat is the SMAS – the Superficial Muscular Aponeurotic System – gliding membrane consisting of connective tissue (a tissue rich in collagen) and muscle. The SMAS, through many extensions, attaches to the layers piled on top of it: the subcutaneous and the epidermal-dermal layer.
It’s no wonder the SMAS is nicknamed the “face’s foundation.” Ulthera uses this structure, heating it with sound waves and thus tightening and lifting the face through all its layers to create a youthful, more natural-looking appearance. Among the youth-inducing results are lifted jowls, tightened muscles, and the improvement of sagging skin. Ultherapy delivers focused ultrasound energy below the surface of the skin to stimulate the body’s creation of new collagen. As a result, skin will lift and tone over a period of several weeks.
The Technology Behind Ulthera
What distinguishes Ulthera from lasers is the precision built into Ulthera – the DeepSEE technology. This technology not only heats the underlying skin, but also allows doctors to see which areas they’re targeting and treat these areas with precision. In a sense, DeepSEE allows doctors to rehearse before actually treating areas.
An initial ultrasound is used to find problem areas, which the doctor then narrows down to specific regions. The doctor then directs the sound waves to the deepest layers of the skin. One great advantage of DeepSEE technology is that not only are problem spots treated, but also the depth of the sound waves is also controlled, usually to 3 to 4 millimeters to target the SMAS.Before we can understand how the sound waves pass through the skin, we’ll need a brief physics lesson. Sound waves can only travel through a medium, such a solid, liquid, or gas. In order to maximize the sound waves absorbed into the skin and minimize reflection, a gel is used before the waves are fired into the skin. Sound waves then travel through the gel-slathered skin, vibrating until they reach areas of high-collagen concentrations (such as the SMAS) where they are absorbed and warm up the soft tissue, provoking an inflammatory response that sets off a healing response that in turn starts up collagen production

What does collagen do?
Collagen is a natural protein that gives skin its youthfulness and bounce by keeping it firmed and toned. As we age, collagen loses its strength, elasticity and the ability to stand up to the effects of gravity that pull the skin downward. Ultherapy jump starts a repair process that strengthens your existing collagen and produces fresh, new collagen.
Is Ultherapy uncomfortable or painful?
It really varies from patient to patient. Some patients tolerate the procedure well while other patients experience significant discomfort or pain while the energy is being delivered. This pain and discomfort are temporary and a signal that the collagen-building process has been initiated. We have extensive experience with pain management for Ultherapy and are able to offer the highest possible level of patient comfort during the procedure. The doctors will adjust the procedure based on each patient’s response and comfort threshold and will provide numbing injections as well as oral medications as needed for patient comfort. There is no pain after the procedure and patients usually tell us that any discomfort was well worth it given the benefits to come.
How long does it take to recover?
Typically there is no downtime, and patients can return to their normal activities after treatment.
How long does it take to see results?
Patients may see some initial effect but most lifting and toning will take place over 2-3 months, as tired collagen is replaced with new, more elastic collagen. As this collagen-building process continues, further improvements can appear up to 6 months following a procedure

How long do the results last?
Patients treated with Ultherapy still have fresh young collagen a year after the procedure, but skin continues to age. Future touch-up treatments can help keep pace with the aging process, and the appropriate frequency varies for each patient.
Can Ultherapy replace a facelift?
Ultherapy is an “uplift” not a “face lift.” While it is not a replacement for surgery, it is a viable option for those not ready for a face lift or those looking to prolong the effects of cosmetic surgery.
What about treating regions other than the face?
Recent clinical research shows that Ultherapy can be effective in tightening sagging skin on the body, particularly on the chest, abdomen, under the arms and around the knees. If you are interested in areas other than the face, please schedule a consultation with  doctors to see if Ultherapy would be a good approach to tighten and smooth your trouble spots.
How does Ultherapy compare to lasers?
Lasers typically address issues in the superficial layers of the skin (e.g. fine lines, wrinkles, pigment changes). Ultherapy addresses the deep skin layer to lift and lend support to the skin. The two technologies address different areas and thus can be used together when a combined approach is desired.
Are there any side effects?
There may be slight redness for a few hours following the treatment, and it is not uncommon to experience slight swelling, tingling or tenderness to touch for a few weeks. These side effects are typically mild and temporary. It is also possible to experience certain post-procedural effects such as bruising and small areas of numbness, but these are less common and will typically dissipate over the two weeks following treatment.
How much does it cost?
Ultherapy typically costs between $ 800 and $3,000 depending on the extent of treatment. You will receive a precise estimate after your consultation with the doctors.
 Is Ultherapy safe?
Ultherapy has been cleared by the FDA after demonstrating safety in clinical studies, and tens of thousands of treatments have been performed worldwide without any significant adverse events.
How many treatments are needed?
The majority of patients only need one treatment, while those with a fair amount of laxity may need more than one treatment. Annual touch-up treatments can help slow down the rate of skin aging.
Who is a good candidate for Ultherapy?
There is a broad range of people who can benefit from Ultherapy, but typically those in their thirties and older are candidates. While this is not a replacement for surgery, there are many people who want some lifting, in order to look more refreshed and toned but are not ready for surgery (mentally, financially, or logistically). And then there are younger people who want to “stay ahead of the game” as well as those looking to prolong the effect of surgery.