Ultherapy PRIME

"I have had this done, and I would have it done again, and I want to say that first because the rest of this file is going to sound more cautious than that."

"KKC Clinic, Bangkok. The machine is a cart with a screen and a handpiece about the size of a large computer mouse. They drew a grid on my face in white pencil, put cold gel on, then pressed the probe down and looked at the screen instead of at me. That is the part that sold me. On the screen was a cross-section of my own face: skin, then fat, then the sheet of tissue a surgeon lifts in a facelift, then bone. She found the layer, confirmed it, and only then fired. Every other machine in this category fires blind at a depth somebody guessed. This one looks first."

"Then it fires, and I will not pretend that is pleasant. It is a line of hot pinpricks under the skin, and over the jawbone it is a deep ache that makes you hold your breath. On the original machine people described this the way they describe a root canal. On PRIME it is about half that, which matches the one study anyone has run, and I got through a full face and neck in about forty minutes on numbing cream alone. My face was pink for an hour and tender along the jaw for a week, like a bruise you cannot see. The brand's website says no downtime. That is not the phrase I would use. Call it a week of not touching your face."

"Then nothing, for a month. Then somewhere around the third month the line of my jaw was back. Not different. Back, the way it was a few years ago. My neck was tighter and my brows sat a little higher. It is not a facelift and nobody honest says it is. It is the difference between a photo you delete and a photo you keep, and it lasted me over a year from one afternoon."

"Here is what I read. There are forty-two studies on this technology and nearly nine in ten people improve on them. The review that pooled all forty-two was paid for by the manufacturer and written largely by doctors who consult for it, and to their credit that is disclosed on the first page, along with the fact that only two of the forty-two had a control group. I believe the effect because I can see it on my own face. I would believe it more if someone the company does not pay had measured it. And nothing at all has been published on this generation of the device: the FDA filing says outright that clinical testing was not necessary to clear it."

"Then there is the manual. Not the brochure, the actual federal document a clinic is required to keep. It lists what has been reported since this technology went on the market: fat loss in the face, numbness, muscle weakness, nerve effects that lasted months, burns, scars. It says most of those come from technique, a tilted probe, a pocket of gel, lines placed too close together. A review last year pulled 106 of those reports out of the federal database. I have never seen a word of it on a brochure. The manual is honest and the marketing is a brochure, and the device deserves to have the two say the same thing."

"So one star, for a machine I would pay for again. The star is for the imaging, which is the whole point, for a result that lasted a year from one appointment, and for a manual that tells the truth. What holds it at one is not the hardware. It is that it works by hurting you a little on purpose, that whether it hurts you a lot depends entirely on the hands holding it, and that the company which wrote the honest manual sells it with the words no downtime. Publish the elasticity trial. Fund a study you do not run. Say where it is made. Match the box to the filing. The device can carry the truth."

"One practical note. Bangkok and Seoul have done more of these than anywhere in the world, every serious clinic in both has upgraded to PRIME, and the same treatment costs roughly a third of what it does in Los Angeles. The operator is the variable in this procedure. If you are going to have it done, go where the hands have done the most of it."