If you have been researching non-surgical skin tightening, you have likely come across both XTherma and Ultherapy. Both are energy-based devices designed to stimulate new collagen production without surgery or significant downtime, and both are used to address loose or sagging skin on the face, neck, and in some cases the body. That overlap is exactly why patients ask us which one is better.
The honest answer is that neither treatment is a stronger version of the other. They use different technologies, they are typically described in different ways by their manufacturers, and they tend to suit slightly different patients and priorities. At Allen Medical Aesthetics, we offer both XTherma and Ultherapy, so our recommendation during your consultation is based on your anatomy, your goals, and your comfort priorities, not on which machine happens to be available.
Allen Medical Aesthetics has provided medically supervised aesthetic treatments for seven-plus years serving Des Moines and the greater Seattle-Tacoma area, and treatments are performed by ARNPs and licensed master aestheticians. This guide walks through how each device works, what the appointment feels like, what a comparison table looks like side by side, and how to think about which one fits your situation.
XTherma and Ultherapy both use energy-based heating to stimulate new collagen for firmer, more lifted skin, but through different mechanisms. Ultherapy uses micro-focused ultrasound (MFU-V) to target the SMAS, the same structural layer addressed in a surgical facelift, and it carries FDA clearance for lifting the brow, chin, and jawline and improving lines on the decolletage. XTherma uses monopolar radiofrequency with integrated cryogen cooling, which makes the treatment considerably more comfortable, and it is also used on body areas such as the abdomen, arms, and thighs. Neither is a stronger version of the other. The right choice depends on the area you want treated, how much comfort matters to you, and your goals.
Think fit, not winner. Ultherapy is the option with FDA clearance specifically for brow and jawline lifting. XTherma trades that specific clearance for a notably more comfortable session and body-area versatility. Either can also be paired with SylfirmX RF microneedling for texture and tone.
How XTherma and Ultherapy Work
Both treatments are non-surgical, energy-based devices that heat tissue to trigger a collagen remodeling response, but they arrive at that goal differently, and they are described differently in the source information each manufacturer provides for its device.
Ultherapy uses micro-focused ultrasound (MFU-V) to deliver energy to the SMAS, the superficial musculoaponeurotic system, the same deep foundational tissue layer that surgeons address during a surgical facelift. The device includes real-time ultrasound visualization, which lets your provider see the tissue layer being treated on a screen before delivering energy. Ultherapy is the only non-surgical treatment with FDA clearance for lifting the skin on the brow, under the chin, and along the jawline, and for improving lines and wrinkles on the decolletage.
XTherma is a monopolar radiofrequency device that operates at 6.78 MHz, delivering high-frequency energy to the deeper layers of the skin. This thermal energy causes immediate contraction of existing collagen fibers and initiates a remodeling process that produces new collagen and elastin over the following weeks and months. What sets XTherma apart is its Smart Temperature Cooling (S.T.C.) system, which delivers seven integrated cooling pulses per shot, before, during, and after each radiofrequency pulse, protecting the skin surface throughout treatment.
Both devices target deeper tissue rather than the surface layer that treatments like RF microneedling address, though Ultherapy specifically visualizes and targets the SMAS while XTherma is described more broadly as reaching the foundational layers of the skin. For a fuller look at the technology on its own, see our guide, What Is XTherma.
Comfort, Treatment Time, and What the Appointment Feels Like
This is where patients notice the most practical difference between the two treatments, and it is often the deciding factor for people choosing between them.
An Ultherapy session takes 60 to 90 minutes depending on the areas treated. Most patients describe brief bursts of heat or prickling as the ultrasound energy is delivered, and the jawline and chin tend to be more sensitive than the brow or decolletage. Comfort measures include topical numbing cream and oral pain medication, and we also offer the Ultherapy Prime protocol, an updated approach with refined energy delivery for improved comfort. There is no real downtime: most patients return to normal activities immediately, though mild redness, swelling, or tenderness can persist for a few days, and occasional tingling or numbness resolves on its own.
An XTherma session takes 45 to 60 minutes. Because of the integrated cryogen cooling, topical numbing is generally not required, and most patients describe the sensation as a deep warmth with simultaneous cooling on the surface. Downtime is minimal to none, with any redness typically resolving within a few hours, so patients can return to normal activities the same day.
For patients who researched Ultherapy but were hesitant because of the anticipated discomfort of a longer session, XTherma is frequently the treatment we discuss as a more comfortable starting point.
XTherma vs Ultherapy at a Glance
The table below lines up the two treatments across the factors patients ask about most. Cost is intentionally left off this table because a meaningful comparison depends on your treatment areas and plan, which we cover after the table.
| Factor | XTherma | Ultherapy |
|---|---|---|
| Energy type | Monopolar radiofrequency (6.78 MHz) with integrated cryogen cooling | Micro-focused ultrasound (MFU-V) with real-time visualization |
| Primary tissue target | Deeper layers of the skin, described broadly as foundational tissue | The SMAS, the structural layer addressed in a surgical facelift |
| Treatment time | 45 to 60 minutes | 60 to 90 minutes |
| Comfort during treatment | Deep warmth with surface cooling, numbing generally not needed | Brief bursts of heat, more noticeable at the jawline and chin |
| Downtime | Minimal to none, mild redness may last a few hours | None required, though mild redness or tenderness can last a few days |
| Typical sessions | 1 to 2 for initial improvement, 2 to 3 for more significant laxity | 1 session, with annual maintenance |
| Timeline to results | Progressive over months 1 to 3, peak around months 3 to 6 | Visible by 2 to 3 months, peak around 6 months |
| How long results last | 12 to 18 months, with annual maintenance recommended | 12 to 18 months, with maintenance sessions available |
| Areas commonly treated here | Jawline and neck, plus body areas such as the abdomen, arms, and thighs | Brow, jawline, neck, and decolletage |
| Pairs with SylfirmX RF microneedling | Yes, for texture and tone alongside deep tightening | Yes, for texture and tone alongside deep tightening |
Questions about skin rejuvenation?
Our providers offer consultations to discuss your options. The $50 fee is applied toward your first treatment.
Talk to a ProviderWhich Treatment Fits Which Concern
Because the two devices work differently and are described differently by their manufacturers, they tend to fit different patients and priorities rather than one simply outperforming the other.
When Ultherapy Tends to Fit Better
Ultherapy is the treatment with FDA clearance specifically for lifting the brow, chin, and jawline, and for improving decolletage lines, so patients whose primary concern is one of those specific areas often gravitate toward it. It is also appealing to patients who prefer a single, one-and-done session with annual maintenance rather than a short series.
When XTherma Tends to Fit Better
XTherma tends to fit patients who researched Ultherapy but were concerned about pain or cost, patients who want skin laxity addressed on body areas like the abdomen, arms, inner thighs, or knees, and patients who prefer a shorter, more comfortable series over one longer session.
When Combining Either Device With SylfirmX Makes Sense
Both XTherma and Ultherapy are described as working well alongside SylfirmX RF microneedling, since SylfirmX targets the mid-dermal and superficial layers for texture, tone, and pigmentation while XTherma or Ultherapy address deeper tissue laxity. Patients dealing with both structural laxity and surface texture concerns often build a plan that layers one of these tightening treatments with SylfirmX rather than choosing a single technology to do everything.
“Patients often come in having already decided which device they want, and the first thing we do is talk through what they actually want to accomplish. If the priority is a specific brow or jawline lift and they are comfortable with one longer session, Ultherapy fits. If they want a more comfortable series, or they want to treat an area on the body as well as the face, XTherma is usually the better starting point. We offer both, so the recommendation is about the patient, not the equipment.”
Guidance from the clinical team at Allen Medical Aesthetics
Cost, Sessions, and Getting a Recommendation at Consultation
Pricing for both treatments depends on the areas treated and the number of sessions your provider recommends, which is why we do not quote a flat number without a consultation. As a general point of comparison, XTherma paired with SylfirmX typically costs the same as or less than a single Ultherapy session while addressing a broader range of concerns.
Financing through Cherry, CareCredit, and Sunbit is available for either plan.
Board-certified medical director Tod Work, ARNP oversees all treatments at Allen Medical Aesthetics, and every XTherma and Ultherapy session is performed by ARNPs and licensed master aestheticians. Your provider evaluates your degree of laxity, the areas you want to address, and your comfort priorities before recommending XTherma, Ultherapy, or a plan that pairs either device with SylfirmX.
Frequently Asked Questions
Is XTherma or Ultherapy better for skin tightening?
Neither is universally better. Ultherapy carries FDA clearance specifically for lifting the brow, chin, and jawline. XTherma uses integrated cooling for a considerably more comfortable treatment and also treats body areas. The right fit depends on your treatment area, comfort priorities, and goals, which is why we build your plan around a consultation.
What is the main difference between XTherma and Ultherapy?
Ultherapy uses micro-focused ultrasound with real-time visualization to target the SMAS, the same structural layer addressed in a surgical facelift. XTherma uses monopolar radiofrequency with integrated cryogen cooling, which causes immediate contraction of existing collagen and initiates new collagen and elastin production over the following weeks and months.
Which treatment is more comfortable, XTherma or Ultherapy?
Patients generally find XTherma more comfortable. Its Smart Temperature Cooling system delivers seven cooling pulses per shot before, during, and after the radiofrequency energy, producing a sensation most patients describe as deep warmth with simultaneous surface cooling. Ultherapy delivers brief bursts of heat that are more noticeable along the jawline and chin, though topical numbing cream, oral medication, and the Ultherapy Prime protocol can improve comfort.
How many sessions will I need?
Ultherapy is typically performed as a single session, with annual maintenance recommended. XTherma is often performed as one to two sessions for initial improvement, with a series of two to three sessions spaced four to six weeks apart recommended for more significant laxity or when paired with SylfirmX.
How long do results from XTherma and Ultherapy last?
Both treatments are associated with results lasting roughly 12 to 18 months, with annual maintenance recommended to sustain the effect. How long results last for you depends on your skin quality, age, and lifestyle.
Can XTherma and Ultherapy be combined, or paired with SylfirmX?
Each device pairs well with SylfirmX RF microneedling, which targets the mid-dermal and superficial layers for texture, tone, and pigmentation while XTherma or Ultherapy addresses deeper tissue laxity. Whether to combine XTherma and Ultherapy with each other depends on your anatomy and treatment history, which is a question for your consultation.
Related Articles
This article supports our Xtherma Skin Tightening service page. Learn more about treatment options, candidacy, and what to expect.