Last updated on February 24, 2026 by Giorgia Guazzarotti
Exilis vs Ultherapy, which one is better for skin tightening? It’s a question many people silently ask – usually after standing in a certain light, or capturing themselves in a photo and thinking, “My neck looks a little softer and the skin that used to just… sit on top is now doing something different.” So you start noticing things. Someone mentioned Ultherapy. Someone else takes the Oath of Exilis. A clinic tells you there is one better and (surprise!) this is what they offer. You remain more confused than when you started. This article uses real clinical evidence to help you find which treatment is really best suited for your skin, your concerns, and your life.
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Exilis vs Ultherapy: what are they
So first things first: These two are constantly lumped together as “skin tightening treatments” and while that’s technically true, they work in very different ways.
exilisMade by BTL Aesthetics (you may call it Exilis Elite or Exilis Ultra 360, depending on which version of the clinic you have) Uses radiofrequency energy. Radiofrequency waves create heat, and that heat penetrates the skin and subcutaneous tissue sitting below. The new Exilis Ultra treatment technically combines RF with ultrasound technology, but the radiofrequency energy is doing the heavy lifting in terms of skin tightening. The treatment itself involves moving a handheld Applicator slowly over the treatment area – most people feel it like a warm massage, not really unpleasant. You will usually need four to six treatment sessions, spaced about a week apart, to get the best results.
ultratherapy Is a different animal. it Uses microfocused ultrasound with visualization. In plain English, it uses ultrasound waves focused at very precise points at specific depths beneath the surface of the skin. We’re talking 1.5mm, 3mm and 4.5mm, all aimed independently. That 4.5 mm depth is what really matters, because it reaches the SMAS layer (superficial musculoaponeurotic system), which is the same structural layer that a surgeon will work on in a surgical facelift. It’s the only non-invasive procedure with FDA clearance that actually reaches and stimulates that layer, which really makes a meaningful difference. Usually you only need one Ultherapy treatment, and then you wait – results develop gradually over two to three months as the tissue responds.
Short version: Exilis is widely heated in skin tissue. Ultherapy applies heat to precise, targeted points, more deeply.
Connected: Intensive RF vs. Ultherapy: Which One is Right for You?
What are their benefits?
Both treatments are basically trying to do the same thing, i.e. trigger collagen production, but the way they get there is different, and it matters to understand what kind of results you can realistically expect. When you heat skin tissue to the right temperature, the collagen fibers shrink and then, over the next few weeks, your body begins to produce new collagen to repair and strengthen the area. A histological study on radiofrequency treatment found a statistically significant 7.9% increase in dermal collagen content and a 34.7% increase in collagen synthesis in the treated areas.
Ultherapy works by creating What are thermal coagulation points called – small, deliberately controlled areas of thermal damage Heating the tissue at those specific locations, at each targeted depth, to approximately 65°C. Your body perceives this as an injury and responds by producing new collagen and elastin as part of the healing process. At the SMAS level, it also causes structural tightening of the tissue, which is why Ultherapy can produce a measurable lift rather than just general firmness. A 2023 systematic review pooling data from sixteen Ultherapy studies found that 92% of patients showed measurable improvement in skin tightening at ninety days..
Now here’s the part that’s really worth knowing, because you won’t hear it in most clinics: A randomized, split-face clinical trial published in Dermatologic Surgery placed subjects with Ultherapy on one side of their faces and monopolar RF on the other.No statistically significant differences were found between the two treatments together, and at thirty, ninety, or one hundred and eighty days. So when clinics tell you that one is dramatically better than the other, the published evidence doesn’t actually support it.
Where they really differ is on the body. Exilis treatment is FDA approved for skin tightening as well as fat lossG – Radiofrequency energy at the right depth causes fat cells to undergo apoptosis, essentially breaking them down. So if you’re struggling with stubborn fat deposits and loose skin in the same area (think abdomen, inner thighs, upper arms after weight loss) Exilis can address both simultaneously. Ultherapy does not do this nor is it designed to do this. It’s a facial rejuvenation and neck lift device, and that’s all.
Which areas do they target?
This is one of the most practically important differences and it’s important to be clear about it before booking anything. Ultherapy’s FDA-approved target areas are the brow, chin, neck and décolletage. That’s the list. It’s specifically designed to lift the facial skin and neck, and if your main concerns are eyebrows that are starting to droop, wrinkles forming along the jaw, or a neck that’s losing its definition, Ultherapy is working in those areas exactly as intended.
Exilis is quite widespread. Yes, it works on the face (jowls, under the chin, around the eyes), but it is also widely used on the abdomen, inner thighs, upper arms, love handles and areas where the appearance of cellulite is a concern. If your skin concerns extend beyond your face and neck, or you want to address fat deposits and skin laxity on the body at the same time, Exilis is simply the more versatile option because Ultherapy isn’t suitable for those areas at all.
Exilis vs. Ultherapy: Pain and Comfort
There is a real, consistently documented difference here, and it matters. Exilis is comfortable. The hand piece moves over the skin and the heat, while noticeable, is gentle and controlled – no numbing creams required, no painkillers recommended. Most people really enjoy it. The more comfortable treatment experience is one of the main reasons why people choose it over alternatives.
Ultherapy is not comfortable. pain during the procedure This stands out as one of the most consistently reported characteristics in study after study. Topical anesthetic and oral analgesia are usually recommended before treatment. The sensation is usually described as brief, sharp pulsations (almost like a deep tingling or aching sensation), especially along the jaw and cheek bones where the bone is close to the surface. Most people overcome it easily with proper preparation, but expecting it to be comfortable is a mistake.
Exilis vs Ultherapy: Side Effects and Recovery Time
Both have lower side effect profiles than invasive surgery, which is the whole point. Recovery time is essentially zero for both – You can resume your daily activities the same day, without any interruptions, without the use of needles.
With Exilis, you’ll usually notice some temporary redness and warmth in the treated area for a few hours. Since the heating occurs gradually and is distributed rather than concentrated, there is less risk of uneven thermal injury when it is done by someone who knows what they are doing.
With Ultherapy, redness, swelling, and tenderness are common after treatment and usually resolve within a day or two. Some patients experience temporary tingling or numbness in the treated area, which can sometimes last for a few weeks. Injury is possible. More serious side effects – nerve irritation, prolonged numbness, temporary facial weakness – are rare but they are documented in the literature, and it’s worth knowing about them. (PS: When treatment is performed by a board-certified dermatologist or experienced aesthetic physician who is using imaging guidance correctly and is not rushing the procedure, these risks are significantly reduced.)
How long do the results last?
Exilis results increase gradually during treatment sessions and improvements continue for several weeks thereafter As collagen remodeling continues to progress. People generally describe stable firmness, improved skin elasticity, improved skin texture and slight but real fat reduction on areas of the body. Maintenance sessions every six to twelve months This is usually recommended to maintain results.
The results of Ultherapy develop more slowly – most visible changes occur around day ninety, with some improvements continuing for up to six months. The single-session format is really convenient. Clinical data suggests results last one to three years for most people, although this varies greatly depending on age, baseline skin quality, and how fast your skin continues to lax.
Here’s what both had to say honestly: Nor does it give the same type of lift that you get from surgery. If you are expecting any dramatic changes, you will be disappointed. What both treatments really offer is a meaningful improvement in mild to moderate loose skin (a change that helps you look more like yourself) without the recovery time or cost. This is a real and valuable thing, not a miracle.
bottom line
Clinical evidence does not give any one treatment a clear winner for face and neck skin laxity – head-to-head randomized trials show comparable results for both. The right treatment depends on what exactly you’re trying to fix, how much discomfort you’re willing to tolerate, what body areas are part of the picture, and how many sessions fit into your life. Ultherapy makes sense if you want a single-session facial lifting treatment, you don’t mind some discomfort, and you want the treatment with the deepest penetration and the largest published evidence base behind it. Exilis makes more sense if you want a comfortable multi-session option, you’re treating your face as well as body areas, or fat loss is part of your desire. Either way, a personal consultation with a board-certified dermatologist who has actual experience with both techniques can help you find out which treatment plan is really right for your skin — not a clinic that only offers one of them.
