Sofwave vs Ultherapy comes down to depth. Both use ultrasound heat to make the skin build new collagen. Sofwave heats the middle layer of the skin, at about 1.5 mm, with cooling built into the handpiece. Ultherapy can work at 1.5, 3 or 4.5 mm, which reaches the deeper support layer a surgeon tightens in a facelift [1][7]
The only trial to compare the two directly, on the upper arms, found them equally effective, with similar pain [3] So the right choice depends on where your looseness sits, not on which machine goes deepest.
At Hampstead Aesthetics I offer Sofwave, and HIFU for deeper laxity. I do not offer Ultherapy. I chose Sofwave deliberately, and this page explains why, as fairly as I can.
Sofwave and Ultherapy side by side
Sofwave | Ultherapy | |
How it heats | Parallel beams of ultrasound heat a band of tissue | Focused ultrasound heats small points of tissue |
Depth | About 1.5 mm (range 1 to 2 mm): the middle layer of the skin [1] | |
Built-in features | Cooling protects the skin surface [1] | On-screen ultrasound imaging shows the tissue layers [2] |
US FDA clearances | Lines and wrinkles, brow, under the chin and neck, upper arms, acne scars, short-term cellulite [10] | Brow, under the chin and neck, lines on the décolletage [2] |
Usual sessions | Usually one; the brow and neck study used two [5] | Usually one, according to the manufacturer [11] |
Treatment time | About 30 to 45 minutes for a full face, according to the manufacturer | Took longer than Sofwave in the arms trial [3] |
Pain in studies | No significant difference from Sofwave in the arms trial [3] | |
Afterwards | Short-lived redness and swelling | Redness, swelling and occasional bruising [7] |
Longest published follow-up | Six months, with results stable [6] | The manufacturer says up to a year or more in some patients [11] |
London price (October 2026) | Here: lower face £1,450, full face £1,850, full face and neck £2,450. Other London clinics: about £1,000 to £3,690 [12] | Not offered here. Fees vary by clinic and area |
Offered at Hampstead Aesthetics | Yes | No (we offer HIFU for deeper laxity) |
Prices vary according to the treatment area and an individual assessment. The table compares treatments, not clinics.
A patient who had Ultherapy elsewhere
A professional in her early fifties came to see me after having Ultherapy at another clinic. She had noticed her jawline slowly losing definition. Her lower face looked heavier than it had five years earlier. She did not want surgery, and she avoided filler because she wanted to keep the natural shape of her face.
She had read widely before choosing Ultherapy. She expected some discomfort. She was surprised by how intense it felt, especially along the jawline, and even with pain relief she found parts of the session hard to get through.
For a few days she was swollen and tender. She went back to work quickly and nobody noticed anything, but her lower face stayed sensitive to touch for a while.
At three months she could see a modest change. Her early jowls looked slightly softer, mainly in side-on photos, and her skin felt a little firmer. She would not say it had failed. She had wanted natural, and it was natural. Given the pain and the price, though, she was not sure she would do it again.
Her questions for her next treatment were exactly the right ones. How comfortable is it? Which layer of the skin does it treat? Is there a gentler way to get a similar, natural improvement? The rest of this page answers those three questions.
Why depth matters more than patients expect
Most people assume deeper means stronger. It sounds logical. In practice, the deepest treatment is not automatically the right one, and I think the right depth for the right face matters far more.
Think of the face in layers. On top is the epidermis, the thin outer skin. Beneath it is the dermis, the layer of collagen and elastin that gives skin its firmness. Below that sits fat, and under the fat is the SMAS, a sheet of fibrous tissue that holds the face up. You can read more in how Sofwave works.
Sofwave delivers its heat into the dermis, at about 1.5 mm, and heats it to around 60 to 70°C The heat damages collagen in a controlled way, and the skin responds by building new collagen and elastin over the following months. It does not aim at the deeper fat or the SMAS.
Ultherapy creates tiny heated points at the depth the practitioner chooses, down to about 4.5 mm [1][7] At the deepest setting it reaches the SMAS, which is why it can lift heavier tissue. It also has a screen that shows the layers beneath the skin during treatment, so the practitioner can see where the energy will land [2]
That difference shaped my decision. Many of the patients I see are in their forties, fifties and sixties, and many have already lost some fat from their face. For them I wanted a treatment that concentrates on the quality and firmness of the skin itself, rather than one aimed deeper.
The head-to-head trial, and what it cannot tell us
Only one published trial has compared Sofwave and Ultherapy directly [3] Doctors treated the inner upper arms of 14 women, using Sofwave on one arm and Ultherapy on the other, chosen at random. Each arm had a single session, and the results were checked at 30 and 90 days.
What the evidence says • Sofwave was as effective as Ultherapy for loose, crepey skin on the upper inner arms at 90 days [3] • Pain scores were not statistically different between the two [3] • The Ultherapy side took longer to treat [3] Randomised split-body trial, 14 women, published 2025. Reviewed by Dr Chike Emeagi, GP and aesthetic doctor. One small trial, on arms, followed for 90 days. It does not tell us how the two compare on the face. |
That last point matters. The trial was small, it treated arms rather than faces, and it stopped at three months. It is useful evidence that neither treatment is plainly stronger, but it cannot settle the question for jowls or a neck.
What each treatment has shown on its own
Each device also has its own studies. These are not directly comparable, because they used different patients, areas and ways of measuring, but they show what each can do.
What the evidence says • Ultherapy: 35 patients had one session to the face and neck. At 90 days, 30 of 35 (86 per cent) were judged by blinded doctors to show a clinically significant brow lift, and the brow rose by an average of 1.7 mm [4] • Sofwave: in the study behind its first US clearance, blinded reviewers correctly picked the after photo for 78 per cent of patients (45 of 58) treated for lines and wrinkles, and no device-related adverse events were reported [1] • Sofwave: after two sessions, the brow rose by under 1 mm on average and loose skin under the chin and on the neck improved in 85 per cent of patients at three months [5] • Sofwave: in a small study of 15 patients with two sessions, the brow, under-chin and neck improvement was stable at six months [6] Prospective studies; several were funded by the manufacturers. Reviewed by Dr Chike Emeagi, GP and aesthetic doctor. Both treatments produce real but modest changes. Neither replaces surgery. |
Comfort compared
Neither treatment is painless, and I would never tell a patient otherwise. Both make the skin feel intensely hot for a moment, and the jawline and forehead tend to be the most sensitive areas.
In Sofwave’s own studies, average pain ranged from 5.3 to 7.5 out of 10, depending on the area treated [1][5][6] Sofwave cools the skin surface during treatment, which helps. In the arms trial, though, pain was no different between the two devices [3] so I do not claim that Sofwave hurts less.
What I can tell you is what patients describe. Most say Sofwave is intense but manageable, especially along the jaw, and afterwards they look a little pink and carry on with their day. More detail is in Sofwave aftercare guide.
What patients who had Ultherapy elsewhere tell me
Because I do not offer Ultherapy, I hear about it from patients who had it at other clinics. Their accounts vary widely, which in itself is useful to know.
- One woman in her fifties came in a few days after treatment for her jowls and cheeks. Her skin felt smoother but she saw no lift yet and was mildly tender. She also had cheek filler, which made her result harder to judge.
- Another felt her jawline was smoother at two months and thought it worthwhile, but was disappointed the improvement was not greater.
- A third was happy at six weeks, with her jowls improving, but described real pain and a week of swelling and soreness.
- One patient paid a substantial fee to treat early jowls and saw no noticeable change. She was unhappy about the cost.
- Another had a subtle, attractive improvement but found the treatment extremely painful.
- A man in his fifties who had lost a lot of weight was delighted with his neck two weeks after treatment, although it hurt far more than he had expected.
A few patients have also told me they worried that their face looked hollower afterwards. Their accounts alone cannot show that the treatment caused it. It is a concern I hear, though, and it is one reason I prefer a treatment whose heat stays in the dermis for faces that are already lean.
Who suits Sofwave, and who suits a deeper treatment
My starting point is always the face in front of me, not the age on the form. I assess where the ageing is actually happening: in the skin, in the fat, in the support layer, or in the bone beneath.
What I see at assessment | My usual approach |
Early jowling and mild loose skin | Sofwave |
Crepey skin, fine lines, loss of firmness | Sofwave |
A lean face, worried about losing volume | Sofwave considered, after careful assessment |
Deeper, more marked sagging | A deeper treatment such as HIFU, or a surgical opinion |
Heavy jowls and loose skin, hoping for a facelift result | An honest talk about surgery and realistic expectations |
Patients who suit Sofwave often tell me their face looks tired, their jawline is less defined than it was, or that they want firmer skin without filler. For them, improving the skin itself is the goal. The Sofwave candidate guide goes into this in more detail.
For more pronounced descent of the deeper tissues, a treatment that reaches the SMAS makes more sense. And if someone has marked sagging and expects the result of a facelift, I tell them plainly that neither Sofwave nor Ultherapy can reliably deliver that. Jowls caused by sagging skin and fat descent need a different plan from jowls caused by lost volume.
Darker skin and thinner faces
Ultrasound passes through the outer skin rather than being absorbed by its pigment, which is why both treatments are used across skin types. The published Sofwave data in darker skin is still small. The manufacturer’s own data included 10 patients with Fitzpatrick IV to VI skin [9], and a 2026 study of 42 Asian patients found improvement in loose skin under the chin and neck in 83 per cent at three months, with only short-lived redness and swelling [8] Ultherapy has its own published guidance for Asian patients [13]
In thinner faces I am careful with both. The same Asian study found a small trend towards reduced volume along the jawline and under the chin after Sofwave, which did not reach statistical significance [8] Even a treatment aimed at the dermis therefore needs a proper assessment in a face that is already lean.
Why I offer Sofwave and HIFU, not Ultherapy
I chose Sofwave because it fits the results I want my clinic to be known for: firmer skin, better skin quality and a subtle lift, with patients still looking entirely like themselves. Its controlled depth and built-in cooling suit that approach.
For patients whose laxity sits deeper, we offer HIFU, using a medical-grade system that delivers energy to the SMAS at around 4.5 mm. It is not the same device as Ultherapy, and it does not have Ultherapy’s on-screen imaging. It does give me a deeper option at a lower cost, and the Sofwave vs HIFU comparison explains how the two differ.
I would rather tell a patient which of these suits them than sell them the one in the room. Some patients are better served by HIFU, some by Sofwave, and some by a surgeon.
My verdict
I do not believe the most aggressive treatment is always the most effective. What matters is understanding the anatomy of the face, finding what is actually ageing, and choosing a technology that improves it without changing what makes that face recognisable.
Ultherapy has its place, particularly where deeper structural treatment is needed. For many of the patients I see, who want firmer, healthier-looking skin without major downtime, Sofwave is the treatment I recommend. You can see realistic timelines in Sofwave before and after and current prices in the Sofwave cost guide.
Key points
- Sofwave heats the middle layer of the skin at about 1.5 mm; Ultherapy can also reach the deeper support layer at up to 4.5 mm.
- The only head-to-head trial, on upper arms, found them equally effective with similar pain.
- Neither is painless, and neither gives a surgical facelift result.
- Sofwave suits early jowling, crepey skin and loss of firmness; deeper sagging may need HIFU or a surgical opinion.
- At Hampstead Aesthetics we offer Sofwave and HIFU, not Ultherapy.
Frequently asked questions
Which lasts longer, Sofwave or Ultherapy?
Nobody can say yet, because no study has compared how long the two last. Sofwave’s longest published follow-up is six months, and results were stable at that point. Ultherapy’s manufacturer says results can last up to a year or more in some patients. In both cases the new collagen keeps ageing with you, so many patients choose a maintenance session later. How long your result lasts depends on your skin, your age, sun exposure, smoking and weight changes as much as on the device.
Which hurts more, Sofwave or Ultherapy?
In the one trial that compared them directly, on the upper arms, pain scores were not statistically different. Both create intense heat for a moment, and the jawline and forehead are usually the most sensitive areas. Sofwave cools the skin surface during treatment, and numbing cream is applied beforehand. Some of my patients who had Ultherapy elsewhere found it very painful, while others tolerated it well. I would be wary of anyone who promises either treatment is painless.
Which is better for the neck?
Both are cleared in the US for lifting loose skin under the chin and on the neck. In Sofwave’s brow and neck study, 85 per cent of patients improved after two sessions, and a 2026 study in Asian patients found improvement in 83 per cent after one. Ultherapy can reach deeper on the neck, which may help where the tissue has dropped more. The right choice depends on whether the problem is mainly crepey skin or deeper descent, which is something an examination can tell apart.
Can I have Sofwave after Ultherapy?
Yes, in principle, because the two work at different depths. There is no published study of that sequence, though. It is sensible to wait until the full result of your first treatment has shown, which takes around three months, before deciding whether more is needed. Tell your practitioner exactly what you had and when. If you have filler in the area, mention that too, as the manufacturer advises against treating directly over filler.
Which suits darker skin better?
Both use ultrasound, which passes through the outer skin rather than targeting pigment, so both are used across skin types. Sofwave’s published data in darker skin is still small: 10 patients with Fitzpatrick IV to VI skin in the manufacturer’s data, and a 2026 study of 42 Asian patients with only short-lived redness and swelling. Ultherapy has published guidance for Asian patients. Whichever you choose, an assessment by a doctor who treats darker skin regularly matters more than the device.
Why don’t you offer Ultherapy?
I chose Sofwave because its heat stays in the dermis, which suits the natural, skin-focused results I want, and because many of my patients already have some facial volume loss. For patients who need a deeper treatment, we offer HIFU at around 4.5 mm. I respect the evidence behind Ultherapy, and if I thought a patient needed it specifically, I would say so. More often, the honest alternative is a surgical opinion.
How many sessions will I need?
Most patients have one session of either treatment. Sofwave’s brow and neck study used two sessions, and some patients choose a second for a stronger result. Collagen builds slowly, so the result develops over about three months rather than straight away. We review patients at six to eight weeks, and only then do we decide whether a further session would add anything.
If you are weighing up Sofwave, HIFU or a deeper option, arrange a skin assessment at Hampstead Aesthetics. We will look at where your laxity actually sits and tell you honestly which treatment, if any, suits it.
Dr Chike Emeagi
About the author
Dr Chike Emeagi, MBBS, MRCGP, MRCS, MSc, MBA. Over 12 years in Aesthetic Medicine. Hampstead Aesthetics, West Hampstead, London. GMC registration number: 4418489.
Dr Chike Emeagi is a GP and aesthetic doctor based in West Hampstead, London, with over a decade of clinical experience in non-surgical facial rejuvenation. He chose Sofwave for Hampstead Aesthetics and offers HIFU for deeper laxity, and he assesses every patient for whether an energy treatment, an injectable or a surgical opinion will serve them better.
This article is for informational purposes only and does not constitute medical advice. Individual results vary. A clinical assessment is required before any aesthetic treatment.
References
- US Food and Drug Administration. 510(k) summary K191421: Sofacia (Sofwave) system. 2019. Includes Sofwave treatment depth (1 to 2 mm), the Ulthera transducer depths (4.5, 3 and 1.5 mm), pain scores and pivotal study results. accessdata.fda.gov View source
- US Food and Drug Administration. 510(k) summary K180623: Ulthera System. 2018. Indications for use and imaging to 8 mm. accessdata.fda.gov View source
- Loyal J, Hartman N, Goldman MP. A single- center, blinded, split-body, randomized clinical trial of high-intensity, parallel ultrasound beams versus microfocused ultrasound with visualization for the treatment of upper inner arm skin laxity. Dermatol Surg. 2026;52(4):349-354. doi:10.1097/DSS.0000000000004881. PMID 41025649. View source
- Alam M, White LE, Martin N, Witherspoon J, Yoo S, West DP. Ultrasound tightening of facial and neck skin: a rater-blinded prospective cohort study. J Am Acad Dermatol. 2010;62(2):262-9. doi:10.1016/j.jaad.2009.06.039. PMID 20115948. View source
- US Food and Drug Administration. 510(k) summary K211483: Sofwave brow lift and submental and neck indications. 2021. accessdata.fda.gov View source
- Gold MH, Biron J. Efficacy and safety of high- intensity, high-frequency, non-focused ultrasound parallel beams for facial skin laxity. J Cosmet Dermatol. 2024;23(1):117-123. doi:10.1111/jocd.16098. PMID 38031530. View source
- Fabi SG. Noninvasive skin tightening: focus on new ultrasound techniques. Clin Cosmet Investig Dermatol. 2015;8:47-52. doi:10.2147/CCID.S69118. PMID 25709486. View source
- Chung MMH, Wong CSM, Chan MWM, Shek SYN, Yeung CK, Chan HHL. Evaluating the use of high-intensity non-focused ultrasound treatment to improve skin laxity and facial wrinkles in Asian patients. Lasers Surg Med. 2026;58(8):637- 643. doi:10.1002/lsm.70153. PMID 42226470. View source
- Sofwave Medical. Clinical white paper PB00030 (manufacturer data). sofwave.com, accessed October 2026. View source
- US Food and Drug Administration. 510(k) summary K250146: Sofwave system indications. 2025. accessdata.fda.gov View source
- Ultherapy UK (Merz Aesthetics). Patient information. ultherapy.co.uk, accessed October 2026. View source
- Published price lists of London clinics offering Sofwave, accessed 7 October 2026 (clinics not named).
- Park JY, Lin F, Suwanchinda A, et al. Customized treatment using microfocused ultrasound with visualization for optimized patient outcomes: a review of skin-tightening energy technologies and a Pan-Asian adaptation of the expert panel's gold standard consensus. J Clin Aesthet Dermatol. 2021;14(5):E70-E79. PMID 34188753. View source
