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Blepharoplasty consistently ranks among the top five most popular cosmetic procedures, but not every patient with eyelid concerns is a candidate for surgical intervention, and others may wish to avoid the downtime associated with surgery. Treatment with radiofrequency (RF)-based devices is considered the gold standard for non-surgical eyelid rejuvenation. Still, individuals who have thicker skin or more severe laxity around the eyelids don’t always achieve optimal results with RF technology.

Ultherapy is increasingly considered an option for these individuals and can produce extremely impressive and natural-looking results. Ultrasound energy may penetrate more deeply into the skin than RF energy, bypassing the epidermis, to tighten collagen in the dermis. The high frequency sound waves may also bypass the melanocytes in the epidermis, which is why the technology poses low risk for pigmentation issues.

A Role for Ultherapy

For patients with mild laxity around the eyes, I recommend Ultherapy treatment once a year, but for those with moderate to severe laxity, treatment every four to six months can achieve the desired aesthetic results. Results may appear gradually, typically within six to 12 weeks after treatment. Ultherapy results would be permanent if we didn’t continue to age, therefore regular maintenance sessions are recommended. In the last three years, we have performed more than 1,000 of these procedures, and most patients return for maintenance before we even remind them to schedule a follow-up appointment.


Manjula Jegasothy, MD discusses the Ultherapy body lift and other minimally invasive body contouring techniques and technologies with Joel L. Cohen, MD.

Operator technique is important. In my opinion, eye shields tend to be problematic, so I hold the eyes closed during the procedure. Treating the upper lid is more painful than the lower eyelid, because there are more nerve endings in the upper lid. No anesthesia is required, but some patients prefer oral medication to reduce any discomfort or anxiety.

Some patients may experience redness and linear urticaria after treatment. This can be prevented with prophylactic topical steroids on all treated areas. I sometimes recommend an antihistamine such as cetirizine (Zyrtec) before bed to minimize this reaction. Patients should sleep upright or at a 45-degree angle and watch salt intake for the first 24 to 48 hours after the procedure. In some cases, an over-the-counter diuretic serves to reduce residual swelling.

Ultherapy vs. Blepharoplasty

While minimally invasive eyelid rejuvenation procedures don’t provide the same results as blepharoplasty, an Ultherapy eyelift can achieve about 30 percent of the improvement seen with blepharoplasty. With repeated treatments, this improvement may approach 70 to 80 percent of what is seen with an eyelid lift without changing the shape of the eye, a major downside of surgical eyelid lifts.

This article is based on a presentation given at Cosmetic Surgery Forum (CSF) 2018. CSF moves to Nashville, December 4-7, 2019. Visit for more information.

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