Botox needs no introduction, and neither does Ultherapy. Both are unarguably the world’s most sought-after anti-aging solutions loved by medical practitioners and clients alike. But for those looking to start their own non-invasive skin-rejuvenating journey, there’s always a question as to which of these two they should go for.
While the most likely answer you’d get from a professional is that your choice depends on your concern: Ultherapy for those with overall skin sagging and botox for wrinkles and lines. However, we beg to differ. There’s no rule indicating that you cannot be treated with both Ultherapy and botox at the same time. On the contrary, the combined session, if done by an experienced practitioner, works wonders to eliminate any possible aging-related skin concern you may ever have.
Ultherapy and botox: The Differences?
Although Ultherapy and botox (we use the uncapitalised ‘botox’ here to refer to the line-reducing injectable treatment using botulinum toxin type A in general, and not the trade name Botox in particular) are the most revered treatments for skin-rejuvenation, they are as different as chalk and cheese in the involved procedure and result. Ultherapy uses micro-focused ultrasound to generate controlled damage and stimulate collagen-rich layers within the skin. This process practically jump-starts the body’s natural ability to create new collagen for firming and toning results. Botox, however, inhibits contraction in targeted muscles and in turns smooth wrinkles and fine lines. So, for people who only have either one of these two concerns, choosing one over the other treatment is more likely. But seriously, do we really have that luck, or luxury, of having just one singular aging concern when the time has come for us to start aging?
But if the combined treatment is available, why didn’t anyone talk about it earlier?
There’re probably a few reasons. First, patients usually visit a skin clinic with their choice of solution in mind and that’s usually botox. This is due to the fact that the injectable trade name has long been ingrained in our culture through, ahem, Hollywood and entertainment news. In addition, fine lines and wrinkles are easier to notice than skin sagging. You can have forehead and frown lines as early as in your mid-twenties while it’s not likely that you’d feel your collagen shrinking until nearing your forties. Coupled with the fact that botox is also used for facial contouring and slimming, which are famous even among university students and high-schoolers, who have a few decades to go before they need to know what Ultherapy is all about.
Another reason why the combined treatments may not be mentioned much is because it requires expertise from medical practitioners who need to be precise in analysing the problems to execute the treatments in ways that best benefit the patients. Also, we should never forget that although the Ultherapy technology we have now is quite comfortable and bearable, it was nothing like this at the beginning. The thought of going through the pain of the early Ultherapy, followed by botox, could give any patient a shudder.
So, it’s Ultherapy first, then followed by botox, right?

Yes, and there’s a reason for that. “We do Ultherapy first because the current machine and the new method we use is so advanced it helps determine the problems in the deep layers, allowing you to use botox only where Ultherapy doesn’t work well. This helps minimise the use of botulinum toxin,” said Dr. Sarawalai Rakchart of iSKY Centre. “The procedure we’re using is called Ulterapy Hyper-Personal Lift, which is a custom treatment plan executed in three sequential stages: See, Plan & Treat or you may have heard of the name Ultherapy SPT, which is basically a Real-Time Visualisation (MFU-V) technology. With this, aestheticians can assess the composition of the skin and its structure so they can plan each step of the procedure with more accuracy and confidence.
And botox right after Ultherapy…

Not literally as you’ll have a quick break to clean your skin. With Ultherapy giving you an immediate result, it’s much easier for the doctor to deliver botox to where you really need it. The question, however, is what brands of botulinum toxin should you use? Many clients who seek Ultherapy following years of botox injections reflect that the result of their recent procedures is not as satisfactory as earlier sessions, despite heavier dosage. “This is due to botox resistance,” said Dr Sarawalai. “Basically, the formulation of most botulinum toxin type A contains some impurities which can be proteins, inactive neurotoxins or bacteria DNA, for example. They are safe, however, they can trigger the immune system to create neutralising antibodies which can reduce the efficiency of the treatment or worse, make it entirely ineffective.”
The solution? Try Xeomin, a botulinum toxin type A formulated with 0% impurity. This German injectable works even for those with resistance to most botox. And if you’re a first-time patient, we highly recommend starting with Xeomin so you can enjoy the result of the injection for many years to come.
What about fillers? Can we incorporate them into the same session?
Since the effect of botulinum toxin type A usually take at least a few weeks to be noticeable, we highly recommend you check with your doctor after a month of your combined Ultherapy and botox session to see, first, if you need extra shot on any particular spot and, second, if you are still not satisfied with any particular parts where neither Ultherapy or botox work, such as laugh lines. “This is to correctly identify the remaining problems that can only be solved with fillers. Once you start to see the results of the combined session, you may think you don’t really need fillers anymore or even if you really need them, you’ll likely need much lower does that when you just using only fillers,” concluded Dr. Sarawalai.
Learn more about Ultherapy and Xeomin at www.merzclubthailand.com