Last Updated on February 24, 2026 by Giorgia Guazzarotti
Exilis vs Ultherapy, which is better for skin tightening? It’s a question a lot of people ask quietly – usually after standing in a certain kind of light, or catching themselves in a photo and thinking, “my neck looks a bit softer and skin that used to just… stay up, is doing something different now.” So you start looking into things. Someone mentions Ultherapy. Someone else swears by Exilis. A clinic tells you one is better and (surprise!) it’s the one they offer. You leave more confused than when you started. This article cuts through that, using actual clinical evidence, to help you figure out which treatment genuinely makes sense for your skin, your concerns, and your life.
Struggling to put together a skincare routine that minimises wrinkles, prevents premature aging, and gives your complexion a youthful glow? Download your FREE “Best Anti-Aging Skincare Routine” to get started (it features product recommendations + right application order):
Exilis VS Ultherapy: What They Are
So first things first: these two get bundled together constantly as “skin tightening treatments” and while that’s technically true, they work in pretty different ways.
Exilis, made by BTL Aesthetics (you might see it called the Exilis Elite or Exilis Ultra 360 depending on which version a clinic has) uses radiofrequency energy. Radiofrequency waves create heat, and that heat penetrates into the dermis and the subcutaneous tissue sitting underneath. The newer 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 a handheld applicator being moved slowly over the treatment area – most people describe it feeling like a warm massage, genuinely not unpleasant. You’ll usually need four to six treatment sessions to get the best results, spaced roughly a week apart.
Ultherapy is a different beast. It uses microfocused ultrasound with visualisation. In plain English, it uses ultrasound waves focused into very precise points at specific depths below the skin’s surface. We’re talking 1.5mm, 3mm, and 4.5mm, all targeted independently. That 4.5mm depth is the one that really matters, because it reaches the SMAS layer (the superficial musculoaponeurotic system), which is the same structural layer a surgeon would work on in a surgical facelift. It’s the only non-invasive procedure with FDA clearance to actually reach and stimulate that layer, which is a genuinely meaningful distinction. One ultherapy treatment is typically all you need, and then you wait – results develop gradually over two to three months as the tissue responds.
The short version: Exilis heats broadly across the skin tissue. Ultherapy heats in precise, targeted points, deeper.
Related: Profound RF VS Ultherapy: Which One Is Right For You?
What Are Their Benefits?
Both treatments are fundamentally trying to do the same thing, ie trigger collagen production, but the way they get there is different, and that matters for understanding what kind of results you can realistically expect. When you heat skin tissue to the right temperature, collagen fibres contract and then, over the following weeks, your body gets to work producing new collagen to repair and reinforce 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 treated areas.
Ultherapy works by creating what are called thermal coagulation points – tiny, deliberately controlled zones of thermal damage at each targeted depth, heating tissue to around 65°C at those specific spots. Your body treats this as an injury and responds by producing new collagen and elastin as part of the healing process. At the SMAS level, this also causes structural tightening of the tissue itself, which is why Ultherapy can produce a measurable lift rather than just a 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 genuinely worth knowing, because you won’t hear it from most clinics: a randomised, split-face clinical trial published in Dermatologic Surgery put Ultherapy on one side of subjects’ faces and monopolar RF on the other, simultaneously, and found no statistically significant difference between the two treatments at thirty, ninety, or one hundred eighty days. So when clinics tell you one is dramatically superior to the other, the published evidence doesn’t really support that.
Where they do genuinely diverge is on the body. The Exilis treatment is FDA-cleared for fat reduction alongside skin tightening – radiofrequency energy at the right depth causes fat cells to undergo apoptosis, essentially breaking them down. So if you’re dealing with stubborn fat deposits and loose skin in the same area (think post-weight-loss abdomen, inner thighs, upper arms) Exilis can address both simultaneously. Ultherapy doesn’t do this and isn’t designed to. It’s a facial rejuvenation and neck lifting tool, and that’s it.
Which Areas Do They Target?
This is one of the most practically important differences and it’s worth being clear about before you book anything. Ultherapy’s FDA-approved target areas are the brow, chin, neck, and décolletage. That’s the list. It’s specifically built for facial skin and neck lifting, and if your main concerns are a brow that’s starting to drop, jowls forming along the jaw, or a neck that’s losing its definition, Ultherapy is working exactly as intended in those areas.
Exilis is considerably broader. Yes, it works on the face (jowls, under the chin, around the eyes) but it’s also widely used on the stomach, 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 appropriate 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 gradual and controlled – no numbing cream needed, no pain relief recommended. Most people genuinely enjoy it. A more comfortable treatment experience is one of the main reasons people choose it over alternatives.
Ultherapy is not comfortable. Pain during the procedure comes up in study after study as one of its most consistently reported features. Topical anaesthetic and oral analgesia are commonly recommended before treatment. The sensation is typically described as brief, sharp pulses (almost like a deep zapping or aching feeling) particularly along the jawline and cheekbones where the bone is close to the surface. Most people get through it fine with proper preparation, but going in expecting it to be relaxing is a mistake.
Exilis VS Ultherapy: Side Effects And Recovery Time
Both have low side effect profiles compared to invasive surgery, which is the whole point. Recovery time for both is essentially zero – you can get back to your daily activities the same day, no downtime, no use of needles involved.
With Exilis, you’re typically looking at some temporary redness and warmth in the treated area for a few hours afterward. Because the heating is gradual and distributed rather than focused, the risk of uneven thermal injury is low when it’s done by someone who knows what they’re doing.
With Ultherapy, post-treatment redness, swelling, and tenderness are common and usually settle within a day or two. Some patients get temporary tingling or numbness in the treated area, which can occasionally stick around for a few weeks. Bruising is possible. The more serious side effects – nerve irritation, prolonged numbness, temporary facial weakness – are rare but they are documented in the literature, and they’re worth knowing about. (PS: These risks decrease significantly when the treatment is performed by a board-certified dermatologist or experienced aesthetic physician who’s using the imaging guidance properly and not rushing through the procedure.)
How Long Do Results Last?
Exilis results build gradually across the treatment sessions and continue improving for several weeks afterward as collagen remodelling keeps progressing. People typically describe a steady firming, improved skin elasticity, better skin texture, and on body areas, modest but real fat reduction. Maintenance sessions every six to twelve months are usually recommended to keep the results going.
Ultherapy results develop more slowly – most of the visible change comes in around the ninety-day mark, with some improvement continuing up to six months. The single-session format is genuinely convenient. Clinical data suggests results lasting one to three years for most people, though that varies a lot depending on age, baseline skin quality, and how quickly your skin laxity continues to progress.
Here’s the honest thing to say about both: neither delivers the kind of lift you’d get from surgery. If you’re expecting a dramatic transformation, you’ll be disappointed. What both treatments genuinely offer is meaningful improvement in mild to moderate sagging skin * the kind of change that makes you look more like yourself) without the recovery time or cost of going under the knife. That’s a real and valuable thing, just not a miracle.
The Bottom Line
The clinical evidence doesn’t hand a clear win to either treatment for facial and neck skin laxity – head-to-head randomised trials show comparable outcomes for both. The right treatment comes down to what you’re actually trying to fix, how much discomfort you’re willing to tolerate, whether body areas are part of the picture, and how many sessions fit your life. Ultherapy makes sense if you want a single-session facial lifting treatment, you’re okay with some discomfort, and you want the treatment with the deepest reach and the largest published evidence base behind it. Exilis makes more sense if you want a comfortable multi-session option, you’re treating body areas alongside your face, or fat reduction is part of what you’re after. Either way, a personalised consultation with a board-certified dermatologist who has genuine experience with both technologies is how you figure out which treatment plan is actually right for your skin – not a clinic that only offers one of them.
