How are Ulthera, Sculptra and Thermage combined in one plan?

By Dr. Young Jun Kim, Medical Director, Violacell Plastic Surgery · Board-certified plastic surgeon (Korea)

They are combined by layer: Ulthera for the deeper supporting layer (SMAS) and, at shallower depths, the dermis; Sculptra for lost volume and support; and Thermage, often with the skin booster Re2O, for the skin itself. A plan starts by deciding which layers have actually changed, so many people need only one or two of these, not all three. The order and spacing are then set so that swelling from one treatment does not hide or distort the next, and so that injected product is not disturbed while it settles.

Combining is not about doing more. It is about matching each tool to the layer it suits and leaving out what is not needed.

Why one treatment rarely covers everything

The face ages in five layers: skin, the fat under it, the muscle with its supporting sheet (SMAS), deep fat and bone. Most faces show change in more than one. A cheek can have lost volume while the jawline below it has loosened and the skin over both has thinned. A single device or product reaches only part of that picture.

Dr. Kim writes that lifting should start by looking at every layer to find the cause (blog post). A combination plan is simply that principle applied to a face with more than one cause.

Which tool for which layer

Treatment	Main layer	What it aims at	What it does not do
Ulthera / Ultherapy PRIME	SMAS at 4.5 mm; dermis at 3.0 and 1.5 mm	Firming and a modest lift of the deeper layer; skin firmness	Replace lost volume, remove excess skin
Sculptra	Fat layer and, in some areas, close to bone	Gradual restoration of volume and support	Lift heavy, descended tissue
Thermage FLX	Dermis and the fibrous strands below it	Firmer, smoother skin, including around the eyes with the Eye Tip	Lift the SMAS or add volume
Re2O	Skin (dermis)	Skin quality: texture and thickness	Tighten or lift

Not everyone needs all three

Some common patterns, as general illustrations rather than fixed recipes:

Mainly skin: fine lines, crepey or dull skin with little sagging. Thermage, with or without Re2O, may be enough.
Early laxity with good volume: a softening jawline in a face that is not hollow. Ulthera, sometimes with Thermage for the skin.
Volume loss with early laxity: hollow temples or flat cheeks above a loosening jawline. Sculptra and Ulthera planned together.
A lean face with laxity: deep energy is placed more conservatively, and volume support may come first or alongside.
Clearly descended tissue or excess skin: no combination of these replaces surgery.

Order and spacing: the general principles

Thermage and Re2O on the same day: the device is commonly used first and the injections afterwards, so the injected material is not heated or pressed by the treatment tip. Separate visits suit sensitive skin or an upcoming event.
Ulthera and Thermage: they are often combined so each works on the layer it suits. Whether they are done on the same day or separately depends on the areas, comfort and swelling.
Sculptra with a device: the device treatment and the injections are separated or ordered so that swelling from one does not confuse the assessment of the other, and so that injected product is not disturbed by device energy while it settles.
Series treatments: Sculptra is typically given as two or three sessions about four to six weeks apart. In his column on Re2O, Dr. Kim describes around three sessions spaced three to four weeks apart for a fuller effect, noting that one session can already help.
Reassessment: Ulthera is commonly reassessed about once a year. Thermage, in his answers to patients, typically holds for around ten months to a year.

An example of how the timing can fit together

The table below only shows how these spacing rules can fit into a calendar. It is not a protocol, and the actual plan, order and number of sessions are decided after examining the face.

When	What might happen
First visit	Examination by layer. If indicated, an energy treatment such as Ulthera and/or Thermage; Re2O after Thermage if chosen.
A few weeks later	Early review. A Sculptra or Re2O session if they are part of the plan.
About 4–6 weeks after that	Next Sculptra session if needed, planned from how the face responded.
About 3 months	The period when many people first see firming from the device treatment.
About 6–12 months	Reassessment of all layers before anything is repeated.

How each step is judged before the next

Each treatment in a plan should be judged on its own before more is added. That means waiting until early swelling has settled, comparing photos taken in the same light and position, and checking by touch how the tissue has changed. If the first step has already done enough, later steps can be reduced or dropped. If one area responded less, the next session is adjusted for that area rather than repeated as before. This is one reason Dr. Kim treats shot numbers and depths as following the diagnosis rather than a fixed package.

Before you start a combination plan

Tell the clinic about all previous treatments in the area, especially fillers, threads and fat grafting, since they change how energy and injections should be placed.
Mention blood-thinning medicines and supplements that make bruising more likely.
Plan around events: Re2O bumps usually settle within a day or two, Sculptra can cause swelling and bruising for several days, and tenderness after Ulthera can last longer along the jaw.
If you are travelling, ask how a series can be fitted into your visits; see Planning non-surgical lifting on a visit to Seoul.

What Dr. Kim has said about combining

In his answers to patients, he explains that radiofrequency devices such as Thermage suit fine wrinkles and skin elasticity better than focused ultrasound, which works deeper, and that combining the two lets each treat the layer it suits.
In one answer, he describes around 300 Ulthera shots together with around 300 Thermage shots as a good option for light maintenance; as with all his shot numbers, the right amount follows the diagnosis.
In his column on Re2O, he writes that it can be used alone but is often paired with Ulthera or radiofrequency, so that the device works on lifting and firmness while Re2O works on the dermis.
In 2026 he lectured to clinicians at the HILO WAVE launch symposium on an injection strategy that plans the lift first while keeping natural volume (report), and gave a theory lecture on stepwise combination treatment at the DEEP Symposium in Seoul (report).

Why it matters who plans it

A combination plan is only as good as the reading of the face behind it. Dr. Kim trained in facial surgery at Chonnam National University, where he was a clinical professor, so he learned the layers by seeing them. He plans Ulthera from the ultrasound image and palpation, places collagen stimulators by layer and goal, and pairs Thermage with Re2O when the skin itself has changed. When tissue has descended beyond what these can do, he says so, although he does not perform surgery at Violacell. Why Dr. Kim for Ulthera, Sculptra and Thermage

Risks and who should not combine

Combining adds the risks of each treatment: swelling, tenderness, bruising, rare nerve irritation or burns from devices, nodules from Sculptra, and rare vascular complications with any injectable. Swelling can build up when treatments are close together, and it becomes harder to tell which treatment caused a reaction. More treatment also means more visits and more cost. Combination plans are generally postponed during pregnancy or breastfeeding and with active skin infection, and Thermage is generally not used with a pacemaker or other implanted electronic device. Results vary and cannot be guaranteed.

Common questions

Do I need Ulthera, Sculptra and Thermage together?

Usually not. Each treats a different layer, so the plan includes only the treatments for the layers that have changed. Many people need one or two.

Can Ulthera and Thermage be done on the same day?

They are often combined so each works on its own layer. Whether on the same day or separately depends on the areas treated, comfort and swelling, and is decided at consultation.

Why are Sculptra and a device not always done together?

Swelling from one can hide or distort the effect of the other, and injected product needs time to settle before device energy is applied over it. So they are separated or ordered with care.

Can a combination replace a facelift?

No. Together these can improve firmness, volume and skin quality, but they cannot remove excess skin or reposition clearly descended tissue. When sagging is marked, a mini facelift or facelift is usually the more effective option.