Sofwave: 4 situations when a doctor may advise against it

"Ultherapy was so painful that I could never have it again." "My skin is thin. Is a lifting treatment still an option?"

These are things I hear from people who come to ask about Sofwave.

To be frank, Sofwave is not an upgraded replacement for Ultherapy. Its shallower treatment depth means less pain, but it cannot play the same role as Ultherapy when the sagging comes from deeper layers.

That is why I sometimes advise against Sofwave even when someone specifically requests it. Choosing it solely for less pain may not produce the change they wanted.

"If it works at a shallow depth, aren't the results shallow too?"

People occasionally ask me this. I do not see it that way. What matters is reaching the layer responsible for the problem; depth alone does not determine the size of the result. For someone whose main concern is dermal elasticity, energy delivered at a depth of 4.5mm is like an arrow that has passed its target. Energy targeting the upper to middle dermis, by contrast, hits the right target for that person. Collagen regeneration is known to develop gradually over several weeks to 2–3 months rather than immediately after treatment, so the timing of assessment should reflect that pace. Shallow does not mean weak; it means addressing a different layer. If dermal elasticity is the main concern, a device targeting that depth may be the more reasonable choice.

Four situations in which I consider it first

In my Cheongdam dermatology practice, there are generally four situations in which I consider Sofwave first. First, people with thin skin for whom delivering energy deep into the tissue may be burdensome. With thin skin, energy aimed at deeper layers can create an unwanted burden, making a device that treats a shallower layer a safer option. Second, people who have put off lifting treatments because they are sensitive to pain. I have often seen people give up on treatment altogether after a painful first experience. Third, people who want to manage dermal elasticity before pronounced sagging develops. At that stage, there is often no reason to address the deeper layers. Fourth, people who also want to treat thin-skinned areas such as the eye area or forehead. Thin treatment areas call for different device-selection criteria. Conversely, if deep-layer sagging is the main problem, Sofwave alone may fall short, so I first discuss a different plan. The device does not choose the patient; the condition of the skin determines the device.

Can Sofwave and Ultherapy share the work?

I am also asked, "If I have Sofwave, does that mean I do not need Ultherapy?" The short answer is that the two devices are closer to complementary treatments than substitutes. We may consider combining them, using Ultherapy for the deeper layers and Sofwave for the dermis. However, a combination is not always the answer. It makes sense when both layers have issues; if only one layer is involved, one treatment can be enough. I consider avoiding unnecessary additional treatment part of good planning.

How we decide at LUNN

I do not begin a consultation with a device already chosen. LUNN has Ultherapy, Thermage FLX and Sofwave, so there is no reason to steer the conclusion toward a particular device. I personally assess skin thickness, elasticity and sensitivity to pain before deciding whether Sofwave is appropriate, and I continue to handle treatment and follow-up myself. Treatment time depends on the area and extent, but it is often completed within an hour, so people with limited time may also consider it. Temporary redness or mild warmth can occur afterward. Collagen regeneration is gradual, and the time at which changes become noticeable varies between individuals. I explain these points before treatment.

There certainly are skin conditions suited to Sofwave. The decision, however, should be based on which layer the sagging originates in, rather than a preference about pain. Choose a practice that identifies that for you.

Related column: Ultherapy vs. Thermage: how do they differ, and do you need both? Related treatment information: Lifting and tightening lasers