Dr. Angela Hwee: Can Sofwave and Ultherapy replace injectables?

Today, there are a variety of aesthetic treatments that are well proven to treat facial lines, wrinkles, and other symptoms of ageing. These run the gamut, from non-surgical facelifts to HA fillers

While they might work differently and cater to varying patient profiles, these burgeoning technologies have a few things in common: they’re safe, painless and brisk. 

In this article, we’ll shine the spotlight on two popular ultrasound treatments: Sofwave™ and Ultherapy®. Most importantly, we’ll address if they can replace conventional anti-ageing injectables like Botox and fillers. 

What are Sofwave and Ultherapy?

Firstly, both treatments make use of ultrasound technology to stimulate new collagen in order to firm, lift, and redefine one’s visage. The main difference is the depths at which ultrasound energy is delivered:

  • Sofwave uses proprietary Synchronous Ultrasound Parallel Beam SUPERB™ technology to heat the mid-dermal tissue at a precise depth and temperature, rejuvenating collagen and improving skin.
  • Ultherapy targets the deep structural layers of the skin. It is known by aestheticians as the go-to for non-surgical skin lifting because it offers unique micro-focused ultrasound with real-time visualisation and proven efficacy.

Dermal fillers, on the other hand utilise varying substances like autologous fat and hyaluronic acid to boost HA levels in the skin. While they are a choice option for many, improper administration can lead to swelling and lumpiness, and more severe side effects such as tissue death and embolism leading to blindness[1].

How do Sofwave and Ultherapy work?


As ultrasound energy is delivered, patients may feel a warmness of the skin, which can be resolved by applying a topical anaesthetic cream before treatment.

Following treatment, there is no need to apply special care to the skin. Treatment for the full face and neck usually takes around 45 to 60 minutes. Patients may resume their daily activities quickly post-treatment.


Ultrasound goes deeper than any other non-invasive treatment and can firm and lift the face   After treatment, you’ll be able to immediately return to your usual activities. Your skin might appear flushed initially, but the redness should disappear within a few hours or days. 

Ultherapy treatments usually last:

  • 30 minutes: Décolletage
  • 45 minutes: Lower face and neck
  • 60 minutes: Full face
  • 90 minutes: Full face and neck

Research finds that Ultherapy treatment can increase the rate of collagen production in the skin by an average of 42%[2].

Comparing Sofwave and Ultherapy

How new it isEstablished in 2020Established in 2004
Treatment areasThe eyebrows, neck, and submental area.The full face, neck and décolletage.
FDA clearanceYes.Yes.
DepthSofwave is delivered at 1.5 to 2mm, producing bulk heating of the middle-to-deep layer of the skin where collagen is most abundant.
This lowers the risk of destroying good fat in the face, or causing injury to muscles and nerves in the deeper tissue.
Ultherapy is delivered at 1.5mm, 3.0mm, and 4.5mm. 
Amongst the non-invasive skin treatments, Ultherapy reaches the deepest.
It is the only treatment other than surgery to affect the SMAS  layer.
Real-time visualisationNo.Yes.
EffectsIt improves fine lines and wrinkles; crepey skin becomes firmer and more youthful in appearance.Loose and sagging skin is  tightened, lifted, and firmed, resulting in a more youthful appearance.
DowntimeNo downtime.No downtime.
ResultsFinal results take about 2-3 months and last a year.Full results take 3-6 months to show and last a year. 
Treatment length for face45 minutes.
45 minutes. 
No. of treatments neededOne.One.
Applicable to all skin typesSuitable for all skin types and tones.Suitable for all skin types and tones.

As you can see, Sofwave and Ultherapy are not that different, apart from the skin depths they can reach. When the various depths of the skin are treated together, optimal results can be achieved. 

For that reason, I often recommend patients to do both treatments to enjoy the best of multiple worlds. Differing treatments do not have to be done together – a patient can do them at separate times (eg. a few months apart).

Who should go for Sofwave or Ultherapy?

Firstly, Sofwave and Ultherapy are great alternatives for those who are not ready to undergo plastic surgery. While surgery obviously produces more dramatic results, it also comes with more risks and possibilities of scarring.

​​Neither Ulthera nor Sofwave is inherently better than the other – they’re different, and work best for different people.

Skin issuesAge groupPriority treatment
Skin quality issues (eg. crepey or thin skin) characterised by collections of lots of fine lines (as opposed to deep folds or wrinkles)If a patient is relatively young (eg. in their late twenties) with no to mild signs of sagging.Sofwave
Deeper wrinkles and folds, and have not just loose skin, but sagging cheeks and jowls (which usually occurs later in life)Older patients who have developed sagging jowls.Ultherapy

Do note that your lifestyle will affect the outcome of your results. Unhealthy lifestyles, like smoking or unprotected sun exposure, will affect both your ability to produce collagen and rate of collagen destruction.

How do Sofwave and Ultherapy compare to injectables and other collagen biostimulators?

Unlike botox and fillers, Sofwave and Ultherapy do not directly deliver any substances into the skin. They deliver energy to stimulate the production of new and au naturel collagen. Therefore there is no danger of producing too much collagen and looking unnatural.

With that said, I do not encourage dismissing injectables altogether. In fact, any good physician who has your best interests at heart should tailor a regime that targets different regions of the face – this often involves a combination of injectables, ultrasound technologies and/or laser therapy. 

Take a patient with a large and bulky jawline. To address the cause of the squarish face shape, it is necessary to decrease the size of  the jaw muscles with neurotoxins. Once the jaw muscles are relaxed and smaller, that’s where Ultherapy or Sofwave come in to tighten, firm and lift the skin, enhancing the results and contributing to a V-shaped face. 

For further improvement, I usually advise fillers 2-3 months later after the face has been lifted and the skin tightened

Choosing the right clinic for Sofwave or Ultherapy 

Every technology (especially good, reputable ones) has imitators, so beware of fake machines.

​​All practitioners who have purchased the genuine Ultherapy system will have a Certificate of Authenticity which they should be able to show you in their clinic. In addition, they will be included on this list of authorised Ultherapy® clinics.

Any questions? Feel free to drop me a message! 


  1. Vedamurthy, M. (2018). Beware What You Inject: Complications of Injectables—Dermal Fillers. Journal of Cutaneous and Aesthetic Surgery, 11(2), 
  2. Ultherapy. (n.d.). Ultherapy. Retrieved July 25, 2022, from https://ultherapy.com/