Ulthera and EXION: A New Geometry for the Face
- Dr. Jan Dipasupil
- May 2
- 9 min read
She is forty-three. The dress for the dinner is hanging on the back of the bathroom door. The lighting in this particular bathroom has not been flattering since 2019, and she has stopped pretending otherwise. She tilts her chin up. The jawline she had at thirty-five is no longer the jawline she has now. Somewhere between the second child and the third promotion, the architecture of her face quietly relocated.
This is the appointment that fills Dr. Jan’s Tuesday afternoons.
The instinct, in a city now saturated with aesthetic technology, is to ask which device. The better question, the one Dr. Jan asks instead, is which layer.
Two layers, one face
Beneath the skin sits a fibrous sheet called the SMAS, the Superficial Musculoaponeurotic System. It is the architectural plane a surgeon engages during a facelift. Above it sits the dermis, the fat, and everything else that makes a face look like a face. When a face begins to descend, it is the SMAS that has loosened. When a face begins to thicken in places it never used to, it is the layers above that have changed.
Two different problems. Two different solutions.
The architectural device, in brief
Ulthera, internationally known as Ultherapy, is the only non-invasive device that delivers focused ultrasound directly into the SMAS. Three transducers, three depths: 1.5mm for the superficial dermis, 3.0mm for the deeper dermis, 4.5mm for the SMAS itself. The fourth-and-a-half millimetre is the one that matters. It is the depth at which a non-surgical device crosses into surgical territory.
Ulthera does not soften, retexture, or melt. It tightens the scaffold. The result builds for three to six months as new collagen lays itself along the precise points where the ultrasound left its heat. For the right face, particularly one with confirmed structural descent and intact dermal quality, it is a phenomenal device.
It is also, at present, not a device offered at Jan Medical Group. Dr. Jan does not pretend otherwise.
“Ulthera has earned its reputation,” he says. “When a client presents with a face whose only meaningful problem is that the SMAS has descended, Ulthera is the right answer, and I will say so in the consultation room. We will offer her a referral if she would like one. What we do not do is pretend a device we run can substitute for a device we do not.”
The refinement device, at Jan Medical Group
EXION, made by BTL, is the device Dr. Jan does prescribe, and the device installed at the Bonifacio Global City flagship. EXION lives above the SMAS, in the layers where most of what a woman actually sees in the mirror lives. It pairs monopolar radiofrequency at 4MHz, which heats the dermis into remodelling collagen, with targeted acoustic ultrasound, which reaches into the subcutaneous fat layer and reduces stubborn localised fat by up to twenty-two percent in the treated area.
Hyaluronic acid synthesis improves on the way through, which is why clients describe their skin as feeling more hydrated for weeks after.
EXION is the device for the fullness under the chin that lingered after Mounjaro. The blurred jawline that a GLP-1 medication did not quite finish resolving. The dermal quality that has gone slightly flat in the last few years and cannot be argued with at any price point of cream.
For most of the women who walk into a JMG consultation, EXION is also the right place to begin.
Three women, three starts
A thirty-six-year-old executive sits on the consultation chaise on a Tuesday afternoon. She has lost twenty-five pounds on Mounjaro over eight months. The blazer she wore to the appointment is one she could not button last December. Her concern is the fullness under her jaw that did not leave with the rest. Dr. Jan examines the dermis. It is firm. The SMAS is not descending. The architecture, in a clinical sense, is intact.
For her, EXION Face. Three or four sessions, one week apart. The dermis tightens. The submental fullness softens. Ulthera was never the right question for her, because nothing structural was failing.
A forty-one-year-old, the most common case in the room now, has both. She lost eighteen pounds on Wegovy last year. Her jaw is still soft along its lower edge, where the fat has not finished resolving, and her brow has begun the descent that her mother began at the same age. Two problems. Two layers. One face.
Dr. Jan begins with what he can offer, and what she most immediately wants resolved. EXION Face first, to address the contour and the residual fat. Six months later, with the surface refined and the architecture now clearly visible, he revisits the question of the SMAS. If structural lifting is still indicated, he refers her to a colleague who runs Ulthera. The work is sequenced, not duplicated. To lift architecture before refining the surface is to commit a face to scaffolding that is still wearing last year’s drapery.
A forty-eight-year-old in a silk shirt sits on the same chaise on a different Tuesday. Her weight has been the same for twelve years. Her concern is the brow she did not used to need to lift in photographs, the early jowl that has begun to soften the line of her jaw, the neck that has lost an angle she remembers having. The dermis is healthy. The fat is appropriate. What has changed is the SMAS.
For her, EXION is not the first answer. Dr. Jan tells her so. He explains the architecture, walks her through what Ulthera does, and gives her the name of a colleague who runs the device. EXION may be useful later, after the structural lift is complete, to refine the dermis. That is a different conversation, six months from now. The first move is the architectural one, and it is not a move JMG offers.
The Dr. Jan principle
“We do not ask the client to choose between Ulthera and EXION,” Dr. Jan says. “We ask the face which layer is failing first. The face is always honest. It does not care which device is trending, and it does not care which device is in our clinic. My job is to read the face truthfully. If the answer for that face is a device we do not run, I will tell her so.”
How EXION fits into the larger picture
For most of the clients who arrive at Jan Medical Group, particularly the post-GLP-1 client, EXION is the appropriate first device. The contour and fat-layer concerns it addresses are usually what the client most acutely sees and most acutely wants resolved. For some clients, EXION will be the only device they need. For others, EXION clarifies the picture, and a structural device like Ulthera is then sequenced afterwards, on referral.
EXION can also be added on after Ulthera. For the client who has had her SMAS lifted elsewhere and now wishes to refine the dermis, smooth the texture, or address residual contour, EXION layers cleanly on top of completed structural work.
What is not advisable, and what Dr. Jan resists when clients propose it, is doing both at once without sequence. Layered work is layered for a reason. The architecture should be visible, or visibly intact, before the surface is refined.
The Renewed Body Programme
For the client navigating the post-GLP-1 era, EXION anchors The Renewed Body Programme at Jan Medical Group. EXION Face for the jawline and submental fullness. EXION Arms and EXION Body for the silhouette below. Where the architectural layer has also begun to descend, Dr. Jan refers the client to a colleague who runs Ulthera, and the two protocols are sequenced over the year. One programme. One face. As many devices as the face actually requires, prescribed honestly, in the right order.
The forty-three-year-old in the bathroom, the one with the dress on the door, will not need to ask which device. She will need to be asked, by a physician with the training to read the layers, which layer is failing first. The dress on the door will be there in March either way. The face under the dress is the longer conversation.
EXION is available at Jan Medical Group, Park Triangle Mall, Bonifacio Global City. Consultations with Jan Paolo P. Dipasupil, MD, and the physicians of Jan Medical Group are by appointment. Where a client requires a device not currently offered at JMG, including Ulthera, the clinic provides considered referrals. Enquiries: clinic@janmedicalgroup.ph.
Quick Reference
Ulthera and EXION, briefly
Ulthera (also known as Ultherapy) is a non-invasive micro-focused ultrasound device that delivers heat at three depths: 1.5mm, 3.0mm, and 4.5mm. It is the only non-surgical device cleared to reach the Superficial Musculoaponeurotic System (SMAS), the same architectural layer engaged during a surgical facelift. It is best suited for clients with structural descent: jawline blurring, early jowls, brow descent, neck laxity. Results build progressively over three to six months as new collagen forms. Ulthera is not currently offered at Jan Medical Group; clients who require it are referred to a trusted external provider.
EXION is a radiofrequency and acoustic ultrasound platform from BTL that works in the dermis and the subcutaneous fat layer above the SMAS. It tightens the dermis, improves skin quality and hydration, and reduces stubborn localised fat by up to 22 percent in the treated area. It is best suited for clients with contour concerns, post-weight-loss residual fullness, and dermal-quality issues. EXION Face addresses the jawline and submental area; EXION Body and Arms extend the protocol below the neck. EXION is available at Jan Medical Group, Bonifacio Global City.
The two devices reach different layers and solve different problems. They are typically used in sequence, not in competition.
Frequently asked questions
What is the difference between Ulthera and EXION? Ulthera is a micro-focused ultrasound device that reaches the SMAS layer at 4.5mm depth, the same architectural plane a surgeon engages during a facelift. EXION is a radiofrequency plus acoustic ultrasound device that works in the dermis and the subcutaneous fat layer, above the SMAS. Ulthera lifts the architecture. EXION refines the surface and reduces localised fat. They address different problems and are often used in sequence.
Which is better for the face, Ulthera or EXION? Neither is universally better. Ulthera is better for structural descent (descending jawline, early jowls, brow drop, neck laxity) because only it reaches the SMAS. EXION is better for contour and dermal concerns (post weight loss fullness, soft jawline, dermal texture) because it works the fat and dermis layers Ulthera does not target.
Does Jan Medical Group offer Ulthera? No. Jan Medical Group offers EXION at its Bonifacio Global City flagship. Where a client presents with structural descent that requires Ulthera, Dr. Jan provides a considered referral to a trusted external provider. The clinic’s view is that honest assessment matters more than running every device under one roof.
Should I start with EXION or Ulthera? For most clients, particularly those whose primary concern is contour, fullness, or post-weight-loss residual fat, EXION is the appropriate first device because it addresses what the client actually sees in the mirror. For clients whose primary concern is structural descent, Ulthera is the appropriate first device, and Dr. Jan will refer accordingly.
Can EXION and Ulthera be combined? Yes, in sequence. The most considered protocol is to begin with EXION on the dermis and fat layer, then layer Ulthera underneath to address the SMAS once the surface work is complete and the architecture is visible. Some clients begin with Ulthera elsewhere and add EXION at Jan Medical Group afterwards to refine the dermis. What is not advisable is performing both at once without sequence.
Can I do EXION after Ulthera? Yes. Many clients do Ulthera first to lift the SMAS, and then add EXION afterwards to refine the dermis, smooth skin texture, or address residual contour concerns. EXION layers cleanly on top of completed structural work.
Does Ulthera reduce fat? Ulthera is not a fat-reduction device. It tightens skin and lifts the SMAS architecture. Some clients notice a slight reduction in submental fullness because of the tightening effect, but Ulthera does not target the fat layer the way EXION does.
Does EXION reach the SMAS? No. EXION works in the dermis and subcutaneous fat layer, above the SMAS. This is by design. EXION’s strength is contour refinement and dermal tightening, not architectural lifting.
Where can I get EXION in the Philippines? EXION is available at Jan Medical Group’s Bonifacio Global City flagship. Consultations include a full clinical assessment that determines whether EXION is the right device, whether a complementary protocol like Ulthera is also indicated, and the order in which the work should be sequenced.
How many sessions are needed for EXION? EXION is typically a series of three to four sessions, one week apart, with maintenance every six to twelve months. A standard Ulthera course, by comparison, is typically a single annual session, with results building over three to six months.
Is there downtime with EXION? No. EXION is non-invasive and requires no downtime. Mild redness or warmth resolves within a few hours. Clients return to work and social activities the same day.
About the author
Jan Paolo P. Dipasupil, MD is the medical director of Jan Medical Group, a physician-led medical aesthetics and wellness clinic with flagships in Bonifacio Global City, Taguig and Quezon City. He is Vice President at the Philippine Digital Medicine Society (PDMS). His clinical practice integrates obesity medicine and lifestyle medicine, with a particular focus on the post-weight-loss client on GLP-1 therapy.
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