Which tightening system is the least painful and most effective?
Between Thermage and Ultherapy, in my opinion, they are equally effective when done well, but Ultherapy is much more painful. The newer Exilis system is least painful of all three of them, and seems to be (limited data still) as effective or possibly even slightly more effective than the first two.
But………. and this is key……….. no tightening system at age 58, is going to give you great results. More info on these systems.