Great question — this is something that comes up often in consultations. Previous Ulthera (Ultherapy) treatments generally do not affect the SMAS layer directly, as the energy doesn’t penetrate deeply enough to reach below it. However, they can cause changes in the subdermal plane, such as tissue tightening and fibrosis, which may affect surgical dissection. While it doesn’t necessarily make the surgery riskier, it can make the procedure more technically demanding. The surgeon may need to spend more time performing careful, precise dissection to avoid damage to adjacent tissues. In experienced hands, a deep plane facelift can still be performed successfully after Ultherapy — but it’s important to let your surgeon know about your treatment history, as it may influence the surgical approach and planning. I hope this helps clarify things!