I did Ultherapy but the doctor didn't use 4.5mm head for my treatment. Is this usual？

Many of my patients don't have thick enough skin of the cheek to use a 4.5 mm. transducer. I like doing Ultherapy because it gives me real-time visualization of the tissue I'm treating as I see it on the monitor and know exactly how deep I should treat, and what depth I need to avoid. This way I focus on tightening the dermis and stimulating more collagen. I have not had one patient develop fat loss from Ultherapy and have been doing this for all the years since it became FDA cleared.Using only the 3mm. transducer is in many cases, the only right way to do it as I have learned from experience.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs. 

The transducers are determined by what is seen on the Ultrasound scan- your provider will choose the depth based on your skin and muscle depths. Results of the ultherapy are seen after 4-6m so be patient to allow its effects to work. 1000 lines is reasonable for the lower face. 

Thanks for your question. It is correct that the Ultherapy treatment heads used are dictated by the thickness of the tissue. The doctor can see the target layer with the ultrasound and choose the right tip to reach it. Going "too deep" delivers energy to the bone, which does nothing for a lift as you can imagine. You would not be expected to see anything at this point. Wait 3 months to redo your photos.
Best,
Lisa Vuich, MD