I Have Read That Ulthera Hurts but What About Preventive Measures?

In October 2012, Ulthera announced a new protocol that is vastly more comfortable than the previous protocol.  Previously, ultherapy was extremely difficult to get through without pain management.  Now, most patients do not need pain medications.  However, for those that do, a combination of anti-anxiety medication and ibuprofen may be all that is needed.

Numbing cream does not penetrate to the dermal layer and connective tissues that are affected by Ultherapy so it's not used.  Pain killers and pills to reduce anxiety such as Ativan or Valium, help make the Ultheapy a much more comfortable procedure. Our practice in NYC is accredited as an office based surgical facility.  We ask our patients to consider thispain reduction regimen, and then if they agree, they schedule the treatment having had arranged someone to go home with them as they are not permitted to leave alone.

Most patients tolerate the treatment well, but there are patients who know themselves so well and they tell us they have a very low pain threshold and would not be able to tolerate the treatment despite medication by mouth. In that event, we have a board-certified anesthesiologist that can perform sedation in our accredited office-based surgical facility. This is extremely rare for Ultherapy.

The discomfort that patients experience with Ultherapy is variable but the pulses of micro-focused ultrasound are very brief. Some discomfort is unavoidable though because Ultherapy stimulates collagen remodeling through heat, and if the peak temperature is not high enough then there won't be much of a response. Most of our patients do well without numbing medication or drugs but we are happy to offer it if desired.

We have performed Ultherapy since 2011 in hundreds of patients with high satisfaction rates.I have had the procedure myself and asked my physician assistant to stop twice because of discomfort around the jaw. I pretreat my patients with ibuprofen an hour before and another does of 800 mg immediately before in liquid form and have never had a problem with my patients. I also recommend the use of Swell-X bioflavonoids for 10 days after the procedure.There is no need to write for prescription pain meds after the procedure. Read the Ultherapy book on the link below.

Ultherapy is the only technology that can treat the facial musculature from the surface, and yes, some discomfort can be experienced during the treatment.  Areas close to, or over the bone will be more uncomfortable.  I offer my patients prescription pain and anti-anxiety medication.  A topical numbing cream can also be applied.  Effectiveness varies upon the individual.  However, we have treated hundreds of patients in my office, and while some have found the procedure uncomfortable, I have never had a patient unable to complete the treatment.

The protocol change in 2012, significantly reduced the discomfort associated with Ulthera.  Most of my patients do very well with cool air or local anesthetic.  Some do well with nothing at all!  With local anesthetic, the patient feels very little of the treatment. Overwhelmingly, the patients have said that the results are worth the treatment and would do it again!

Facial numbing is generally not effective for pain control because the zones of treatment area much deeper than the penetration of commercially available numbing cream. However, there are oral or intramuscular injections that can be administered to make the procedure more comfortable.

I have performed several hundred Ultherapy treatments and have treated patients without meds, with nerve blocks, with valium/vicodin/and a nerve block, +/- NuCalm (a natural oral supplement that creates deep relaxation without controlled substances, causes no side effects, and requires no recuperative time or supervision).

Following are my personal observations:

Patients that state they have a "high pain tolerance", and are full-faced usually do well without any anesthesia and rate the discomfort between a 2-4.

Anxious patients who are thin do best with a block and valium/vicodin cocktail.

Non-anxious patients with average facial volume do well with a nerve block.

Men have overall tolerated this procedure better than women. 

I recommend a high dose of ibuprofen prior to the treatment per a current Ulthera Trial that has shown it to be as effective as a narcotic.

It is important to take the "pain medications" at leat 1 hour prior to the Ultherapy treatment. 

Patients should be reassured to know that if they are "uncomfortable", they can have more of a block, or they can do their treatment zones in stages.  Patients tolerate a 30 minute treatment, but anxioujs patients seem to fatigue after this point and if they break up the treatment into two sessions they do better (i.e midface, neck, and forehead treated on different days)

NuCalm helps to keep patients relaxed during treatment and is a great option for patients that don't have a driver but need something to "relax".

We avoid cooling the skin during the treatment because we want to maintain the heat in the skin for the best results.

 

Ulthera is worth it and Yes! it does and can hurt during treatment, so let's talk about pain management, first, a great and caring nurse for your treatment counts for a lot, second the Zimmer Air Cool, is really important, that cold air blowing on the skin numbs the skin surface, and really helps, third and most important with all of our patients we have a real discussion about pain medicines and nerves, and helping with nerves, and using Ativan can be just as important as helping with pain medicines, and which work for you and which don't,  Percocet, Vicodin, or Ultram, these are choices to discuss at your consult, and just as importantly the need for a designated driver, if you choose these medications.

There is no question that Ultherapy has some discomfort associated with it which can sometimes be significant. The level of discomfort really depends on the patient as pain thresholds vary widely from person to person. I had the treatment performed on me without any anesthetic or pain medication and I have to admit, it was certainly no trip to the spa! The good news is that I have never let any of my patients do that because the process can be made much more comfortable. I offer several different options to my patients for managing any pain associated with the treatment. My  preference is to utilize a combination of local anesthetic as well as some oral pain medication. I have offered mild oral sedatives to those patients who requested it--although they then needed to arrange for a ride home.

Fortunately, whatever discomfort or pain that you experience during the actual procedure only lasts during the course of the treatment itself. It does not carry over after you are done with the procedure. More importantly, the vast majority of my patients have been thrilled with the results and they have told me that any discomfort associated with the treatment was worth it.

Hope this helps.

Dr. Yalamanchili