Why don't doctors put their Ultherapy patients in a twilight sleep?

This is a great question. I think the procedure was initially thought not to cause much pain and was an alternative to surgery so it was more enticing to the company to promote it as an office procedure. That being said, I have had a board-certified anesthesiologist sedate one of my NYC Ultherapy patients who I knew from prior procedures to have an extremely low pain threshold. The pain is usually bad in just a few spots and it goes away as soon as the transducer is moved to the next spot.  Oral medication that we provide often is very helpful in reducing the pain to a manageable discomfort. Physicians just don't want to add unnecessary risk to elective cosmetic procedures, but if this is a concern of my patients, and as we have an accredited office-based surgical practice, we can administer sedation via an anesthesiologist during the procedure.

Our office specializes in Ultherapy procedures in Los Angeles. We offer a comprehensive lineup of anesthesia options for Ulthera with a board certified anesthesiologist. Dr. Karamanoukian 

Ultherapy is a very effective FDA approved treatment that uses ultrasound to induce collagen production with subsequent lifting and tightening.At our office, we have the capability of providing a range of "anesthesia" options to perform Ultherapy treatments. The range can be from nothing, to oral medication, to twilight sleep or even general anesthesia. Most patients tolerate Ultherapy treatments very well, but everyone's "pain" threshold and expectations are different, so we offer a variety of options to provide the best possible experience for our patients.The attached link provides more information.I hope this helps.

Here in our office we offer the Ultherapy treatments using dental blocks and topical for those patients who would like to be able to drive themselves home after the treatment. For those that are more sensitive to discomfort we will generally offer a valium so long as they have someone to drive them home or in the event that you are particularly sensitive to pain we also offer the procedure under IV Sedation. The IV sedation is overseen by a board certified anesthesiologist and generally adds from $450.00 - $1,000.00 depending on the ammount of time necessary to deliver the procedure.

You can be given medications for anxiety, pain and sedation.  I also sometimes use nitrous, this is very helpful.  I suggest going to someone who offers better pain control and the procedure will be more tolerable.  Thermage is equally as good in my hands without any pain.  Best, Dr. Emer.

It is possible to have sedation on general anesthesia with Ulthera. As long as you are having the procedure done at a facility where they offer it, such as Hall Plastic Surgery and Rejuvenation in Austin Texas.

I have done Ultherapy procedures for at least 4.5 years and have only stopped once because a patient could not tolerate it. Fortunately, they were 2 sisters. One sister had it done right before the other and kept telling her "don't be a baby". I stopped the procedure because she was obviously having significant discomfort. Reducing the amount of HIFU energy would have made the procedure less effective, so it was better to bring her back with some oral valium. Having said that, I have myself have had Ultherapy and found it to be a little uncomfortable around the lower face. This was 3 years ago. Since then, they have reprogrammed the device and there is really no concern in regards to pain from the patient standpoint. It is really the choice of the physician and patient. If you want to pay for the conscious sedation, you should go ahead and do it. The real 'art of sclerotherapy' is to find an expert who can do Ultherapy without conscious sedation where you have little or no discomfort. Someone like that has perfected the technique and can assure you that there will be little or no discomfort. Read the Ultherapy book on the link below - ebook section

Thanks for your
question and the reality is that everyone’s pain threshold is different and
that some patients need to be into a twilight sleep while others tolerate the
procedure with virtually no pain control. The addition of sedation adds a cost,
and when needed, we all will agree that this is something that should be
available to patients. Whether you use oral medication and intramuscular
sedation and pain control, the patients need to understand that they cannot
drive after the procedure, and believe it or not, this sometimes is an issue. We
do make sure that we have keys before the procedure and that the patient has
their ride ready for them – otherwise we have all had patients say this and
then go drive off on their own, which is a liability nightmare.



Ulthera has new
protocols called Amplify – with less pain now as compared to previous
protocols. Many tolerate this without too much discomfort. But in the end,
patients should be comfortable and we all work towards this goal during Ulthera
treatments.

There
are many options for pain control, which experienced doctors do use. But there
is a positive and a negative side to each approach. Some forms of anesthesia
add not only risk but also cost. There
are topical methods, injections, and oral medications that are commonly
used. Discuss your options with an experienced
provider. Also, many patients like to be
able to drive themselves immediately after the procedure and actually do
tolerate it quite well without any systemic pain intervention.

Like the other consultants, I agree that Ultherapy is both safe and efficacious, however in all "life enhancing" procedures, the degree of discomfort also has to be weighed against financial and convenience considerations. We have a two-fold approach for face and neck: 1) topical anesthetic creams & oral pain meds +/- Valium. Drivers are required; 2) Monitored anesthesia care = similar to colonoscopy cocktail. Driver required. This is the default if a patient emphatically doesn't want to have any recall or if additional procedures are added to the mix. Having a licensed en-suite OR is a definite advantage but we do screen patients with preop labs, EKG, etc. Stand alone decolletage treatments are generally well tolerated with minimum anesthesia.