Should Ulthera Be Painful?

Ulthera 1st attempt was painful and had to stop. Also,have tenderness along jawline 2 days afterward. 2nd attempt scheduled soon with pain medication. Is my experience typical? Please advise.

Doctor Answers 67

Ultherapy: No pain, no gain?

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It is not unusual for people to report discomfort or even some pain during their Ultherapy treatment. The therapy works by delivering heat energy to the muscle and deeper layers of skin which is what allows the desired lifting and tightening effect. This heat, however, is also what can make the procedure uncomfortable while you are undergoing it. Although it is not unusual to have that "tightened", almost sunburned feeling after the treatment for several days, any discomfort from the procedure itself stops the moment the treatment is complete.

Interestingly, it seems that those who have undergone some sort of laser treatment or hair removal procedures in the past are better able to tolerate the procedure--although this may be because they have something to compare it to. Regardless, just as people's threshold for discomfort is highly variable, so is the response to this treatment. Fortunately, with a little preparation (e.g. ibuprofen,other NSAIDs, or maybe even something stronger), the experience is much improved and much more easily tolerated.


Hope this helps!

Dr. Y

Varying levels of discomfort

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Pain levels during Ultherapy treatments vary from patient to patient.  Some of my patients say it doesn’t hurt at all, while others say it ranks from 6 to 9 on a pain scale of 1 to 10.  Having had the treatment myself, I can say that the entire treatment is easily tolerable, and that the area around the forehead is the most sensitive.  We certainly want our patients to be as comfortable as possible during all treatments, so we offer patients the option of pre-medicating to ensure a painless experience.

Daniel J. Leeman, MD
Austin Facial Plastic Surgeon

Ultherapy is not painless

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Most patients are able to tolerate the Ultherapy procedure without significant pain however, they can certainly feel the procedure.  How intense this sensation feels is extremely variable from patient to patient. 

When we were considering the device, both my partner and I had a treatment without any sedation or local anesthesia.  We had to take frequent breaks and finished the procedure but our experience made us decide to offer something to help with the tolerability of the treatment.  Since then, I have done the procedure with oral sedation, local anesthesia injection and nothing at all.  They all work.

An additional pearl is that all areas of the face are not equal in terms of pain sensation.  Around the eyes and over any bony prominence tend to be much more intense.

Finally, although you can certainly feel the treatment, the discomfort is for the most part completely gone immediately after the area is treated.  To date, we have not had to prescribe a single pain med for any of our patients.  Good luck with your treatment.

Joseph Campanelli, MD
Portland Facial Plastic Surgeon

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Ultherapy Pain Management

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Ultherapy involves penetrating ultrasound energy to stimulate collagen production in the deeper dermal and subdermal levels.  As a result, most topical anesthetic creams will have limited benefit except when treating with the newer, shallower penetrating treatment head/transducer that is used for wrinkle reduction.  All patients are going to feel something but the perception of whether or not this is painful and to what degree is very individual depending on one’s pain tolerance.  As a result, no single “pain” management option is appropriate for everyone.  This is why it is important for your physician to consult with you about the options available from over-the-counter medications such as ibuprofen to prescription narcotics or valium, the latter of which would require a ride home.  These oral medications should be taken about an hour before the start of the procedure to provide optimum benefit.  Many patients prefer to start with the ibuprofen knowing that if the discomfort is more than expected, they have the option of adding local anesthetic nerve blocks.  Although this may not cover all areas, it relieves enough of the discomfort in the more sensitive areas such as near the mouth, the forehead and jawline, that the procedure becomes tolerable.  After the treatment, it is common to experience some tenderness under the chin, near the cheekbones and along the jawline which is often described as a soreness that is really only noticed when touched.  It is also common to experience some degree of numbness in those same areas.  Both of these symptoms generally resolve in days to a couple of weeks depending on the intensity of the treatment.  Overall, Ultherapy is a well tolerated procedure especially by the informed patient who is aware of what to expect.

Is Ulthera painful?

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Yes.  Ulthera hurts.  In a way thats how you know it is working.  Nerve blocks or oral pain medication is the most common methods of helping with the pain experienced during treatment.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 170 reviews

Ulthera treatment hurts

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I have an Ulthera in my office and has been very busy. I also had it done myself. It hurts. I did not have any medication because I did it in between seeing patients. If I repeat the treatment, I will probably take a tramadol and a valium. That is what we recommend our patients now. It seems to take the edge off. The results take time but are worth it. As a plastic surgeon and patient, I recommend it.

Luis A. Vinas, MD
West Palm Beach Plastic Surgeon
4.8 out of 5 stars 28 reviews

Profound is a less painful alternative to Ultherapy

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My experience has shown me that Ultherapy patients experience quite a bit of pain. We have been more recently using Profound RF which is done with local anesthesia injections. I have also seen better results overall and better patient satisfaction.  

Management Of Analgesia With Ultherapy Should Be Customized To Each Patient

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Of Course Ulthera can be painful, depending on the settings used, the area being treated, the number of lines being laid down, and the pain tolerance of the patient. In our clinic, this is not a one-size-fits-all treatment, nor do we believe that it should be.

To manage any pain associated with Ultherapy, we use a strategy we call Escalation Dominance, meaning that we make sure we have the ability to to appropriately manage whatever level of pain the patient might experience with the procedure, within the parameters of the patient's own preferences and health. For instance, a patient with a high pain threshold, relatively thick skin and a desire to "avoid drugs" might be treated with just a topical anesthetic (it is important to leave this on for a long enough period of time to derive the full benefit of this treatment) and an oral NSAID.

As we ascend the ladder of anesthetic and analgesic interventions used during Ultherapy, we might  administer intramuscular ketorolac, give oral  narcotics, use intramuscular injections of narcotics, perform local nerve blocks or use intravenous sedation with appropriate cardiopulmonary monitoring. The essential point here is that we can achieve a level of analgesia appropriate to the needs of each patient, neither under-treating nor over-treating her. We have found that this not only allows us to deliver a better and more individualized treatment to each patient, but that the patient's understanding prior to undergoing Ultherapy that we can efficiently and effectively treat whatever level of pain she might experience, and, in most cases, avoid any significant discomfort in the first place, significantly reduces patient anxiety associated with Ultherapy.

Ultherapy Painful - It does not need to be

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Discomfort experienced during Ultherapy treatments varies between patients and the areas treated.

In general patients with thin skin experience more discomfort than those with thicker skin.  The neck region seems to be the area that tolerates the Ultherapy treatment the best.

Pain control in my  patients is achieved with oral Ibuprofen (Motrin), Valium (anti-anxiety) or Percocet (narcotic), and local anesthesia.  In general I try not to give a narcotic as it nauseating to many patients. I use the oral regimen alone if I am treating a small area. 

For the larger treatments(full face, lower face, brows and around the eye, cheeks) patients are given local nerve blocks. I have a special local anesthetic mixture and it is injected into specific anatomic sites where the nerve provides sensation to that specific part of the face. 

Once the nerves are blocked patients tolerate the procedure well. One woman even slept during a full face treatment.  

Rondi Kathleen Walker, MD
Washington Facial Plastic Surgeon

Ulthera does not need to be painful

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Like many physicians, I began using Ulthera 16 months ago with minimal pre-medication for my patients. Following my own personal Ultherapy treatment with no medication, I made the decision to offer local anesthesia to all of my patients.  This eliminates the need for pre-medication, eliminates most discomfort during the procedure, and makes the entire experience more comfortable.  Patients are able to drive themselves to the office for treatment and return to normal activity immediately after treatment with no downtime.  

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.