Ultherapy Should Not Hurt, Right?

I read that ulthera should not be painful (as it was for me) if the doctor is aware of where facial nerves and bones are, and performs the procedure correctly. Why did mine hurt while others did not? (I do have good pain tolerance.) Thanks!

Doctor Answers 11

Ultherapy can be painful when done correctly.

On a scale of 1-10, I have had patients rate the pain from 0 to 11. Everybody experiences the sensation of the treatment differently, but we offer a variety of pain management techniques to aid in patient comfort. These range from distractions, music, and breathing techniques to numbing cream, oral medications, and injectable anesthetics. We tailor pain management specifically to each patient to provide as much comfort as possible.

Atlanta Facial Plastic Surgeon
4.7 out of 5 stars 13 reviews

Ultherapy does hurt!

In my experience, Ultherapy performed properly and to the optimal settings does in fact hurt. We find that using topical anesthetic cream with or without regional blocks make it much easier to tolerate full treatment. Frequently the doctors who are designated to promote the technology on TV will use very low setting so that the on air experience is much more pleasant than the real thing. Unfortunately, this type of exhibition misleads the public into thinking that the treatment is painless. Ultherapy creates a focused beam of ultrasound which is delivered into facial tissue deep to the skin to create injury or burn and stimulate contraction and collagen deposition. Any such energy designed to cause tissue damage will stimulate pain sensation. As in many cases, non-surgical does not mean non-painful. Please be aware and prepare yourself for discomfort during the treatment. If the treatment does not hurt at all, very likely, the settings are considerably below therapeutic recommendations.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

How painful is Ultherapy ?

I have done Ultherapy since 2011 and have done this procedure in hundreds of patients.

I have only terminated the procedure in 1 patient due to 'excessive pain' despite using ibuprofen before (1 hour before 400 mg) and immediately before (400 mg) the procedure. 

The modified or reprogrammed device (3rd generation) is nearly painless at the highest settings of energy delivery. 

Overanxious patients can be driven to the office and are recommended to take 5 - 10 mg of valium an hour before the procedure. 

Read the Ultherapy ebook provided on the link below.

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

Ultherapy can hurt

Ultherapy is very effective at non-invasively tightening the skin. The procedure can be painful, but is felt differently by every patient. Pain varies from hardly any to severe. It is helpful to give a pain medication and a light sedative to help with the pain. If our patients get a sedative I make sure they get someone else to drive them home. Pain is almost gone except for some tenderness as soon as the procedure is over.

John Silverton, MD
Stockton Plastic Surgeon
4.8 out of 5 stars 18 reviews

Ultherapy and pain


 This is an incorrect statement for most patients.  There is some discomfort and this varies from patient to patient.

 I actually like the response from the doctor prior to this entry.  He states that it can be on a 1-10 scale ....a 0 ...or an 11.  This is so true.  Rarely on the extremes but tolerable in most cases as it is in between for most.

           Steven M. Lynch, M.D.

Steven M. Lynch, MD
Albany Plastic Surgeon
5.0 out of 5 stars 18 reviews

Ultherapy facial lift and tightening can hurt

The minority of patients say that it didn't hurt too much but the average patient says it does hurt. Avoiding direct treatment of some nerves is possible, but the bony areas sometimes need to be treated but the depth of the ultrasonic energy is adjusted so as not to allow the energy to reach the bone.  Treatment over the cheeks, without treating bone or nerve hurts with ongoing lines of treatment. We are treating now with multiple transducers to allow  planes of different depths to absorb the energy. The cumulative energy delivered can increase the discomfort.  Multiple dental fillings or dental fractures might cause more pain.  The reality is this is the only device currently that is FDA cleared for facial lifting and I see good results in my practice. Certainly, it does not provide the same excellent amount of lifting that a facelift can create but without downtime and only requiring one to two hours of treatment, most patients are willing to put up with the pain.  I prescribe and provide different medications to my patients to make it a more pleasant experience. I am very explicit with my patients in consultation to let them know that there is pain during Ultherapy. Very rarely, a patient with a very low pain threshold may ask for sedation and this can be delivered in our accredited office-based surgical facility via a board-certified anesthesiologist.

I have trained with one of the founders of Ultherapy and watched as he delivered treatment to his patient that only took Ibuprofen (Motrin, Advil) prior to the procedure. This was with the earlier protocols when far fewer lines of energy were delivered and with less transducers so fewer planes were treated.  I knew then, that those patients who managed with minimal medication were the minority, not the majority of those that would undergo Ultherapy and patients would need some prescriptions including pain killers and pills to relax them so that the treatment would be tolerated. My current protocol has allowed me to treat the overwhelming majority of patients with the maximum safe protocol to afford them the best chance of improvement while minimizing their discomfort. Greater than 95% of patients see improvement and would do it again knowing now what they learned by going through the procedure.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Pain associated with Ultherapy

Ultherapy will cause some discomfort depending upon the area treated. Certain areas can be more uncomfortable than others.  For example, treating the area above the brow tends to be more uncomfortable than the neck area. How people respond to pain varies.  Ultherapy causes heat and can cause an electrical sensation which can really bother some people while others find it less bothersome. I had Ultherapy and found it to be very uncomfortable, so in our office we often give a nerve block to our patients. I tried it with a nerve block and it was much more comfortable. If you’re sensitive to pain, it is important to go to a place where there is physician or nurse available to give you a nerve block.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 66 reviews

Painfulness of Ultherapy

Ulthera is completely non-invasive and does not require anesthesia. Treatment times average thirty minutes. During treatment, the ultrasound applicator is slowly moved over the treatment area, delivering small, controlled amounts of energy to the skin and soft tissue. The ultrasound energy targets the deep layers of tissue, leaving the upper layers intact and unharmed.There is little to no recovery or downtime associated with Ultherapy and patients are able to immediately return to their normal routine. Some minor redness may occur at the treatment sites, but this generally fades within a few hours. Immediate tightening of the skin can be seen after treatment and this will be followed by continued improvement over the next several months as new collagen growth occurs. Ultherapy is a very safe procedure with few risks and complications.

Daniel Shapiro, MD
Scottsdale Plastic Surgeon
4.8 out of 5 stars 107 reviews

Ulthera, pain, does it hurt?

Usually patients experience mild to moderate pain during the treatment, occasionally it may even feel more painful. In our practice, to decrease the painful experience, we use cold air, ice packs and other pain diverting techniques as well as oral analgesics during the treatment. We have had few patients who told us that they did not feel any pain but these are in the minority. All of our patients however have gone through the procedure without any difficulty.

Joshua L. Fox, MD
Long Island Dermatologic Surgeon
4.9 out of 5 stars 19 reviews

Ultherapy Hurts - Follow the "No Pain No Gain" Theory Here

Whoever said it's not supposed to hurt hasn't had the treatment.

Ultherapy reaches very deeply into the skin and the ultrasound beams are focused into one tiny point. That's what you feel and it is not painless by any means.

You have the option of numbing blocks or other types of anesthesia, and most physicians will offer you whatever type of pain control you feel you need. It's not intolerable without prescription pain medication, but it can get pretty intense in a few areas where nerves are in the energy path or where bone is closer to the surface.

The pain is felt ONLY when heat is generated by the focused beams - a few seconds - though with a rapid fire sequence with a rest in between. There is no lingering pain (though you will be tender and possibly bruised)

We've gotten used to thinking we can make major changes and not have to feel anything, That's not the case. Ultherapy is a "purposeful" controlled injury designed to deep tighten and lift. For it to be effective, the energy has to be high. High energy hurts.

Rebecca Fitzgerald, MD
Los Angeles Dermatologic Surgeon
4.1 out of 5 stars 21 reviews

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.