Ulthera focuses ultrasound energy at focal points below the skin nearly half a centimeter deep to cause a controlled and directed thermal injury, thereby initiating the body's natural healing and repair mechanisms to rebuild your tissues. It will not heat the skin or cause any damage to the skin - it essentially passes through it to the deeper focal point. The deeper spots do heat and can be painful, especially around nerves or over bone. We routinely give our patients nerve blocks to make the procedure comfortable and very tolerable. I feel that by blocking the face, it allows me to maximize the treatment energy and hence results. Our patients do very well with the blocks and advil or tyelenol, however we do offer other measures for comfort if needed.