What pain management is best for Ultherapy?

I have been performing Ultherapy since it was FDA cleared and brought to market. I have found it, in general, effective for the right candidates, but I tell my patients in consultation that it hurts. When it first came out the company told doctors that just Motrin would be enough and for some, that was the case, but it became evident, soon, that more was needed for the majority of patients. Until recently I have had my patients arrange a ride/escort home, and administer both Percocet and Ativan for them prior to the procedure. A few years ago, the company redesigned the Ultherapy unit to deliver less energy per line of treatment but changed the protocol to have the doctors deliver more lines. This was done to make it less painful, and the lower energies are better tolerated, but still painful. I prefer to use the higher energies and still am able to deliver sufficient lines of treatment.  
Fortunately, in our practice, we now offer ProNox, nitrous oxide (laughing gas) analgesia, which makes Ultherapy so much easier to tolerate and the patient can go home unescorted, 10 mintues after the procedure is done.

I have been personally doing Ultherapy treatments for 10 years. Pain management is very important.Certainly, different patients have different pain thresholds and this needs to be assessed prior to the treatment. Studies have been done that show pre -treatment narcotics do not really reduce discomfort prior to Ultherapy so I do not prescribe narcotics to my patients. Most of my patients take Tylenol ES x 2 tablets 1 hour before, then, Advil ES x 2 tablets 1/2 hour before. 85-90% of my patients find this is very helpful. I have always found the neck area to be the most sensitive region to be treated so, I apply a lidocaine/tetracaine topical mixture to the neck just before the treatment begins, and clean it off after the cheeks have been successfully treated. I am also a great believer in "talkaesthesia" and this helps distract my patients as well as using stress balls!I also am certain that patients feel very relaxed at the start of their treatment, knowing that an experienced dermatologist is actually doing the entire treatment. Due to my experience with Ultherapy, the actual treatment time for the entire face and upper neck is 45 minutes so this is relatively quick, which also helps. Less than 15% of my patients require Ativan 1-2 mg, SL, given 45 minutes prior to the ultherapy treatment, but they need a friend or family member to drive them to and from our office. Hope this helps.

Great question. Patient's comfort is our number one priority. Here at Clear Lake Dermatology our office offers a variety of pain management options. Depending on pain tolerance some can go through treatment with just Ibuprofen and Valium . Another option is local anesthesia with lidocaine injections which makes the procedure more comfortable. 

Hello, 
We've had different patients with various levels of pain tolerance. Most of the people are able to tolerate it without anything. Ibuprofen is suggested by the manufacturer. Ultherapy is marketed as the "lunch time" procedure and with that you should be able to go through that without any problems. With all other medications you will need to have someone take you home.

Despite everything you may read on the internet, in my experience most of my patients tolerate the Ultherapy treatment very well without any medication at all. That being said, if I believe the patient is very sensitive, I prescribe Valium (Diazepam) 5 mg and Percocet 5/325 prior to the procedure. I would stay away from aspirin or aspirin containing products as some of my patients have had mild to moderate bruising with these products.