Updated: 6 mo post- NO effect at all.

I’ve had Botox in my forehead about twice a year for the last few years, and the occasional skin peel, but never anything beyond that. In the last year I was aghast to realize the skin where my double-chin met my neck was starting to wrinkle, and I hated how my double chin just looked saggy (especially on zoom meetings). The cosmetic surgeon who does my Botox shots said she offers Ultherapy as it’s the ”gold standard” of non-invasive skin tightening procedures. She examined me and said my skin was in good shape, mild laxity in the mid-face and minimal jowls, while my double-chin was actually mostly skin and sagging muscle, not much fat. She said I was a great candidate for Ultherapy, and quoted me $3400 for a full-face treatment which would be “somewhat painful but not overly so.” I sat with that for about 9 months, partly out of fear and partly because $3400 was out of my budget as an academic lecturer.
But when my hubs surprised me with a trip to Costa Rica (which has an excellent medical system with many US and UK trained doctors + much lower costs) I started researching Ultherapy providers there. I found four, settled on two who seemed to have the best medical training and highly active practices, and ultimately chose Dr. Alejandra Quesada because of her affiliation with Costa Rica’s top hospital and her schedule availability. Her staff quoted me $1800 for lower face/double-chin and $2300 for full face. She also offered hyperdiluted Radiesse in the double-chin area for another $450. After evaluating me she said I didn’t need a full face, and that would risk losing fat in areas that looked fine right now (cheeks, etc). So we were going to just do lower face & double-chin plus the radiesse.
I was a little nervous about the idea of doing a procedure in another country, but this was in her clinic at the best hospital in the country, accredited by JCI, and when I got there it was a pleasant surprise to see a sparkling modern facility that was way nicer than the local hospital in my Pennsylvania town. Her staff were great, extremely professional, and after Dr. Quesada evaluated me, her RN prepped me by slathering on numbing cream everywhere & having me take 800 mg of ibuprofen. 30 minutes later I couldn’t feel anything, and it was time to get started. Dr. Quesada performed the treatment herself (I’ve read reviews here that treatments were performed by a nurse), which ended up taking a total of 3 hours.
I was nervous when we got started, but the initial zaps were nothing! She did three levels of RF- 1.5mm, 3mm and 4.5mm- which meant going back over each area 3 times with multiple passes for each depth. Initially there was no pain, just an uncomfortable electric sensation in my lower cheek areas. Each cheek took about 45 minutes to fully complete and by the end of the three rounds of RF waves, a good amount of heat and discomfort was accumulating (but still not what I would call PAIN).
Then came the chin. Hoo boy, that was a shocker. Right from the start of the under-chin area, I was feeling pain at all three depth levels. The deepest level also hit my jawbone several times, which caused an ache (like someone hit the bone with a rubber mallet) about 1-2 seconds later. Where I had been able to complete nearly 200 zaps on my cheeks without stopping, my double-chin area hurt so much that eventually I had to ask her to only do 5 at a time so I could rest between. She also added more numbing cream to the area, and her nurse pressed a vibrating wand against my chin and jawline which distracted from (but definitely didn’t eliminate) the RF zap pain. The chin area took more than an hour because it hurt so badly. By the end I was so exhausted I just couldn’t handle the thought of putting a cannula with radiesse in the same area, so we agreed not to do that part. The air conditioning had been on full blast in the treatment room but by the end I was sweating and tense from the pain. On the positive side, 20 minutes after we were done, there was no more sharp pain or dull ache anywhere. I didn’t really touch my face that night or the next day, but today (48 hours later) I do feel a very slight soreness when I press on areas of my cheeks and neck.
With regard to results, I didn’t see any of the “immediate tightening” that some folks experience due to the inflammation from the RF. My skin was pink, but other than that looked no different. Dr. Quesada said she wanted to schedule a 30-day zoom follow up to see if I was experiencing any tightening, and then a second follow up at 3 months. So right now, I don’t know if this will turn out to have worth it. Crossing my fingers, because I hate the saggy chin!

The attached photos are 5 days post, and as you can see there is almost no difference whatsoever. I am not expecting huge changes in the double chin because my doctor had said that it was mostly due to laxity in the underlying muscle and not that I had a lot of extra fat there. The one change I have noticed in this short period of time (given it takes 1-3 months to really see any change) is that the wrinkly skin area feels slightly tighter. That may just be due to inflammation, but it is a difference I can feel when I run my finger over the area... it used to jiggle back and forth and now there is more resistance. So, too early to see real changes, but just posting an update to document.

I forgot to post this comparison photo with my previous update earlier today. Here is the one noticeable change so far... before and 5-day after comparison of the amount/texture of wrinkly skin under my chin.