"Everyone who's gotten it says it hurts, so I'm scared."
"But then others say it was tolerable. Why is it so different?"
Because stories vary so much for the exact same procedure, this is often the very first question people ask before getting Ulthera.
Hello, I'm Director Kwon Si-jin at DA Clinic Myeongdong ^^
We're getting ready to open our doors in Myeongdong soon, and since so many people worry about the pain ahead of our opening, I wanted to put this together for your information first.
With Ultherapy, the closer to bone the area and the deeper the layer being worked, the more it registers. Even when using the same device at the same intensity, what you feel can differ depending on where that energy passes through.
So reducing pain isn't just about enduring it; there are several different ways. I'll show you clearly which areas feel that way and why.
Why it feels that way
Ultherapy is described as gathering ultrasound energy at a point and delivering it to deep layers.
It's likened to focusing sunlight with a magnifying glass — a structure that passes through the surface and lets heat form only at a set depth. Where it forms is called a thermal coagulation point.
This is what determines the character of the pain.It isn't the gentle warming of a broad surface as with radiofrequency; it's a point landing in an instant, so it passes as a sharp or stinging sensation rather than a warm one.
And when that energy passes near bone, the vibration carries more strongly.It's why the same intensity registers differently by area.
It divides by depth too
As important as the area, and less well known, is depth.
Ultherapy doesn't fire at one depth only. It's generally divided across three layers.
- 4.5mmthe deep layer called the SMAS, described as the same depth surgeons work at when they lift. Felt as the heaviest
- 3.0mmthe layer above that, below the dermis. Somewhere in between
- 1.5mmthe shallow layer. Texture and fine lines. The lightest
So "Ultherapy hurts" is hard to bundle into one sentence. Even on the same forehead, passing at 4.5mm and at 1.5mm are different things.
Ask in consultation "which depths today, and how many shots at each?" and you'll have a sense in advance of where the pain will come.
Broken down by area
- Foreheadbone sits directly beneath, so the stimulation tends to register strongly
- Jawline and around the mouththin and sensitive, so it's distinct. Some describe it resonating towards the teeth
- Cheeksrelatively fuller, so often lighter
- Neckthin, but approached at lower energy, so it feels different
- Around the eyesthin with bone close by, so people tend to feel it keenly
The pain is decided before you start
People find this surprising, but what most changes the sensation with Ultherapy is the preparation before anything is fired.
First, whether the mapping is done sitting up.Lying down pushes sagging tissue up and back, so where it has actually descended looks different.Lines drawn while you're lying down miss the places that need work and put energy into places that don't — which means hurting where you needn't have.
Second, whether shots are distributed differently by area.How far the cheekbones project, how thick the cheeks are, which way the jawline has descended — all differ from person to person, so at the same total shot count, where those shots go changes the result and the pain together.
Third, whether the layers are visualised while firing.The Ultherapy family is described as being able to run with ultrasound imaging that confirms the skin layers.Confirming the layer reduces wasted shots, and fewer wasted shots means the same effect for less stimulation.
The whole treatment is generally described as around an hour.If that time is markedly short, it's worth checking whether mapping and distribution were skipped.
Making it more manageable
- Some people avoid scheduling it just before or during a period, when pain sensitivity can rise
- Reducing caffeine beforehand is sometimes said to help
- If it's hard to bear, say so immediately. The energy can be adjusted area by area
- Pain relief and anaesthetic options are worth discussing in advance with wherever you're having it done
- Better to book a day with time to spare. Rushed through, the same shot count feels harder
There's one thing I'd like to underline.How much it hurts doesn't track with how well it works.
Going in harder than necessary to match the idea that "it has to hurt to work" grows the strain faster than the repair.Which layer, and how it's distributed, decides the result far more than raising the intensity.
If the pain is too much, there are other routes
Ultrasound lifting isn't all of lifting. The families divide by the layer targeted and the type of energy.
Let me be a little candid here.
- Ultrasound (HIFU)deep layers, point by point. Lifting the sagging itself
- Radiofrequency (RF)warming the dermis as a plane. Firmness and texture. Generally described as less painful
- Microwavereaching the fat layer. Tidying the contour
All three families are in place at our Myeongdong clinic.Ultherapy PRIME, Shurink Universe and Sofwave on the ultrasound side; Thermage FLX, InMode, XERF and Volnewmer on the radiofrequency side; and Onda on the microwave side.
I'm not writing this to show off devices. You can only say "you don't need this right now" if there are alternatives. With one device, every concern converges on that one device.
If pain really is a burden, rather than gritting your teeth through ultrasound it's better to revisit whether your concern is sagging or firmness. If it's firmness, a different family suited it from the start.
There's no need to rush in these cases
Honestly, if any of the following apply, now may not be the time.
- If you have relatively little cheek fat — excessive energy is associated with a hollowed look instead
- If texture and firmness rather than sagging are the main concern — the target layer is different
- If your skin is inflamed, or you've just had a strong treatment
And please tell us in advance if you're pregnant, have metal implants in the treatment area, or have a keloid tendency. Dental titanium implants are described as not falling into this category.
In my experience, a place that says "you don't need this right now" tends to be the more trustworthy one.
Afterwards
A pressed, aching feeling or light swelling can remain for a few days, and is generally described as settling with time.It's explained as a response arising from collagen contracting.
The change itself comes slowly.After the light tightness right afterwards, it's described as emerging over two to three months as collagen builds. So there's no need to judge it in the mirror the next day.
While you recover, attend to sun protection and moisturising, and it's safer to postpone anything that adds a lot of heat, such as saunas, for a week or two.
These are different, though.
- Blisters, as with a burn
- Numbness that persists for a long time
- An expression that has become unnatural on one side
- Pain that doesn't ease but worsens
In these cases it's safer to contact the clinic that treated you straight away rather than wait.
- It varies by area and depth
- The closer to bone, the more it hurts
- How much it hurts and the result are not proportional
Frequently asked questions
Q. Can I have it under sedation?
A. Some places offer it, but you should weigh that you can't communicate your pain response, which makes adjusting the setting harder. Hear the trade-offs fully before choosing.
Q. Does reducing the shot count hurt less?
A. It may, but the treated area shrinks accordingly.It's better to discuss other ways of reducing discomfort first.
Q. Does it hurt the same the second time?
A. Many people find it less severe than the first time, but it varies with your condition on the day and the area, so it's hard to generalise.
Q. Do you look inside the skin during the treatment?
A. The Ultherapy family is described as being able to run with ultrasound imaging that confirms the layers.Firing while seeing the layer, and firing without, make it a different treatment even on the same device.
Q. How do I confirm it's genuine?
A. You're welcome to ask to see the tip (cartridge) opened. The set shot count is tied to the tip, so checking tip and shot count together is the surest way.
More pain is not better work
Keep only the point and it's this.
Ultherapy pain divides by area and depth, and how much it hurts isn't proportional to the result.
This is my answer to the question you came in with.
DA Clinic Myeongdong is set to open soon.We'll share news of our opening and treatment information first on our blog and Instagram ^^
Thank you for reading this long piece.This was Director Kwon Si-jin at DA Clinic Myeongdong.
This column is an informational article meant to provide general medical information, and the effects and side effects of treatments may vary by individual. DA Clinic Myeongdong is set to open soon. (Medical Service Act Art. 56)