Before Ultherapy: A Full Preparation Guide from a Dermatologist

This is an English adaptation of a clinical article Dr. SangYoul Yun — board-certified dermatologist and Medical Director of Delight Dermatology in Gangnam, Seoul — originally published in Korean. Read the Korean original on Naver. It has been restructured and translated for international readers.

Ultherapy is the original ultrasound lifting device for shaping the facial contour, and it can help those whose face has gradually begun to sag. This is a fuller guide to what to know before the procedure — candidate selection, intensity, shot count, cycle, timing, and pain. (For three quick takeaways, see the shorter companion piece, 3 things to know before Ultherapy.)

What Ultherapy is

Ultherapy gives elasticity and a lifting effect without surgery. It is an FDA-approved non-invasive procedure that lifts the neck, jaw, and brow, using ultrasound to create thermal coagulation points deep in the skin that regenerate collagen. Among the lifting devices we know, the ones that shape the facial contour are the ultrasound (HIFU) devices — and the oldest and strongest of these is Ultherapy. Others include Tentera, Shurink, and Linearz.

How it works

Ultherapy forms linear thermal coagulation points in the fascia that wraps the muscle beneath the skin and in the tissue above it; the fascia and tissue then contract, producing the lift, and collagen is remodeled to restore elasticity. If you look at the Ultherapy handpiece, it is noticeably sturdier and heavier than other devices — because it contains a real-time ultrasound feature that confirms the treatment depth as it touches the skin. That detail allows more precise treatment than other devices.

Ultherapy typically uses three tips — 4.5 mm, 3.0 mm, and 1.5 mm. The 4.5 mm tip is used mainly on areas with sufficient fat, such as the cheek or a double chin; the 3.0 mm tip on thinner-skinned areas; and the 1.5 mm tip around the eyes. Alternating the 4.5 and 3.0 mm tips generally gives the best result. Because the stimulation reaches deep, there is also some fat-reducing effect.

Who should have Ultherapy

Broadly, most people experiencing facial sagging are candidates. There are two nuances worth knowing:

• Those who are younger and whose sagging is not severe may do better with a lighter ultrasound lifting procedure.
• Those with little facial fat who worry about the cheeks looking hollow may be better suited to a radiofrequency lifting procedure such as Thermage.

Intensity, shots, cycle, and timing

On intensity: higher would seem better, but if it hurts so much that a patient never wants to return, or if they move a lot during treatment, precision suffers — so a tolerable level matters. On the cycle: because the degree and duration of the lift vary between individuals, first-timers should note how long their result holds and repeat according to that change.

Does it hurt?

Ultherapy has a reputation for pain, and honestly, it does hurt. But how much a person feels varies with sensitivity: some tolerate it well with local anesthesia alone, while others need a nerve block or sedation. Sedation is generally not recommended, though — the procedure is relatively short at 15–20 minutes, and the time usually passes quickly while chatting with the doctor.

The advantages, in short

• Few sessions needed — about 1–2 times a year.
• An FDA-approved device, which supports its safety.

Bottom line: Ultherapy lifts and firms without surgery, works best when matched to your anatomy and a tolerable intensity, and shows its effect over the weeks after treatment as collagen remodels. If you are deciding between ultrasound and radiofrequency lifting, that choice is best made together with your dermatologist.

Medical disclaimer. This article is general information and does not replace individual consultation. Whether Ultherapy suits you — and the appropriate tips, shot count, intensity, and anesthesia — should be decided after an in-person consultation with a dermatologist.