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“I heard from my friends Ultherapy is very painful!”
“I tried Ultherapy before and got traumatised!”
As a high volume Ultherapy clinic, we hear this every week at Bay Aesthetics Clinic.
So, is Ultherapy painful? We tried it for ourselves and the answer is…. Yes
As Ultherapy believers, Medical Directors Dr Hoe Ying Min and Dr Bernard Tan get Ultherapy treatments every year to stay young and lifted. From personal experience, Ultherapy does sting a little bit, with the pain score about 5-6 out of 10. An Ultherapy treatment feels like little stinging sensations like small ants biting the skin, for 45 minutes (800 lines). The pain is slightly worse in areas where the skin is thin, such as the neck and the eyebrows. Not the worst ever, but not something you look forward to.
Pain is a subjective sensation, and a simple yet effective way to rate it would be the Wong Baker Pain scale. Out of 10 points (with 10 being the worst possible pain), most of our patients rate Ultherapy to be 5-7. Certain patients don’t find it painful at all (1-3 points), and certain patients find it unbearable (8-10 points).
Ultherapy works by using micro-focused ultrasound to generate microscopic areas of thermal injury, measuring approximately 1mm in diameter, at fixed depths (4.5mm, 3mm and 1.5mm) under the skin. Known as Thermal coagulation points, each spot is essentially an area of controlled injury that is heated to 70 degrees Celsius, resulting in the tightening of existing collagen and the production of new collagen.
Facial structures such as facial nerves or bones (eg skull, jawbone) are extremely sensitive and if accidentally “hit” by Ultherapy, will be very painful for the individual. Thankfully, with real-time Ultrasound guidance, the chance of accidental injury to these structures is very low, unless the provider is not paying attention to the screen!
Basic, standard of care Ultherapy pain management includes:
1
Topical anaesthetic for ~30 minutes (we use topical benzocaine 10%-lidocaine 6%-tetracaine4%, the most potent concentration of topical anaesthetic available)
2
Oral painkillers (paracetamol, NSAIDs such as arcoxia or ibuprofen)
3
Light oral sedation (lorazepam)
The above is good enough for the majority of patients, making the Ultherapy treatment tolerable with a pain score of 3-5 out of 10.
For patients with low pain thresholds or those who have previous painful Ultherapy experience, additional levels of pain control may be necessary
1) Intravenous sedation - a sedative such as midazolam may be administered, putting patients into a sleepy and calm state (but still awake and responsive)
2) Local anaesthetic injections, nerve block- injections to numb the face may be given to numb the sensory nerves that transmit sensations of pain.
3) General anaesthesia - for patients undergoing other concurrent procedures (eg liposuction, tummy tuck, breast augmentation) with Ultherapy, then General Anaesthesia becomes an option. This needs to be performed in the operating theatre of a hospital.
Pain control is crucial for a successful Ultherapy treatment. A patient who experiences a painful Ultherapy treatment may not be able to complete the treatment- we have encountered cases where patients give up halfway and request to abort the treatment. Those who endure the pain and push themselves to complete the treatment end up mentally traumatised and will not return next year for their annual Ultherapy treatment. A patient may also struggle and flinch during the Ultherapy treatment, increasing Ultherapy risks such as burns or blisters due to poor transducer contact.
Ultherapy Prime was launched in 2024, building upon the legacy of Ultherapy (2009). Ultherapy Prime features a 35% larger screen, higher resolution ultrasound images, faster processing speeds, improved patient comfort and quicker treatment times. From March 2025 onwards, all Ultherapy cases at Bay Aesthetics Clinic are performed using the Ultherapy Prime system. Our experience with Ultherapy Prime has been positive, with patients reporting the treatment to be significantly less painful (3-4/10 pain) versus legacy Ultherapy (5-7/10 pain). In addition, Ultherapy Prime treatments are faster (45min) than legacy Ultherapy (60-75 minutes). Ever since introducing Ultherapy Prime, we have had fewer patients requesting intravenous sedation or local anaesthetic injections during Ultherapy, with most patients finding the discomfort level tolerable with basic pain management protocols alone.
Yes. Due to the consistent and higher power output of Ultherapy, it is generally rated as more painful than HIFU treatments. Thankfully, Ultherapy is once a year, while HIFU needs to be done monthly
Patients who have experienced both Thermage FLX and Ultherapy have usually rated Thermage FLX as being more painful.
Areas with thinner skin and closer to the bone tend to be the most sensitive, such as the jawline or forehead areas.
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