Does Sofwave hurt? What it feels like and how we reduce it

Before any treatment, people want to know how painful it will be, and Sofwave is no exception. It is sometimes described as a treatment without pain, but it does hurt. This article covers how much Sofwave hurts and how we reduce the pain.

Studies report moderate pain

Each Sofwave pulse lasts 5 seconds. The pain is hot and aching, and it comes the instant a zone of heat forms in the dermis. The dermis is hottest as the pulse ends, so the pain peaks at that point. How much it hurts varies from person to person, and areas with thin tissue over bone hurt more.

In one clinical study, average pain was 6.64 on a 0 to 10 scale (Hongcharu 2023, PMID 36757157), and in another it was 5.6 (Gold 2024, PMID 38031530). In a study of acne scars that used forced-air cooling alone, with no numbing cream, the average was 3.94 (Boonchoo 2025, PMID 40132902). Scores in this range are bearable for some people and fairly painful for others. Despite what some advertising claims, Sofwave is clearly not a treatment without pain.

No study has compared Sofwave and Thermage head to head. In a study of 46 people treated on both sides of the face with Thermage FLX, average pain after 30 minutes of numbing cream was 6.62 to 7.12 (Wang 2026, PMID 41924292). That is similar to or slightly above the Sofwave scores, but anesthesia and settings differed between the studies, so the numbers cannot be compared directly.

Numbing cream and other options reduce the pain

Numbing cream is the baseline. The longer it is left on, the deeper it works. In a study that applied lidocaine-prilocaine cream for 30 to 120 minutes, numbness was deepest at 90 minutes or longer (Bjerring 1990, PMID 2317421). If the pain is severe during treatment, tell us rather than tolerating it. We can adjust the settings or the pace immediately.

Pain can be reduced further in several ways. One is a nerve block, which places local anesthetic around the sensory nerves of the face. In a study of focused ultrasound treatment that blocked one side of the face, pain scored 2.9 out of 10 on the blocked side and 7.5 on the unblocked side, with no adverse events (Polacco 2020, PMID 31996891). Another is cooling the skin with forced air.

For people who are highly sensitive to pain, or when the treatment area is large, we also consider intravenous sedation. Sofwave heats the dermis at a fixed depth of 1.5 mm and monitors and cools the skin surface in real time, so the risk of a burn is low even if a problem arises during sedation (Boonchoo 2025, PMID 40132902).

The pain ends with the treatment

Once the treatment is over, the pain stops. The area may feel tender to the touch for a few days, but not enough to need a pain reliever. The studies above reported no serious adverse events such as burns or nerve injury.

For the timing of results, see Sofwave results: when they appear and how long they last. For how the device works, see How Sofwave tightens skin: parallel ultrasound heat at 1.5 mm. For the comparison with Thermage, see Sofwave vs. Thermage: which one for which area. For pain with other devices, see Does Ultherapy hurt? What it feels like and how we manage it and Does Thermage hurt? What it feels like and how we manage it.

References

1. Boonchoo K, Hongcharu W (2025). The efficacy and safety of a single treatment of high-intensity, high-frequency, non-focused ultrasound parallel beams for facial acne scars in Asian patients: a preliminary study. J Cosmet Dermatol. PMID 40132902 (opens in new window).
2. Hongcharu W, et al. (2023). The efficacy and safety of the high-intensity parallel beam ultrasound device at the depth of 1.5 mm for skin tightening. J Cosmet Dermatol. PMID 36757157 (opens in new window).
3. Gold MH, Biron J (2024). Efficacy and safety of high-intensity, high-frequency, non-focused ultrasound parallel beams for facial skin laxity. J Cosmet Dermatol. PMID 38031530 (opens in new window).
4. Wang Y, et al. (2026). Evaluation of the effect of laterality and age on pain perception in monopolar radiofrequency facial therapy. Clin Cosmet Investig Dermatol. PMID 41924292 (opens in new window).
5. Bjerring P, Arendt-Nielsen L (1990). Depth and duration of skin analgesia to needle insertion after topical application of EMLA cream. Br J Anaesth. PMID 2317421 (opens in new window).
6. Polacco MA, et al. (2020). Nerve blocks prior to microfocused ultrasound treatment are safe and reduce patient discomfort. Aesthet Surg J. PMID 31996891 (opens in new window).