Does Ultherapy hurt? What it feels like and how we manage it

Ultherapy is known for its pain as much as for its results. Online reviews describe it as "like tapping on bone" or "like an electric jolt," and people often ask whether they need sedation. Others report almost no pain at all. This article covers what causes the pain, how we manage it, and whether Ultherapy PRIME hurts less.

Intense heating of the tissue causes the pain

Each Ultherapy pulse lays down a line of tiny points, focusing ultrasound on one point after another and briefly raising the temperature at each above 60°C (about 140°F). At each point, a spot of coagulated tissue smaller than 1 mm³ forms at a set depth, while the skin surface and the upper dermis above it are spared (Fabi 2015, PMID 25709486). The pain occurs at the hot instants when those spots form. The manufacturer notes that heat or a prickling sensation may be felt as the energy is delivered and that the intensity varies from person to person (Merz Aesthetics 2026).

Bony areas such as the jawline hurt more

In a study of 103 people who received a sedative and a pain reliever before treatment of the lower face, average pain scores out of 10 were 5.68 on the cheek, 6.09 under the chin, and 6.53 along the jawline (Oni 2014, PMID 24990884). The area under the jaw, where the soft tissue is thin, was more painful than the cheek.

If the energy reaches bone, the result is severe pain with no benefit. The manufacturer's treatment guide for clinicians advises adjusting line length, pressure, and transducer choice to avoid bone (Merz product materials). Because Ultherapy displays the bone on its real-time ultrasound image, contact with bone can largely be avoided.

We recommend nerve blocks along with numbing cream

Numbing cream acts mainly on the shallow layers. According to a review of Ultherapy, topical anesthetic helped at the 1.5 mm depth but was no better than an anti-inflammatory pain reliever at 3.0 and 4.5 mm (Fabi 2015, PMID 25709486). Most of Ultherapy's effect, however, comes from those deeper layers. In a randomized study of 14 women who received a sedative and a pain reliever in advance as well as numbing cream, pain still averaged 5.6 and 5.7 out of 10 with the two creams tested (Palm 2018, PMID 30005094).

We therefore usually recommend nerve blocks for the whole face. A nerve block places local anesthetic around the sensory nerves of the face and numbs the area each nerve supplies for a few hours. In a study that blocked one side of the face before Ultherapy, 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).

If you are sensitive to pain, you may take a pain reliever before your visit. The same review suggests acetaminophen or an anti-inflammatory drug beforehand (Fabi 2015, PMID 25709486). If the pain is still severe, we can add nitrous oxide inhalation, commonly known as laughing gas, or intravenous sedation, in which you sleep but keep breathing on your own.

Whether PRIME hurts less is unclear

Our clinic uses Ultherapy PRIME, the newer model, and people sometimes ask whether it hurts less than the original.

Some studies report lower pain with PRIME. In a study of 30 Asian participants treated on the lower face and neck with PRIME, pain averaged 4.50 out of 10, compared with 6.15 in two earlier studies of similar treatment with the previous device. Numbing cream had been applied for at least 30 minutes, and some participants had taken a pain reliever (Lim 2025, PMID 41282450). In a survey at a Thai clinic, 231 people who had received the previous device and later PRIME reported average pain of 5.59 and 2.75, respectively (Panithaporn 2025, PMID 40965929). The manufacturer attributes the more comfortable treatment to a quieter console (Merz product materials).

Both studies, however, were conducted at a single site without randomization. The first was sponsored by the manufacturer, and the second drew the previous device's scores from earlier records. According to the FDA clearance file, PRIME uses the same handpiece, transducers, and ultrasound energy as the previous device (U.S. FDA 510(k) K233996). These studies cannot show where the difference comes from.

For how Ultherapy PRIME reaches the deep layers, see How Ultherapy tightens skin: focused heat at depth, guided by real-time imaging. For pain with other devices, see Does Thermage hurt? What it feels like and how we manage it and Does Sofwave hurt? What it feels like and how we reduce it.

References

1. Fabi SG (2015). Noninvasive skin tightening: focus on new ultrasound techniques. Clin Cosmet Investig Dermatol. PMID 25709486 (opens in new window).
2. Merz Aesthetics (2026). What to expect: Ultherapy PRIME. ultherapy.com.
3. Oni G, et al. (2014). Evaluation of a microfocused ultrasound system for improving skin laxity and tightening in the lower face. Aesthet Surg J. PMID 24990884 (opens in new window).
4. Merz Aesthetics (2025). Ultherapy PRIME product materials: facial treatment guide and brochure for clinicians.
5. Palm MD, Misell LM (2018). Topical transdermally delivered lidocaine and benzocaine compared to compounded lidocaine/tetracaine during microfocused ultrasound with visualization treatment. J Drugs Dermatol. PMID 30005094 (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).
7. Lim J, Siew TW, Xu Y (2025). Early experience with Ultherapy Prime in Asia Pacific: a pilot case series. Plast Reconstr Surg Glob Open. PMID 41282450 (opens in new window).
8. Panithaporn D (2025). Pain, erythema, and edema after facial lifting with Ultherapy Prime or Ultherapy Legacy: a survey study. J Cosmet Dermatol. PMID 40965929 (opens in new window).
9. U.S. Food and Drug Administration (2024). 510(k) Summary K233996: Ulthera System (UC-1 Control Unit PRIME). accessdata.fda.gov.