Ulthera
Ulthera is a non-surgical lifting treatment that uses focused ultrasound to heat small points at chosen depths under the skin, while an on-screen ultrasound image shows the layers being treated. Dr. Kim plans each treatment by combining that image with palpation, feeling the tissue by hand, and by deciding how the shots are distributed across areas and depths.
- What is it?
- Microfocused ultrasound with visualization (MFU-V): tiny heated points in the skin and the deeper support layer (SMAS), without incisions.
- Treatment time
- Typically about 30–90 minutes, depending on how many areas are treated and the pain-control method.
- Downtime
- Usually little. Redness, mild swelling and tenderness for hours to a few days; bruising or numbness can last longer.
- When do results show?
- Gradually. Changes usually build over about 2–3 months and may continue for up to about 6 months. Not everyone sees a visible change.
- How often?
- Commonly reassessed about once a year, but the right interval varies with age, skin, tissue thickness and the previous response.
Why Dr. Kim for Ulthera
The device is the same everywhere. What changes the result is how the face is read and where each line of energy is placed.
Seen and felt
He designs each treatment from the live ultrasound image and from palpation: tissue thickness, fat, bone contours and areas to avoid.
Distributed, not counted
Shots are placed by area and depth, with the 4.5, 3.0 and 1.5 mm depths combined for each face rather than a single default.
A surgeon's anatomy
Trained in plastic surgery at Chonnam National University, where he was a clinical professor, he knows the SMAS, ligaments and fat compartments the energy is aimed at.
Invited to the PRIME launch
Invited to the Ultherapy PRIME Asia launch in Seoul in 2025; Violacell offers both Ulthera and Ultherapy PRIME.
You see the screen too
During treatment he shows patients the same image and explains why an area bulges.
Honest limits
When sagging has gone beyond what a device can lift, he says so.
Where Ulthera Fits
What it does
Ulthera delivers heat to small, precise points at a set depth: the deeper support layer (SMAS) or the lower and upper parts of the dermis. The healing response then builds new collagen, giving a modest tightening that develops slowly.
What it cannot do
It does not remove excess skin, reposition fat that has dropped well below its original place, or release the ligaments that hold sagging tissue down. Its effect is smaller than surgery and fades as aging continues.
Dr. Kim’s emphasis
The device settings are only part of the treatment. Dr. Kim designs each session by reading the real-time ultrasound image together with what he feels by hand, then decides where the energy goes, at which depth, and how densely.
Benefits and considerations
No incision, and most people return to normal activities the same day. But the treatment can be uncomfortable and some people see little change. As a plastic surgeon trained in facial surgery, Dr. Kim can tell you when a device is unlikely to be enough.
Glossary
- MFU-V
- Microfocused ultrasound with visualization: focused ultrasound energy for treatment, combined with ultrasound imaging to see the tissue on a screen.
- SMAS
- Superficial musculoaponeurotic system. A thin, firm layer under the skin and fat that surrounds the facial muscles and supports facial contours. It is the layer a surgical facelift lifts.
- Dermis
- The thick inner layer of the skin that contains collagen and elastic fibers.
- Thermal coagulation point
- A tiny spot where tissue is heated enough for its proteins to change and contract. Ulthera places these points in rows.
- Transducer
- The handpiece cartridge that produces the ultrasound. Each one is built to focus energy at one fixed depth.
- Palpation
- Examining by touch: feeling thickness, firmness, fat, bone edges and how tissue moves.
How Microfocused Ultrasound Works
Ultrasound is sound at a frequency too high to hear. In Ulthera the energy is focused, much as a magnifying glass focuses sunlight, onto a small spot below the surface. At that spot the tissue briefly reaches a temperature above about 60 °C, which is enough to make collagen contract, while the skin surface above it is left largely unaffected.
Each pass of the transducer lays down a short row of these heated points at a single fixed depth. The depth is set by the transducer, not by pressing harder, so treating several layers means switching transducers. Healing and new collagen then develop over months, which is why the effect appears gradually.
| Transducer depth | Approximate layer reached | What it is used for |
|---|---|---|
| 4.5 mm (4 MHz) | The SMAS and the platysma muscle of the neck in areas where the tissue is thick enough | The deeper “structural” layer, aiming at lift along the jawline, lower face and under the chin |
| 3.0 mm (7 MHz) | The deep dermis and the upper part of the fat just beneath it | Firmness of the skin itself; also used where the tissue is too thin for the 4.5 mm depth, such as parts of the forehead and temples |
| 1.5 mm (10 MHz) | The superficial dermis | Skin texture and fine lines in selected areas; used carefully because the skin surface is close |
Narrow versions exist for small or curved areas. The depth a transducer reaches is fixed, but the thickness of each person’s tissue is not, which is why imaging and examination matter.
Why the On-Screen Image Matters
The “V” in MFU-V stands for visualization. Before each pass, the transducer shows a cross-section of the tissue under it on a screen: the skin, the fat, the SMAS or muscle layer, and the bright line of bone where bone lies close to the surface.
This matters because the same 4.5 mm depth falls in different layers in different people, and in different parts of one face. Over the jawline it may land in the SMAS; over the temple of a thin person, bone may be closer than 4.5 mm, and that depth is not appropriate.
What the image helps confirm
- That the target layer is actually present at the transducer’s depth in that spot
- How thick the skin and fat are in each area
- Where bone lies near the surface, so energy is not placed on bone
- That the transducer is coupled evenly to the skin before energy is delivered
The image shows a thin slice directly under the transducer at one moment. It does not show nerves or small vessels reliably, and it does not show the whole face at once. That gap is one reason palpation is added.
Why Palpation Adds Information
Feeling the tissue by hand gives information that a single image slice cannot. With the fingers, a surgeon can follow a bone edge along its whole length, compare the thickness of tissue from one area to the next, feel where fat is soft and abundant and where it is thin, and see how the tissue moves.
Surgical anatomy is part of this step. Facial nerves and vessels follow fairly predictable paths relative to bony landmarks, such as the nerve branch that raises the eyebrow crossing the temple, or the branch that moves the lower lip running near the jawline. In these areas energy is reduced, placed more superficially, or avoided. Dr. Kim combines this hands-on assessment with the ultrasound image when drawing up the treatment map.
| What is felt by hand | Why it can change the plan |
|---|---|
| Tissue thickness area by area | Thin areas may need a shallower transducer or fewer lines; thicker areas may tolerate the deeper depth. |
| Amount and softness of fat | In a face that is already lean or hollow, the plan may avoid placing deep energy where fat is scarce. |
| Bone contours (cheekbone arch, jaw edge, brow ridge) | Energy over bone is uncomfortable and can be ineffective; lines are placed to the side of bony prominences. |
| Expected course of nerves and vessels | Higher-risk zones near the temple, below the cheekbone and along the lower jaw are treated with more caution or left out. |
| Previous fillers, threads or scars | They change how tissue feels and how energy should be placed. |
Shot Count and Shot Distribution
Ulthera is often discussed in “shots” or “lines”. One line is one pass of the transducer: a single row of heated points at one depth. A total is easy to compare, so it is tempting to treat it as a measure of strength or value. On its own, though, it says little about what was done.
Two treatments with the same total can be very different. One spreads lines evenly at one depth; another places more deep lines where the SMAS is thick and sagging is visible, fewer and shallower lines where tissue is thin, and none over bone or near higher-risk nerve areas. What matters is how the lines are distributed by area and by depth, and whether that distribution fits the anatomy of the person being treated.
Why the total alone says little
A larger face needs more lines to cover the same areas. Lines at 1.5 mm and at 4.5 mm act on different layers and cannot be added up as if they were the same.
How distribution is planned
The face is divided into zones. For each, the plan sets whether to treat it, which depths, and how many passes. The deeper depth is kept for zones where imaging confirms enough tissue.
Where more is not better
Many lines in a thin or hollow area add discomfort and may risk a leaner look. Areas over bone and near nerve paths are kept conservative. Fewer lines can suit a slim face better.
What to ask at consultation
Rather than only a number, ask which areas will be treated, at which depths and why, and which areas will be avoided or treated lightly.
| Area | Typical tissue considerations | General depth approach |
|---|---|---|
| Lower cheek and jawline | Often the thickest SMAS and the most visible heaviness; the nerve to the lower lip runs near the jaw edge | Deeper and mid-dermal depths where tissue allows, with care near the jaw edge |
| Mid-cheek below the cheekbone | Can be lean in slim faces; fat loss is a concern for some patients | Often more conservative, sometimes mainly the mid-dermal depth |
| Temple | Thin tissue over bone; nerve branch to the forehead crosses this region | Mid-dermal depth with caution; deep depth is often unsuitable |
| Forehead and brow | Thin tissue close to bone; the brow can be lifted slightly | Mid-dermal and superficial depths, avoiding bone and nerve exit points |
| Around the eyes | Very thin skin, the eye itself nearby | Only superficial treatment in selected areas, staying outside the bony eye socket rim |
These are general principles, not a fixed protocol. The actual plan depends on examination and imaging on the day. For a longer explanation, see Does a higher Ulthera shot count mean a better result?
Pain and Anesthesia Options
Ulthera is not painless. Most people feel each line as a brief, deep heat or a sharp prickling, which is strongest over bony areas such as the jaw edge, cheekbone and forehead, and at the deeper depth. How much it hurts varies a great deal between people and between areas of one face.
The options below can be combined. The choice depends on your health, medicines, the areas treated and whether you need to drive afterwards. Energy can also be lowered, though lowering it too far may reduce the effect.
Common options
- Topical numbing cream Reduces surface sensation but not deep sensation.
- Oral pain relief Taken shortly before treatment, as advised.
- Local nerve blocks Small injections of local anesthetic near selected nerves to numb a region, used in some clinics.
- Sedation In some settings; requires monitoring, fasting and someone to take you home.
Which options are available, and which suit you, is discussed at consultation.
Dr. Kim on Ulthera, in His Own Words
The points below summarise what Dr. Kim has written about Ulthera in his columns and in his answers to patient questions. They describe how he thinks about planning, not a fixed protocol: every plan is decided after examining the face.
The same wish, different tissue
Two people who both want a slimmer jawline may need different things. One needs the deeper supporting layer (SMAS) lifted; for another, reducing the fat layer works better. The size of the salivary glands and the bulk of the chewing muscle also change the design. Seeing these structures on the ultrasound image, rather than assuming them, is what he considers the main advantage of Ulthera over other focused-ultrasound devices.
Looking at the screen together
During treatment he shows patients the same ultrasound image he is working from and explains what they are seeing: how an area is built, and why a particular spot bulges because of where the fat sits. He finds that patients feel more involved and less anxious when they can see the reason for each step.
Combining depths, not defaulting to one
An older rule of thumb was to use mostly the 4.5 mm depth when there is more fat. He describes moving away from that towards combining the 4.5, 3.0 and 1.5 mm depths according to skin thickness and structure. As illustrations he cites proportions such as 6:3:1 in many women and 5:3:2 in many men, while stressing that the actual mix is set for each face.
Shot numbers follow the diagnosis
Asked how many shots are needed, he answers that a small area can be treated with around 100 shots, and that around 300 shots is a common recommendation when the jaw and cheeks carry more fat, but that the number is set after assessing the amount of fat and the shape the patient wants. The distribution matters as much as the total.
Why the PRIME image matters to him
The depth of the SMAS, the position of fat and the shape of the deep cheek fat differ from person to person, and older imaging showed the deepest layers less clearly. He values the sharper, deeper image of Ultherapy PRIME for that reason. He also notes that the time each pulse takes to deliver energy has not changed; what feels faster is the workflow, and in his experience the 4.5 mm depth is less uncomfortable than before.
How long it lasts, and pairing with Thermage
In his answers he describes the effect of Ulthera as typically holding for around six months and Thermage for around ten months to a year, and notes that radiofrequency devices such as Thermage are better suited than focused ultrasound when fine wrinkles and skin elasticity are the main goal. Combining the two lets each work on the layer it suits. Thermage and Re2O
Sources: Dr. Young Jun Kim's columns for Violacell Plastic Surgery on Ultherapy PRIME and the second-generation system (2025) and how Ultherapy PRIME differs (2025); his clinic blog; and his signed answers to patient questions (clinic Q&A archive, 2026). Individual results vary.
Ulthera and Ultherapy PRIME at Violacell
Violacell Plastic Surgery offers both the established Ulthera system and the newer Ultherapy PRIME. Dr. Kim was one of the doctors in Korea invited to the Asia launch of Ultherapy PRIME, held at the Grand Hyatt Seoul in 2025; he writes that invitations in Korea were limited to 50 doctors. Whichever system is used, the planning principle on this page is the same: the image and the hands decide where the energy goes.
| As described by the clinic | Ulthera | Ultherapy PRIME |
|---|---|---|
| Imaging depth on screen | Up to about 4.5 mm | Extended, up to about 8 mm |
| Treatment speed | Standard | Faster, which can shorten the time spent in discomfort |
| Typical treatment time | About 20–40 minutes, depending on the areas treated | |
| Anaesthesia | Numbing cream; other options can be discussed | |
| Return to daily life | Usually immediately, with possible redness, swelling or tenderness | |
A deeper or clearer image helps the plan, but it does not replace judgement. The tissue in each area still has to be read and felt before deciding which depth and how many lines it needs.
Results Timeline
| Timing | Typical course |
|---|---|
| Immediately | Redness and a feeling of tightness are common. Some people notice a slight early change from tissue contraction, which may partly settle as swelling resolves. |
| First few days | Mild swelling and tenderness, especially along the jaw. Tenderness to touch can last a few weeks in some areas. |
| Weeks 2–8 | Collagen remodeling begins. Visible change is usually still small. |
| About 2–3 months | The period when many people first notice firmer skin or a slightly lifted contour. |
| Up to about 6 months | Gradual improvement may continue. |
| Afterward | Aging continues. How long the effect lasts varies widely; manufacturer materials often cite a year or more, while Dr. Kim, in his answers to patients, describes the visible effect as typically holding for around six months. It is not guaranteed. |
In clinical studies, some patients showed no visible improvement. Results depend on age, skin quality, the degree of sagging, weight changes and smoking, as well as on the plan.
Who It Suits, and When Surgery Is the Better Answer
Ulthera firms tissue that is still roughly in place. Surgery moves tissue that has descended and removes excess skin. As a plastic surgeon trained in both, Dr. Kim will explain which group you are closer to.
Ulthera may suit
- Early to mild laxity along the jawline, lower cheek or under the chin
- A slightly low or heavy brow where a small lift is enough
- People who want gradual change and minimal downtime, and accept a modest result
- Maintenance after a facelift, once healing is complete and the surgeon agrees
- Those who are not ready for or not suitable for surgery
Surgery is often the better answer
- Marked jowls and a heavy lower face, or deep folds from descended tissue: see mini facelift and facelift
- Loose neck skin and visible bands that have not responded to devices
- A brow that has dropped onto the upper eyelid: see forehead lift
- Excess upper eyelid skin that rests on the lashes: see upper eyelid surgery and eyelid surgery
- Localized fat that is the main problem: see liposuction
Related reading: Mini facelift or full facelift: which one fits your face? and Heavy upper eyelids: upper blepharoplasty or forehead lift?
Risks and Side Effects
Most side effects are temporary. Correct depth, avoiding bone and higher-risk nerve areas, and even contact of the transducer are the main ways to reduce them.
- Pain during treatment Expected to some degree; see pain control above.
- Redness and swelling Common; usually settle within hours to a few days.
- Tenderness and tingling Can last days to a few weeks, especially along the jaw.
- Bruising Occasional, more likely if you take blood-thinning medicines or supplements.
- Welts or line-shaped marks Raised or reddish streaks on the skin, usually temporary.
- Temporary nerve irritation or weakness Rarely, numbness or weakness of a muscle, such as an uneven smile, has been reported. These have usually recovered over weeks to months.
- Burns or lasting marks Rare; more likely with poor contact or energy placed too superficially.
Fat loss in thin faces
Some people worry that deep energy in an already lean face could make it look hollower. The evidence is limited and mixed, and the treatment is not designed to remove fat. In slim faces Dr. Kim takes this into account when placing deeper energy, and some people may be better served by volume treatment such as Sculptra or by surgery.
Tell the clinic beforehand if you
- Have an open wound, active infection or active acne in the area
- Have a pacemaker, implanted electronic device or metal implant near the area
- Are pregnant
- Have had fillers, threads, fat grafting or surgery in the area
- Take blood thinners, or have a bleeding or healing disorder
Interval Between Sessions
Collagen remodeling continues for months, so a full session is commonly reassessed about once a year, and some people go longer. The interval depends on age, tissue thickness and laxity, and how you responded last time.
Combining With Other Treatments
Ulthera does not replace lost volume or improve surface quality much, so some people combine it with a collagen stimulator such as Sculptra for volume, or with radiofrequency and a skin booster, as described on Thermage and Re2O.
When treatments are combined, their order and spacing are planned so that swelling from one does not distort the assessment for the next.
Frequently Asked Questions
Does Ulthera hurt?
Most people feel brief deep heat or prickling with each line, strongest over bone and at the deeper depth. It varies between people. Numbing cream, oral pain relief, nerve blocks or sedation can be considered, depending on your health and the areas treated.
How many shots do I need?
There is no single correct number. The total depends on face size, which areas are included and which depths are used. How the lines are distributed by area and depth matters more than the total, so the plan is decided after examination and imaging.
Why does Dr. Kim use palpation as well as the ultrasound image?
The image shows a thin slice directly under the transducer. Feeling the tissue by hand shows how thickness, fat and bone contours change across the whole face and how the tissue moves. Combined with knowledge of where nerves and vessels run, this helps decide where energy goes and where it should be reduced or avoided.
When will I see results?
Changes usually develop gradually over about 2 to 3 months and may continue for up to about 6 months. Some people see only a small change, and some see no visible change.
Can Ulthera replace a facelift?
No. Ulthera can firm and slightly lift tissue that has not dropped far. It cannot remove excess skin or reposition tissue that has descended significantly. When sagging is marked, a mini facelift or facelift is usually the more effective option.
Can Ulthera make my face look thinner or hollow?
The treatment is not designed to remove fat, and the evidence on fat loss is limited. Some people with very lean faces have reported looking hollower. In a thin face, deep energy is placed more conservatively, and volume treatment may be discussed instead of or alongside it.