01The procedure POV — minute by minute, what actually happens
0-15 minutes: arrival, photos from 5 standard angles, change into the clinic robe, oral analgesic (typically ibuprofen 400mg or paracetamol 1000mg). Some patients request a single dose of an anxiolytic — we don't routinely prescribe it, but for patients with documented procedural anxiety we'll add it.
This is also when we confirm the 200-line distribution map.
15-45 minutes: physician maps the treatment lines on your skin with a fine-tip white pencil. Each line corresponds to one ultrasound pulse line that'll be delivered.
The mapping looks like a fine grid pattern across the lower face, jawline, and submental area. For the 200-line package, expect roughly 80 lines on the lower face, 50 on the jawline, 40 in the submental, and 30 in the brow region (subject to your specific anatomy).
45-60 minutes: the first depth pass at 4.5mm — the SMAS layer. This is the deepest, most intense pulse.
Each pulse feels like a hot pinprick that ends in under a second. We deliver roughly 60-80 of these in the first 15 minutes.
The discomfort peaks here — most patients rate the 4.5mm pulses at 6-7/10 on a 10-point scale.
60-75 minutes: 3.0mm depth pass, then 1.5mm depth pass. Noticeably more comfortable than 4.5mm — most patients rate these at 3-4/10. Total time for these two passes: ~15 minutes combined.
75-90 minutes: cooling pack on the treated area (10-15 minutes), final photos, post-session instructions, and you're done. We schedule the after-photo at month 6 — not earlier — and confirm the next consultation date.
What you actually feel through the session: a series of hot pinprick sensations, each ending in under a second. Between pulses there's no sensation.
You can talk, ask the physician to pause, request a break for water — none of those would compromise the treatment. The discomfort is intense in the moment but ends with each pulse; it does not accumulate as a continuous pain.
02What 200 lines means and how they're distributed
One 'line' is one continuous ultrasound pulse line delivered by the transducer cartridge. The transducer focuses ultrasound energy to a precise depth (1.5mm, 3.0mm, or 4.5mm depending on the cartridge) and delivers thermal coagulation points along that line.
Each line is typically 25mm long.
Standard 200-line distribution across the lower face and neck: 80 lower face (cheek, marionette area, mandibular zone), 50 jawline (definition + tightening), 40 submental (the 'turkey neck' zone under the chin), 30 brow region (outer brow lift + temple). The physician adjusts this distribution at the mapping step based on your specific laxity pattern — patients with heavier submental looseness might shift to 80 lower face + 30 jawline + 60 submental + 30 brow.
Why we don't split 200 lines across multiple sessions: the collagen rebuild response is cumulative within a treatment session, not across separated sessions. Splitting 200 lines into two 100-line sessions a month apart produces a weaker overall result than delivering all 200 in one continuous treatment.
The biology rewards the larger insult-and-recovery cycle.
Adding neck or décolletage to the 200-line package: separate line count, separate quote. Neck typically adds 50-80 lines; décolletage another 60-100.
These are stand-alone packages that can be added at the time of booking or as a follow-up session. We don't bundle them into the 200-line price because the patient-time and procedure cost is meaningfully higher.
03Ulthera Prime vs Ulthera SPT — what the Prime upgrade gets you
Both machines are made by Merz Aesthetics and deliver micro-focused ultrasound with visualization (MFU-V). Both are FDA-cleared.
Both have substantial clinical evidence. The Prime is the updated handpiece system released in 2022 and is the version we run at Waleerat.
Cartridge depth coverage: standard SPT covers 1.5mm, 3.0mm, and 4.5mm depths. Ulthera Prime adds a 6.0mm cartridge for deeper SMAS engagement — useful for patients with heavier lower-face laxity, denser tissue density, or significant neck looseness.
For a 40-year-old with mild laxity, the 6.0mm cartridge isn't needed. For a 55-year-old with moderate laxity, it materially improves the result.
Pulse timing: Prime's transducer delivers pulses approximately 30% faster than SPT. The clinical implication is shorter session duration for the same total line count — the 200-line package runs 75-90 minutes on Prime vs 100-110 minutes on SPT.
For patients with limited time tolerance, that's meaningful.
Treatment area: Prime's transducer is slightly wider, covering ~5% more skin area per line. The cumulative effect across 200 lines is a more uniform coverage and slightly fewer 'edge effect' zones where two lines meet.
Pricing delta: Ulthera Prime starts at ฿45,000 for a base package vs SPT from ฿18,000. The 200-line package premium is justified for patients 45+ with moderate laxity.
For mild brow lift or early laxity in the 30s, SPT is the more proportionate (and more affordable) intervention.
04Pain expectations — the honest version we tell at every consult
Ulthera is not painless. We pre-medicate every patient with oral analgesics 30 minutes before the session.
Patients consistently rate the discomfort at 4-6/10 average across the full session, with peak moments at 7/10 during the 4.5mm SMAS pulses. This is the realistic expectation — patients who arrive expecting a Botox-level comfort experience consistently leave disappointed by their own expectation mismatch.
Why the 4.5mm pulses are the most intense: that depth corresponds to the SMAS (superficial musculoaponeurotic system) — the connective tissue layer that holds facial structure. Heating this layer requires more focused energy than the more superficial 3.0mm and 1.5mm passes.
The pulse delivery is faster (each pulse ends in under a second) but the intensity per pulse is higher.
Why we don't use nerve blocks: nerve blocks (regional anaesthetic injections) would mask the proprioceptive feedback we use to guide energy delivery. If you can't feel the pulses, we can't calibrate the energy to your specific tissue density.
Topical anaesthetic doesn't reach the 4.5mm depth either — there's no anaesthetic option that would reduce the discomfort meaningfully without compromising the treatment.
What patients can do mid-session: ask for breaks (we'll pause without losing time), request water, take deep breaths between pulses, ask the physician to slow the pulse cadence for the next few lines. Patients who use these tools rate the session more comfortable than patients who tough it out silently.
The physician would much rather pause than have you tense through the rest of the session.
Post-session sensation: mild tenderness in the treated area for 1-2 days, similar to the muscle-soreness feeling after a hard workout. No bruising in 90% of patients (the deep-focused ultrasound doesn't pass through superficial vessels).
No restrictions on normal activity — gym, work, social engagements all fine the same day. We just recommend skipping facial massage or deep facial work for 1 week.
05The 6-month after-photo discipline and why we enforce it
Week 1 after session: immediate tightness from heat-shrink in the treated zones. This is real but temporary — it's the placeholder version of what you'll eventually have permanently.
Some patients photograph at week 1 and decide they're delighted. They are — but they're seeing the temporary version.
The permanent version arrives later.
Month 1: the week-1 tightness has faded to roughly 30% of its initial visibility. New collagen synthesis is starting in the SMAS layer but isn't surfaced yet.
This is the discouraging-looking phase if you expected steady progress. Don't judge.
Month 3: collagen rebuild starts becoming visible. The jawline definition returns, submental looseness softens, lower-face contour sharpens.
This is when patients typically start commenting that 'something looks different but I can't pinpoint it'.
Month 6: peak result. This is the photo we book the after-shoot for.
The lifted contour, sharper jawline, and reduced submental looseness are all visible side-by-side with the pre-session baseline. We always book the after-photo at month 6, not earlier.
Why we enforce the 6-month discipline: patients who judge results at month 2 invariably book unnecessary 'touch-up' sessions that wouldn't have been needed if they'd waited for the natural collagen-rebuild curve to complete. The biology dictates the timeline.
Booking earlier doesn't accelerate the result; it just costs the patient more without changing the outcome.
Ready to talk to our doctor?
Send a photo or describe your concern on LINE — we'll suggest a treatment plan and price range before you visit.