Ulthera Design, Shots and Depths: Questions and Answers
Answers about how an Ulthera treatment is designed: shot counts, depths, transducers and how each area of the face is planned. Dr. Kim decides where each line goes from the ultrasound image and from palpation, so the plan follows the layer that has changed rather than a fixed number.
Shots and Shot Count
How many Ulthera shots do I need?
There is no single correct number; the total follows from your face, the areas included and the depths used. In his answers to patients, Dr. Kim writes 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. He stresses that the number is set after assessing the amount of fat and the shape the patient wants. A longer explanation is in does a higher shot count mean a better result.
Does a higher shot count mean a better Ulthera result?
Not by itself. Two treatments with the same total can be very different: one spreads lines evenly at one depth, while another concentrates deep lines where the SMAS is thick and sagging is visible and keeps thin areas light. In a thin or hollow face, piling on lines adds discomfort and may risk a leaner look. What matters is whether the distribution by area and depth fits the anatomy of the person being treated.
What is shot distribution in Ulthera?
Shot distribution is the plan for where each line goes: which zones of the face are treated, at which depths, and how many passes each zone receives. Plans with the same total can put more deep lines along a heavy jawline and fewer, shallower lines over a thin temple, or the reverse. Dr. Kim treats distribution, not the total, as the core of the design. The principle is set out on the Ulthera page.
Is 300 shots of Ulthera enough for the full face?
It can be, depending on face size, which areas are included and how the lines are split between depths. Dr. Kim has also described 300 shots of Ulthera paired with 300 shots of Thermage as a good way to maintain results lightly. A larger face, a neck added to the plan or a stronger goal may need more. The number is decided after examination, not before.
Is 100 shots of Ulthera worth doing?
It can be, when the target is small and clearly defined. In his answers, Dr. Kim notes that around 100 shots can be enough to treat a limited area, such as part of the jawline or the area under the chin. Spread across a whole face, the same number would be thin and the change hard to notice. A small treatment makes most sense when one area accounts for most of the concern.
Why are Ulthera shot numbers quoted so differently?
Shot totals depend on what is included: which areas, how many depths, the size of the face and whether narrow transducers are used. Packages are also set for convenience rather than for any one face. A total quoted without a plan says little about where the lines will go. Asking how the lines are divided by area and depth makes two quotes easier to compare honestly.
Should I ask for more Ulthera shots for a stronger effect?
Not automatically. More lines in a zone that already has enough adds discomfort without necessarily adding lift, and in a lean area it may raise the risk of looking hollower. In one of his answers, Dr. Kim notes that if the effect felt short or underwhelming, increasing the shot count is one option to consider next time. That is a decision made after looking at how your face responded, so discuss your goal and let the plan follow from it.
Does the same shot count give the same result in two people?
No. Faces differ in size, skin thickness, fat, bone shape and how much the supporting layer has loosened, so the same 300 lines can be generous on one face and sparse on another. Skin and fat thickness also change which layer each depth actually reaches. The response to heat varies too, with age, skin quality and healing. That is why the total is set after diagnosis, not before.
How many passes does Ulthera make over one area?
Usually one or more passes per depth, with lines laid side by side to cover the zone, and sometimes a second pass in a different direction where more effect is wanted. The number of passes per zone is part of the distribution plan. Thick, heavy areas such as the lower cheek may receive more passes at the deeper depth, while thin areas receive fewer or are treated at shallower depths. Areas over bone and near nerves are kept conservative.
Can I see my Ulthera treatment plan before it starts?
You can ask Dr. Kim to explain the plan, including which areas will be treated, at which depths and roughly how the lines will be divided. Zones are commonly marked on the face before treatment, and adjustments happen during treatment as the image shows the tissue under each spot. Dr. Kim also shows patients the ultrasound screen during treatment and explains what it shows. Understanding the plan makes it easier to judge the result later.
Depths and Transducers
What are the Ulthera depths 4.5, 3.0 and 1.5 mm for?
The 4.5 mm depth aims at the SMAS and, in the neck, the platysma muscle, the layer responsible for structural lift. The 3.0 mm depth reaches the deep dermis and the top of the fat beneath it, firming the skin itself and serving areas too thin for the deeper depth. The 1.5 mm depth acts on the superficial dermis for texture and fine lines in selected areas. A full explanation is in Ulthera depths explained.
What is the 6:3:1 ratio in Ulthera?
It is a way of describing how lines are divided between the 4.5, 3.0 and 1.5 mm depths: six parts deep, three parts mid-dermal and one part superficial. Dr. Kim has cited proportions such as 6:3:1 in many women and 5:3:2 in many men as illustrations of combining depths. He stresses that these are examples rather than a fixed prescription. The actual mix is set for each face by skin thickness and structure.
Why combine all three Ulthera depths instead of using 4.5 mm?
Because sagging rarely comes from one layer. Dr. Kim describes an older rule of thumb of using mostly the 4.5 mm depth when there is more fat, and his move away from it towards combining the 4.5, 3.0 and 1.5 mm depths according to skin thickness and structure. The deep depth supports contour, the middle depth firms the dermis, and the shallow depth refines the surface. A combination lets each layer receive the energy it needs.
Is the 4.5 mm Ulthera depth always used?
No. The 4.5 mm depth is reserved for zones where imaging confirms enough tissue above the bone and the target layer actually lies at that depth. Over a thin temple or forehead, bone may sit closer than 4.5 mm, and deep energy there is uncomfortable and inappropriate. In a lean mid-cheek, deep energy may also be limited to avoid a hollower look. The image and palpation decide where the deep transducer goes.
What does the 1.5 mm Ulthera transducer do?
The 1.5 mm transducer focuses energy in the superficial dermis, where it can improve texture, fine lines and the look of pores in selected areas. Dr. Kim has written that the 1.5 mm depth extends treatment to pores and skin texture. Because the skin surface is close, it is used carefully, at appropriate energy and with good contact. It does not lift contour in the way the deeper depth does.
What does the 3.0 mm Ulthera transducer do?
The 3.0 mm transducer reaches the deep dermis and the upper part of the fat just beneath it. It firms the skin itself and is the main depth in areas where tissue is too thin for 4.5 mm, such as parts of the forehead and temples. In many plans it forms a large share of the lines alongside the deeper depth. Its effect is felt as firmer, smoother skin rather than structural lift.
What are narrow Ulthera transducers used for?
Narrow transducers deliver shorter lines, which helps on small or curved areas such as the chin, the angle of the jaw and the zones beside the eyes outside the bony rim. They exist at the deep and middle depths. Using them lets energy follow contours more closely instead of skipping awkward areas. Whether they are needed depends on which areas are in the plan.
Does Ulthera energy level matter as much as depth?
Both matter. Depth decides which layer is heated, while energy decides how strongly each point is heated. Lowering the energy can make treatment more comfortable, but lowering it too far may reduce the effect, and too much energy in thin tissue raises the risk of side effects. Energy is adjusted by area, with more caution over bone and in thin skin.
Can Ulthera target fat and the SMAS separately?
To a degree, yes, because each transducer focuses at one fixed depth and the image shows which layer lies there in each spot. Dr. Kim has written that energy concentrated in the SMAS emphasizes lift, while energy delivered into the fat layer can help adjust volume. Where the SMAS sits at 4.5 mm, the deep transducer acts on it; where fat lies at a shallower focus, the middle depth can firm it. Because tissue thickness differs, the same depth may land in a different layer from one person to the next.
Why does the same Ulthera depth reach different layers in different people?
Because the transducer's focus is measured from the skin surface, while the thickness of skin and fat varies between people and across one face. In a thick lower cheek, 4.5 mm may land in the SMAS; in a thin temple, the same depth may land close to bone. That is why Dr. Kim checks each area on the ultrasound image and by palpation before choosing a depth. A depth chart cannot tell what lies under any particular spot.
Reading the Face: Imaging and Palpation
What does Dr. Kim feel for when he examines the face before Ulthera?
He feels tissue thickness from one area to the next, how much fat there is and how soft it is, the edges of bone such as the cheekbone arch, jaw and brow ridge, and how the tissue moves when it is lifted. He also notes previous fillers, threads or scars that change how tissue behaves. Combined with the expected course of nerves and vessels, this decides where energy goes and where it is reduced or avoided. The image then confirms what lies under each spot.
What can the Ulthera image show that the eye cannot?
It shows what lies beneath the skin at the spot where the transducer rests: the thickness of skin and fat, the position of the SMAS or muscle, and the bright line of bone where it lies close. Dr. Kim has written that the depth of the SMAS, the position of fat and the shape of the deep cheek fat differ from person to person, which is why seeing them matters. Two faces that look alike from the outside can be built quite differently underneath.
What can't the Ulthera image show?
The image is a thin slice directly under the transducer at one moment, so it does not show the whole face at once. It also does not reliably show nerves or small blood vessels. Palpation and knowledge of surgical anatomy fill these gaps: following a bone edge along its length, comparing thickness between areas, and keeping energy away from the paths that nerves typically follow. This is why Dr. Kim uses both rather than relying on the screen alone.
How does Dr. Kim avoid nerves during Ulthera?
Facial nerves follow fairly predictable paths relative to bony landmarks, and surgical training teaches where they run. Examples are the branch that raises the eyebrow, which crosses the temple, and the branch that moves the lower lip, which runs near the jawline. In these zones energy is reduced, placed more superficially or left out. Dr. Kim combines this anatomy with the image and with palpation when drawing up the map.
Why do salivary glands and the jaw muscle matter in Ulthera design?
Because they change the shape of the lower face independently of sagging. Dr. Kim has written that when planning for a slimmer jawline, the size of the salivary glands and the bulk of the chewing muscle are considered alongside the fat and the supporting layer. A wide jaw caused by a large masseter muscle will not be slimmed by tightening the SMAS. Seeing these structures on the image helps match the plan to the real cause.
Is the Ulthera plan decided before or during treatment?
Both. The overall plan, which zones to treat and the general balance of depths, is set at consultation after examining the face. During treatment, the image under each placement confirms whether the intended layer is present and whether bone is close, and the plan is adjusted spot by spot. That is why the final distribution can differ slightly from the drawing made beforehand.
If Ulthera shows an image, why does anatomy training matter?
The device shows a slice of tissue; it does not decide what to do with it. Choosing which layer is responsible for the change you see, where the retaining ligaments and fat compartments lie, and which zones carry nerve risk requires knowing facial anatomy. Dr. Kim trained in plastic surgery at Chonnam National University and served there as a clinical professor, where facial surgery shows these structures directly. Reading the image well depends on that background, as set out on why Dr. Kim.
What is the layer-by-layer approach to Ulthera?
It means finding which layer of the face has changed before deciding how to treat it. Dr. Kim writes that lifting should start by looking at every layer, skin, fat beneath the skin, muscle, deep fat and bone, to find the cause. For Ulthera, that decides whether the deep depth is needed for the supporting layer, whether the fat layer should be addressed, and how much the skin needs the shallower depths. It can also show that Ulthera is not the right tool for the main problem.
Can ultrasound imaging find old filler before Ulthera?
Often it can show material or changed tissue under the transducer, but it is not a reliable way to map every filler or thread. Some products look distinct on ultrasound and others are hard to see, and small amounts can be missed. That is why you should tell the doctor what you have had injected or inserted, where and when. Energy is generally kept away from areas with recent filler or threads.
What does a good Ulthera design look like?
A good design starts from a diagnosis: which layer has changed in which area. It then assigns depths and line numbers by zone, keeps the deeper depth for areas where the image confirms enough tissue, and stays conservative over bone, in thin areas and near nerve paths. It accounts for fat, salivary glands and muscle bulk, and for previous treatments. And it is honest about the result that can realistically be expected.
Designing by Area
How is Ulthera designed for the jawline?
Along the lower cheek and jawline, the SMAS is often thick and the heaviness most visible, so the deeper and middle depths are commonly used where the tissue allows. The branch of the nerve that moves the lower lip runs near the jaw edge, so energy is placed with care there. Whether the plan emphasizes lift, the fat layer, or neither depends on what the image and examination show. More is in Ulthera for a slimmer jawline.
How is Ulthera designed for the area under the chin?
Under the chin, the plan depends on whether loose skin, a soft layer of fat or a lax platysma muscle is the main cause of fullness. The deeper depth can reach the platysma where tissue is thick enough, and the middle depth firms the skin and the fat just beneath it. Lifting loose tissue under the chin and on the neck is one of Ulthera's FDA-cleared uses. When a large fat pocket is the main issue, liposuction may be more effective.
How is Ulthera designed for the cheeks?
The mid-cheek below the cheekbone can be lean in slim faces, and some patients worry about losing volume there. For that reason the cheek is often treated more conservatively, sometimes mainly with the middle depth. In fuller faces, deeper energy may be used where imaging confirms thick tissue. Dr. Kim has noted that the shape of the deep cheek fat differs from person to person, which is one reason he values seeing it on screen.
Can Ulthera lift the eyebrows?
Yes, eyebrow lifting is one of Ulthera's FDA-cleared uses, and a slight lift of a low or heavy brow is a common goal. The forehead tissue is thin and close to bone, so mid-dermal and superficial depths are generally used, avoiding bone and the points where nerves exit. The lift is typically small, measured in millimeters rather than centimeters. A brow that has dropped onto the eyelid usually needs a forehead lift instead.
Is Ulthera used on the forehead?
Yes, for mild firming of the skin and to support a small brow lift. Because the forehead is thin and lies directly over bone, the deep depth is often unsuitable, and the middle and superficial depths are chosen. Energy over bone is uncomfortable and can be ineffective, so lines are placed to avoid bony prominences. Deep expression lines caused by muscle movement may respond better to other treatments.
Can Ulthera treat the temples?
It can, but carefully. The temple has thin tissue over bone, and the branch of the facial nerve that raises the eyebrow crosses this region. The middle depth is generally used with caution, and the deep depth is often unsuitable. In people whose temples are already hollow, volume treatment such as Sculptra may be more appropriate than tightening.
Can Ulthera be done around the eyes?
Ulthera can treat selected areas around the eyes, but within strict limits. The skin there is very thin and the eye itself is nearby, so treatment stays outside the bony rim of the eye socket and uses superficial depths. It is not applied over the eyelid itself. For crepey eyelid skin and fine lines around the eyes, radiofrequency with an eye tip, as used with Thermage, is often a closer fit.
Can Ulthera improve nasolabial folds?
It may soften them slightly, but deep folds are usually not its strength. Nasolabial folds form where cheek tissue descends against the firmer skin around the mouth, and their depth also depends on lost volume and bone support. Ulthera can firm the cheek tissue above the fold, while filler, collagen stimulators or, in marked cases, surgery address the fold more directly. Treatment close to the mouth is also limited.
How is Ulthera designed for the neck?
The neck is treated with lines across its width, using the deeper depth where the platysma lies at that depth and the middle depth for the skin. Treatment stays away from the midline over the windpipe and thyroid, from major vessels, and from areas where the tissue is too thin. Horizontal neck lines usually respond modestly. Strong vertical bands are mainly a muscle issue and are usually changed little by Ulthera.
Can Ulthera help drooping mouth corners and marionette lines?
Ulthera can firm the lower cheek tissue that hangs beside the mouth, which may soften the downward pull a little, but it does little for the lines themselves. Marionette lines and drooping mouth corners also reflect lost volume, muscle pull and the jowl fat above them, so they often need volume treatment or, when marked, surgery. Energy is kept away from the immediate area around the lips. The plan addresses the cause rather than the line.
How is Ulthera planned for the area in front of the ears?
In front of the ears the SMAS is relatively firm and fixed, and in facelift surgery this region serves as an anchor for lifting the lower face. In Ulthera plans it is often included to support the lift of the cheek and jawline, using the depths the tissue thickness allows. The parotid salivary gland lies here, and its size varies between people, which is one of the structures Dr. Kim considers in the design. Energy is kept away from the ear itself.
Can Ulthera be used on the body?
Ulthera is mainly used on the face, neck and décolleté, which is where its FDA clearances and most of its evidence lie. Focused ultrasound is sometimes used on body areas such as the upper arms, abdomen or knees, but evidence there is more limited and results are usually modest. Body skin is thicker and the areas larger, so a large number of lines is needed. Ask what evidence supports a body area before treating it.
Different Faces, Different Plans
Should both sides of the face get the same number of Ulthera shots?
Not necessarily. Most faces are slightly asymmetric in bone shape, fat, muscle bulk and how far tissue has descended, and the plan can reflect that by giving one side more lines or a different depth balance. The aim is a balanced result, not identical numbers. Existing asymmetry should be noted and photographed before treatment, because people often become aware of it when they study their face afterwards.
How is Ulthera planned for a thin face?
In a thin or lean face, the plan is more conservative with deep energy. Fewer lines are placed at 4.5 mm, more of the treatment may use the middle and superficial depths, and areas where fat is already scarce, such as the mid-cheek and temples, are treated lightly or not at all. Some people with lean faces have reported looking hollower after focused ultrasound, although the evidence is limited. More is in does Ulthera make your face hollow.
How is Ulthera planned for a face with more fat?
When the lower face carries more soft fat, more lines may be placed at the depths that reach the fat and the supporting layer, and the total is often higher, as Dr. Kim notes in his answers to patients. Even then, he moves away from simply using the deepest depth everywhere and combines depths by skin thickness and structure. If a fat pocket is large and well defined, other treatments may be discussed alongside or instead.
Does a previous Ulthera session change the next design?
Yes. How you responded last time, which areas changed, which stayed tender for longer, and whether any area looked leaner all inform the next plan. Areas that responded well may need less, and areas that changed little may need a different depth balance or more lines. Bring details or records of earlier treatments if they were done elsewhere, including the system used and the approximate number of lines.
How does Ulthera design change with age?
In younger faces with early laxity, the plan often emphasizes the supporting layer and skin firmness with moderate line numbers. In older faces, the skin is thinner, fat may have shifted or reduced, and bone support changes, so depths are chosen more cautiously and the expected effect is smaller. At some point the sagging moves beyond what any device design can address. Dr. Kim will say when that point has been reached.
Can Ulthera be designed to slim the face rather than lift it?
To a degree. Dr. Kim has written that two people who both want a slimmer jawline may need different things: for one the supporting layer needs lifting, while for another reducing the fat layer works better. Where the fat layer is the target, energy placement shifts accordingly. Where a wide lower face comes mainly from the chewing muscle, botulinum toxin is often a closer fit than any energy device.
How is Ulthera planned after a thread lift?
The doctor needs to know when the threads were placed, what type they were and where they run. Energy is usually kept away from recently placed threads, and some clinicians wait for a period after threading before treating the same area with focused ultrasound. Older dissolved threads may leave firmer tissue that feels and images differently. Palpation helps locate these areas before planning.
Why might Dr. Kim recommend fewer Ulthera shots than I expected?
Because more lines are not always better for a particular face. In thin areas, over bone and near nerve paths, extra lines add discomfort and risk without adding much lift. If the main change is lost volume or skin quality, energy aimed at the supporting layer will not solve it, and a different treatment may be suggested alongside or instead. The plan aims to fit the anatomy rather than reach a number.
Why might Dr. Kim suggest a different treatment instead of Ulthera?
Because the layer that changed decides the tool. If the face looks hollow, volume may need rebuilding with something like Sculptra; if the main issue is thin, crepey skin, radiofrequency and a skin booster may suit better; if tissue has descended a long way, surgery may be the honest answer. Choosing among these follows from the examination, as described in the five layers of facial aging.
Can I ask for a specific Ulthera depth ratio?
You can share what you have read or experienced, but the ratio is better set after examination. Dr. Kim's examples of 6:3:1 and 5:3:2 illustrate how depths can be combined, not a recipe to apply to every face. Your skin thickness, fat, bone and the change you want decide the mix. If a previous ratio worked well for you, that information is useful for planning.