u/Holiday-Weight-2550

I feel like one of the biggest fears patients have before Ultherapy is not even the pain. It is whether they are actually getting REAL Ultherapy or not.

Especially in Korea because there are so many lifting devices now: Ultherapy, Shurink, Doublo, Ultraformer, Oligio, Thermage, Tuneface, etc

So first thing... authentic Ultherapy is a very specific device from Merz.

It is NOT the same thing as Shurink or Ultraformer even though they are all ultrasound lifting devices. Some also mix the terms together in consultations which confuses patients even more

One of the easiest ways to check is actually the screen during treatment. Real Ultherapy has real time ultrasound imaging, this means the doctor can actually see the tissue layers during treatment. You can usually see the black / gray ultrasound screen moving during the procedure.

This is actually one of the biggest differences between Ultherapy and many cheaper HIFU devices. Another thing is the treatment tips, cartridges.

Authentic Ultherapy cartridges are very expensive in Korea, so clinics using real authentic cartridges usually cannot sell extremely cheap unlimited shot promotions.

If you see something like: “600 shots Ultherapy $150” I would personally become suspicious immediately!!

You can also check the NFC tagging and QR code on the tips/transducers themselves. Real Ultherapy tips usually have authentication systems where clinics can scan the QR code or NFC tag to verify the cartridge information and shot usage.

Another thing is that real Ultherapy is usually quite painful. Not saying pain = authenticity obviously, but patients sometimes get Ultherapy with almost no discomfort at all and then become confused later. The energy delivery with Ultherapy feels very deep and sharp especially around the jawline and bone areas.

Also the doctor technique matters a lott. Many patients think Ultherapy is just stamping shots randomly across the face but actually vector, depth, shot placement and facial anatomy matter so much for the final result. For example:

too superficial --> not much lifting

wrong vectors --> unnatural result

too aggressive in thin faces --> volume loss

too few shots --> patients see almost nothing

This is why I feel consultation is honestly more important than patients realize. Some are actually much better candidates for Thermage, Oligio or even simple botox, filler instead of Ultherapy.

And one more thing, authentic Ultherapy does not automatically mean amazing results.

I have seen patients get authentic Ultherapy with almost no visible improvement because of wrong candidate, too few shots, poor vector design, expectations too high and severe sagging needing surgery instead. So the machine matters, but the person using the machine matters too ☺️

Let's talk about pain during Korean skin treatments because honestly I think this is something clinics don't explain enough before patients come in.

A lot of people think aesthetic treatments are either: completely painless or unbearably painful

I have patients who say Ultherapy was completely fine and then complain more during skin boosters. Meanwhile other patients can tolerate needles perfectly but hate lifting devices.

Pain tolerance honestly makes no sense sometimes.

The most basic option is numbing cream

This is enough for treatments like:

- laser toning

- skin botox

- Juvelook

- lighter skin boosters

- Potenza

- pore lasers

Usually we leave it on 20-40 minutes depending on the treatment and honestly GOOD numbing cream placement matters a lot. Some clinics apply it so thinly it basically does nothing.

But numbing cream only blocks the needle pain or surface pain. It does not fully block the deep aching pain from treatments like Ultherapy, Thermage, Oligio, or original Rejuran healer.

For treatments like Ultherapy, the pain is more deep and sharp because the energy reaches the SMAS layer. It feels almost like tiny electric shocks inside the face. That's why some patients tolerate needles perfectly but cannot tolerate lifting devices.

Then there is laughing gas (nitrous oxide)

Honestly I love this option for anxious patients because patients stay awake but become very relaxed and less sensitive to pain. Some people become very giggly, some become super quiet, some keep talking non stop during the treatment

I feel like laughing gas works best for:

- Ultherapy

- Thermage

- filler anxiety

- acne scar subcision

- Rejuran healer

But it doesn't completely remove pain. I would say it changes your emotional reaction to the pain more than removing all the pain itself.

Then there is sleep sedation

In Korea this is becoming much more common especially for people doing multiple treatments together in one session. For example:

- Ultherapy + Thermage + fillers

- facial contouring lasers

- acne scar procedures

- huge amount of skin booster injections

Tbh some patients request sleep sedation even before asking what treatment they are getting 😭 especially patients who had traumatic experiences at other clinics before.

But personally I feel sedation should be used carefully because patients wake up swollen, dizzy, nauseous sometimes and you need proper monitoring. Some clinics treat sedation too casually in my opinion.

Also before sleep sedation, patients usually need around 6 hours of fasting beforehand for safety reasons. A lot of patients forget this part and come after drinking coffee or eating a small snack thinking it's okay 

There are also small tricks doctors use that patients don't notice:

- vibration devices next to the injection site

- ice rollers

- smaller needles like 34G

- slower injection speed

- cannulas instead of needles

- machine injectors instead of manual injections

Injection technique matters A LOT more than people think. I have seen patients say Rejuran was totally fine with one doctor and worst pain of my life with another doctor

Anyways if you are scared of pain during treatments, please don't force yourself to do treatments because they are trending on social media.

There are usually ways to adjust the treatment plan, depth, products, machine settings, or pain management options to make the experience much easier.

The reason for the darkness can be completely different depending on the person and honestly if you treat the wrong type… nothing really improves lol

Like some people keep doing lasers when the problem is volume loss or they keep doing fillers when the issue is pigmentation

Usually when I’m looking at under eyes, I separate it into few categories first

If the under eye looks kind of blue / purple --> usually vascular

This type is super common in thinner skin because the skin under the eyes is VERY thin already, so you’re basically seeing blood vessels + muscle underneath especially people who don’t sleep well, have allergies, rub their eyes a lot, or naturally pale skin

For this type honestly filler is usually not the first thing I think about, I lean more toward: rejuran i, laser toning, sometimes sylfirm x if there’s redness or vascular component

Because the goal is making the skin thicker and calmer, not just filling

And btw… eye fillers under thin skin can sometimes make this type WORSE if done badly because of tyndall effect

Then there’s the brownish under eye type

This is more actual pigmentation usually from rubbing, eczema, chronic irritation, sun exposure, genetics etc

This one responds better to pigment focused treatments honestly, things like: pico toning, laser toning, topical pigment care, VERY gentle peels sometimes

But the problem is under eye skin gets PIH very easily, especially asian skin types, so aggressive lasers around the eyes can backfire fast

I see tourists in Korea overdoing under eye lasers all the time and then wondering why the area became darkerr!

Then there’s the hollow type

This is the one where the under eye itself looks shadowy because of volume loss / anatomy

Usually when light hits from above, it creates that tired hollow look even if the skin color itself is normal. This one is more structural honestly, so treatments like: filler, juvelook volume, collagen stimulators make more sense here

But again… under eye filler is one of the MOST technique dependent things in aesthetics

If the anatomy isn’t suitable or the filler is too hydrophilic, people get puffiness really easily

Especially in Korea now I think doctors are becoming much more conservative with tear trough filler compared to before

TBH… most patients have mixed types (like slight hollow, pigmentation and thin skin) all together. That’s why under eye treatments usually take multiple sessions and combinations instead of one miracle procedure

Personally I think the biggest mistake is chasing bright under eyes instead of healthier under eyes. When the skin becomes thicker, calmer, less inflamed, smoother… the darkness already improves a lot naturally

Korea just has too many options and everything gets marketed as skin booster which makes it 10x more confusing.

First, REJURAN

It’s PN (salmon DNA), and what it really does is repair the skin from inside. When your skin is damaged (too much retinol, acne, irritation, even eczema type skin), there are actually tiny micro-damages in the dermis. Rejuran helps signal the skin to heal and rebuild, so over time the skin becomes thicker and more stable.

So yeah… you’re not going to walk out with glass skin the next day!! actually for the first 1–2 days you’ll have those little bumps (papules), which is normal. The real effect usually starts showing after like 2 weeks when the skin becomes less reactive, less red, and just feels stronger overall.

Also if you’re scared of pain, don’t go for the classic Rejuran Healer. It’s quite painful. Rejuran HB Plus is much easier because it has lidocaine + a bit of HA, so it spreads nicer and hurts way less.

Then JUVELOOK

It’s not filler… it doesn’t just fill things instantly. It has PDLLA, which basically sits in your skin and triggers your body to produce collagen over time. Like a controlled reaction that tells your skin to rebuild itself.

So I usually use Juvelook more when I want to improve structure… like pores that look stretched, shallow acne scars, or skin that feels a bit thin. It’s more about densifying the skin.

But again… not instant 😭 you might see a bit of hydration from the HA at first, but the real pore blurring effect takes like 4–6 weeks because your body needs time to build that collagen.

Also something people don’t think about, if your lifestyle is not great (smoking, poor nutrition, bad sleep), your collagen response won’t be good either… so sometimes results feel underwhelming not because of the product, but because the skin can’t respond properly.

Then RE20

I usually think of it as somewhere between Rejuran and Juvelook.

It doesn’t focus only on repair like Rejuran, and it doesn’t build a strong collagen scaffold like Juvelook. It’s more about improving elasticity… like waking up the fibroblasts so the skin has better bounce

I use this more for patients who say their skin just looks tired… not damaged, not super dehydrated, but just lost that freshness. Especially in their 30s when they start noticing slight sagging but don’t want to jump into machines yet.

Also really nice for neck lines actually. The neck skin is thin and moves a lot, so thicker products can cause lumps, but RE20 is fluid enough to sit nicely while still giving some firmness.

In reality we mix a lot in korea but that’s another story lol

if you’re confused just ask, I’ll reply when I can between patients~

Patients come to me asking for “glass skin” after seeing Rejuran all over social media, so let’s talk honestly about what it actually does.

Rejuran is a polynucleotide (PN) treatment, often called a salmon DNA injection. It is not filler, and it is not a traditional skin booster. It’s a regenerative treatment designed to improve skin quality by supporting the skin’s natural repair process like reducing inflammation, improving hydration, strengthening the skin barrier, and helping with collagen remodeling over time.

In simple terms, it helps the skin function better and look healthier, but it does not create instant transformation.

Who does it work best for? Usually patients with mild acne scarring, enlarged pores, dull or tired-looking skin, under-eye crepey texture, or skin recovering after lasers and resurfacing treatments.

Who is not a good candidate? If your main concern is deep wrinkles, heavy sagging, significant volume loss, or wanting a sharper jawline, Rejuran is probably not the right first treatment. That usually requires a different approach and sometimes a surgical consult.

What to expect: Most patients need around 3 sessions spaced about 4 weeks apart. Treatment itself is quick but involves multiple superficial injections, so yes, it can be uncomfortable even with numbing cream. Mild redness, swelling, and small bumps are common and usually settle within 1–3 days.

You will NOT leave after one session with glass skin. The first treatment can give a hydrated glow, but the real improvement comes slowly as your skin regenerates. Peak results are typically 1–2 months after the last session and can last 6–12 months (longer with maintenance).

Is it worth it? Yes, for the right person who understands it’s subtle and cumulative. It won’t replace great skincare or healthy habits, but it can raise your skin’s baseline health and appearance.

One of the most common questions patients ask is how many times they need to do ONDA or whether 10kJ is actually enough.

Honestly, this is where many people misunderstand the treatment.

With ONDA, more is not always better.

Too much energy or too many sessions does not automatically create better lifting. At the same time, if the treatment is too weak or done too inconsistently, patients often feel like nothing changed and end up wasting both time and money.

The goal is not simply doing more. It is choosing the right amount, the right frequency, and the right treatment cycle for your actual skin condition.

ONDA works by using microwave energy to deliver controlled heat into the deeper layers of the skin.

This helps tighten existing collagen fibers while stimulating fibroblasts to produce new collagen over time. That is where the lifting and elasticity improvement come from.

What makes it more interesting is that it does not only target the surface.

There are usually two different treatment depths.

The shallower layer around 3mm focuses more on collagen contraction and skin tightening. This is where we work on elasticity, pore appearance, and texture refinement.

The deeper layer around 7mm reaches the superficial fat layer, helping organize and reduce unnecessary fat weight that can make the lower face feel heavier.

This is why ONDA can improve both skin firmness and facial contour in the same session. It is not just lifting, it is dual care.

For most patients, I usually recommend monthly intervals.

A basic course is often around 3 sessions, depending on the degree of laxity and the amount of lower face heaviness. Once collagen remodeling starts and the results are established, the improvement can last close to a year if maintenance is done properly.

After the initial sessions, many patients switch to maintenance-only treatments instead of repeating full courses.

Who tends to be a good candidate?

People who do not want frequent aggressive procedures, those who are sensitive to pain, patients worried about redness or burns, and people dealing with both mild sagging and facial heaviness at the same time.

It is also a good option for patients who want to improve enlarged pores and rough skin texture while also addressing elasticity.

Compared to stronger lifting devices, ONDA is generally considered more comfortable because the system includes a cooling function that helps protect the skin surface during treatment.

Aftercare is simple but important.

On the day of treatment, avoid strong cleansers, scrubs, and unnecessary friction. Face washing and makeup are usually fine, but I still recommend avoiding alcohol, strenuous exercise, saunas, and hot baths for about a week.

Daily sunscreen and good moisturization make recovery smoother and help protect the collagen response.

The right amount of ONDA is not about doing the highest energy or the most sessions possible. It is about building a sustainable plan with the right frequency and the right timing.

Good lifting is rarely about doing more. It is about doing it properly.