u/Open-Priority-6101

About 1 in 500.

That is how often fat loss shows up in the published studies on Ultherapy, going by a 2025 review that pulled together 19 papers and 506 patients.

In the FDA complaint database, fat loss is one of the things reported most often.

Both numbers are real. The truth sits somewhere between them.

A reader on our post about treatment order asked about this. They said they couldn't risk losing the little facial fat they had left, and it deserved a longer answer than a reply.

We run Ultherapy, Thermage and Xerf ourselves, so read this knowing we are not neutral.

What the papers say

Studies are small, and they are mostly run by people who are very practised with the device. The complaint database is the opposite.

Anyone can file, nothing gets checked, and nobody knows how many treatments sit behind each report.

A group of doctors who published 5 serious cases in 2018 wrote that these problems are probably underreported. So it's rare, and it is probably a bit less rare than the papers make it look.

Radiofrequency shows the same pattern. An older review from a clinic in Madrid followed 290 patients treated with the same type of RF that Thermage uses.

Fat atrophy was on their list of less common side effects. The authors linked their problems to overheating and recommended moderate energy with no overlapping passes.

Where it comes from

Heat is meant to land in one specific layer. Fat loss is what you get when too much of it lands in fat instead.

Nobody has studied the cause cleanly, so what follows is how it works in practice. Two things matter most.

How deep the device goes over areas that are already lean, and how much energy ends up in one spot.

This is also where the person holding the device matters, which we said we'd come back to on our shot count post.

Two people can deliver the same 300 shots. One adjusts the depth area by area and goes lighter where there is little fat to spare.

The other runs the same pattern on every face. The quote looks identical.

If your face is already lean

This is the group the question is really about. Before anything starts, ask which depth goes over your lean areas and whether any area gets left out.

A clear, specific answer is a good sign. If you get the same plan as everyone else, ask again. Ultherapy gives you an extra question.

The device shows the layers under your skin on a screen, so ask whether they looked at it over the thin spots.

There is one more group who should speak up before the device starts, and that is anyone who might want a facelift one day.

That conversation goes differently. The evidence there is thinner than either side admits.

We can read most quotes people show us. Shot counts are the one thing we still have to ask 2 more questions about before we can say anything, and we do this every day.

Last month we saw two Ultherapy quotes side by side. One said 600 shots, one said 400.

The 600 was cheaper. Nobody was cheating anyone there. The number on its own just doesn't say what you're getting.

Two things decide that. First, what the shots cover.

Face only, face and neck, or the neck counted separately with its own line. Second, which depths those shots are split across.

Ultherapy works at more than one depth, and 300 shots all at one depth is a different treatment from 300 shots spread over three.

Neither of those is usually written on the quote. You have to ask.

Onda and the other kJ machines have the same problem in a different unit. 60 kJ and 80 kJ tell you how much energy went in total.

They don't tell you over how much face, or how long.

The same 80 kJ on the jawline only versus the whole lower face are not the same treatment either.

So we've stopped comparing quotes by the number and started asking three things instead.

What area. Which depths or which setting. And who is holding the device, since the same 300 shots come out differently depending on that.

We'll come back to the last one another time because it's a whole post on its own.

What we're actually curious about is how it looks from your side.

If you've had Ultherapy, Onda, Thermage or anything sold by shots or kJ, did the quote say what area and what setting?

And when you asked, did you get a straight answer?

We'd like to hear the vague ones too. Those are the ones that teach us something.

Someone on our last post said they were 61, dealing with both collagen loss and volume loss, and asked whether one particular product would cover both.

It wouldn't, but the better answer was about what goes in first. Most people who sit down with us wanting two things have never been asked that.

There are three kinds of things people stack.

Heat, which is the lifting devices, Ultherapy, Xerf, Thermage, Onda. Scaffolding, which is Sculptra, Juvelook and diluted Radiesse. And fill, which is hyaluronic acid filler and full strength Radiesse.

The part that is settled is that heat goes before anything injected. On the same day the device runs first and the injections come after. If filler is already in your face, the device waits. In one study, radiofrequency done the same day as filler showed a loss of filler in 5 out of 14 people.

Done 14 days later, 1 out of 14. The gel is what you paid for, and heat is hard on it. When things are split across visits, the combination consensus puts them 1 to 2 weeks apart, mostly so swelling from one thing doesn't get read as the result of the other.

The part people actually argue about is scaffolding versus fill, and there is no study we could find that tested it either way. So this bit is practice, not paper.

Ours goes like this. Scaffolding takes around 2 months to show, so if it goes first you wait those 2 months before deciding how much fill the hollow still needs.

If fill goes first, scaffolding can follow at the normal gap. The mistake we see most is putting fill into an area where scaffolding is still working, then judging both at once.

One more thing moves all of that, and it's what we ask before anyone picks a treatment. What you've already had done.

Filler from last year is often still there, and how far it pushes the device back depends on which filler it was. Some are gone by then. Some are very much not.

Scaffolding from last year is often still working, which changes how much you need now. Neither shows up in a mirror, and both change the plan more than your age does.

For travellers this is mostly good news. Device and injections can be one visit, as long as the device runs first.

What can't be compressed is the 2 month wait to judge scaffolding. If you're flying home before that, the person doing the judging will be a clinic near you, so ask for the product name and the amount in writing before you leave.

For those who did both on one trip: which went first, and did anyone tell you why?

If you've been trying to decide between Rejuran and Juvelook, or between Rejuran and Sculptra, the reason you can't find a straight answer is that those are different categories of product. Different family, different job.

Rejuran and the polynucleotide group are made from salmon DNA. Yes, it's the sperm one everyone jokes about. Once it's in your skin it works like a message. It calms things down and gets your fibroblasts, the cells that keep your skin in repair, back to work. Nothing stays behind afterwards. You're asking the skin you already have to do its job better.

Juvelook and the PDLLA group are closer to scaffolding. Tiny spheres, made from the same material family as dissolvable stitches, sit in your skin while your body builds new tissue around them and inside them. The spheres are gone somewhere between a year and a half and three years. The tissue is the part you keep.

Sculptra sits on that same side. So if you've been weighing Rejuran against Sculptra, you've been holding a message up against scaffolding. Profhilo is a third thing again. That one is hyaluronic acid, so it's mostly about holding water, and it doesn't really belong in either box.

This is why advice from strangers so rarely carries over. Someone let down by a message usually needed scaffolding. Someone who found scaffolding boring wanted skin quality all along. Both of them post that the booster did nothing, and the next person reads that and buys the wrong one too.

If what bugs you is texture, dullness, fine crepey lines, you're on the message side. If your skin has gone soft and thin and you look tired on days you feel fine, that's closer to scaffolding. A photo tells you less than being in the room, so treat that as a place to start rather than a verdict.

So the thing worth taking to a consultation is just which of those two you have. You'll get the same answer wherever you ask it, and that's usually the sign of a good question.

One thing worth knowing before you book flights. The polynucleotide side is the awkward one to find outside Korea. The scaffolding side turns up in more places, so where you are matters less for that half of it.

We do both of these, so weigh that as you like. It's also why we'd rather you bought the right one.

Plenty of people are clearly both, and for them the order matters more than the choice does. What sets the order is usually two things. What you've already had done, and which of the two problems is bothering you more right now. Neither of those is something a post can see from here.

Happy to say which side a specific treatment sits on if anyone's stuck.

Someone in this sub asked last week how often you need to repeat Rejuran. It's the thing we end up explaining most often to people who flew in for it, so here's the longer version.

Some treatments are a single event. Ultherapy, Thermage, HIFU, botox, filler. You get it once, the result shows up and settles over the next few weeks, and there's nothing else you need to do. A trip handles those fine.

Others are a course. One session gets you part of the way, and it tends to look like a weak version of the finished thing.

Roughly:

-Skin boosters, so Rejuran, Juvelook and that family: 2 or 3 sessions, 2 to 4 weeks apart

-RF microneedling for texture or scars: 3 or 4 sessions, 4 to 8 weeks apart

-Laser toning for pigment: 5 to 10 sessions, 1 to 2 weeks apart

-Acne scarring: counted in months rather than visits

The first 2 weeks after a booster look good, and some of that is just the fluid the product comes in. That leaves. Your own collagen comes up over the next 2 to 3 months, so one session puts you a little ahead of where you started.

If your trip runs 10 days or more, ask whether the interval can be shortened. Two weeks is the floor for most boosters, so 14 days can hold sessions 1 and 2. Shorter than that and one is usually what you get.

Tell them your travel dates when you book, not after. It changes what they'd suggest.

The nice part is that some of this you can finish at home. RF microneedling exists everywhere. Collagen stimulators have approved equivalents in most countries, Sculptra and Radiesse included in the US and Canada, so a clinic near you can carry the course on.

Polynucleotide boosters are the awkward one. The injectable has never been approved in the US, though the UK and Europe have CE marked versions, so where you fly home to matters more than people expect.

Happy to answer which bucket a specific treatment falls into if anyone's planning a trip.

Someone asked in the last thread what actually happens in the three days after, so here is the version we give people flying in with a fixed return date.

Three days is enough for more than people assume, as long as the order is right.

Energy work is the free stuff, scheduling wise. Ultherapy, HIFU, RF tightening, most laser toning, standard botox. You might be pink or slightly puffy and nobody at dinner will notice. Botox comes with its own rule about staying upright for a few hours and that is the extent of it.

Anything that puts product under the skin with a needle costs you two or three days. Skin boosters leave small raised bumps at every point, obvious on day 1 and mostly settled by day 2. RF microneedling leaves you looking sunburnt, sometimes with a faint grid, for about the same. Filler swells around day 2 and looks slightly overdone before it settles.

Resurfacing lasers that actually crust, and anything involving threads, need a week at minimum. If your trip is shorter than that, those are not travel treatments, whatever the before and after photos suggest.

What ruins plans is that bruising ignores your schedule. You walk out looking completely fine and it surfaces on day 2, sometimes day 3. Every year someone books injectables on arrival day so they will have time to heal, and then spends the good part of the trip with a mark on one cheek.

So run the trip backwards. Energy treatments early, since they leave nothing to see, and anything with a needle toward the end.

That advice has a hole in it worth naming. Put every injection on your last day and if something needs a second look, you are on a plane instead of in the chair. Leave a day between the last needle and the flight. A day catches most of what is worth catching.

The flight belongs in this calculation too. Cabin pressure and 11 hours of dehydration exaggerate whatever puffiness you already have, so the face in the airport bathroom mirror is not your result. 72 hours before you judge anything.

In a three day window, one energy treatment and one injectable is comfortable. Two of each is where people start telling us the trip stopped being fun.

None of this applies to treatments that need a second session at a set interval. One trip cannot finish those, which is a different planning problem entirely.

If you have travelled for treatment before, what would you move if you did it again?

About half the people who sit down in our treatment rooms start by apologizing for being nervous. Nobody should have to apologize for that. So here is the pain map we wish everyone had before booking anything in Seoul.

The thing that helps most people is understanding that "does it hurt" is really three separate questions. There is the needle prick. There is the device energy, usually heat. And there is pressure or vibration, which is not pain exactly, but surprises people who expected nothing. Every treatment mixes these differently, which is why your friend's experience with one thing tells you almost nothing about another.

From easiest to hardest, roughly:

Botox and skin botox.

A series of quick pricks, each one over in under a second. Most people rate the anticipation worse than the thing itself.

RF tightening (Thermage, and the newer RF devices).

Waves of warmth with brief hot moments. On modern machines with adjustable energy levels, plenty of people just chat through the session. Older machines and maxed-out settings are a different experience, which is one reason quotes for "the same treatment" vary so much.

HIFU and Ultherapy.

This is the one where people expect the worst, and the honest answer is: it is a deep, dull ache that spikes when the device passes over bone.

Jawline corners and the temple area are the moments people remember. The saving grace is that each zap lasts a fraction of a second. Uncomfortable, yes. The horror stories usually trace back to older protocols with higher energy settings.

Skin boosters (Rejuran and friends).

Here is the part that surprises people: this "gentle" category can be the roughest one in the room.

The product is thick, the injections are many, and everything depends on one boring variable: how long the numbing cream sat on your face. Thirty minutes of numbing makes it a non-event. Ten rushed minutes makes it the story you tell your friends.

That numbing window is the single most useful thing to ask about, anywhere you go. Not the device brand.

Ask "how long do you leave the numbing cream on" and you will learn more about how a clinic treats patients than any review page will tell you.

Clinics running on volume cut that window first, because it is the one corner nobody sees being cut.

One more thing. There is a popular treatment we left off this list on purpose, because pain is genuinely the wrong worry for it. The needles are easy.

What it does to the three days after, and to a travel schedule, is the real conversation. That one deserves its own post if anyone is interested.

If you have had any of these done: which one surprised you, worse or better than you expected?

The gap between expectation and reality is basically our field's whole communication problem, and we are curious where it hit you.