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By Dr Kay Low, Senior Aesthetic Physician, VIDASKIN
Most patients know Ultherapy as an ultrasound skin-lifting treatment. Fewer realise that the same ultrasound is used to look beneath the skin before any energy is delivered.
During an Ultherapy treatment, your doctor can see your skin, fat and SMAS on a screen in real time. That image shapes every decision that follows. In this article, I explain what appears on the screen, why your layers are not the same as anyone else’s, and why imaging matters most in the areas patients care about most.
Many energy-based lifting and tightening treatments are delivered without real-time imaging. The practitioner relies on anatomy knowledge, standard depth settings and feel. This can work well in experienced hands, but it means the depth of each person’s tissue is assumed rather than seen.
Ultherapy is different. It combines microfocused ultrasound energy with ultrasound visualisation, so the doctor can confirm what lies beneath the transducer before each line is placed. The newest platform, Ultherapy PRIME, builds on this with an updated imaging display.
On the Ultherapy screen, tissue layers appear as bands of differing brightness:
The SMAS, or superficial musculoaponeurotic system, is the fibrous layer surgeons lift and tighten during a facelift. Ultherapy’s deepest transducer is designed to reach this layer without incisions.
Two people of the same age can have very different layer thicknesses. Skin thickness, fat distribution, muscle tone and bone structure all vary with genetics, weight, hormones, and age.
As an aesthetic doctor with a special interest in women’s skin across life stages, I see this clearly on the scan. Skin and fat distribution can look quite different after pregnancy, with weight change, or through perimenopause. Imaging lets me plan for the face in front of me now, not the average face in a protocol.
The SMAS is not a flat sheet at a uniform depth. Even within one face, it sits closer to the surface in some areas and deeper in others. It is thicker in some zones and thinner, or less distinct, in others. Over the cheekbone, it may sit close to bone. Along the jawline, it may sit deeper beneath fuller fat.
This is why a single depth setting cannot be correct everywhere. The scan lets the doctor match the transducer to the tissue, zone by zone.
If the scan shows the SMAS is shallower than the 4.5 mm setting in a particular zone, or that bone lies close beneath it, the doctor can switch to a shallower transducer or move the treatment line. If the fat is thicker, deep lines may be concentrated where they will engage the SMAS most effectively.
Imaging also shows where energy would not achieve much, such as over bone or where the transducer is not properly coupled to the skin. If the image breaks up, the contact is poor and the line would not deliver energy as intended. Recognising this saves lines for where they matter.
Occasionally, the scan and examination together suggest Ultherapy is not the right choice, or not the right choice yet. Examples include very thin soft tissue over bone throughout, advanced laxity beyond what a non-surgical treatment can address, or volume loss being the main concern.
In these cases, the most useful thing I can do is say so. Sometimes the right recommendation is a different treatment, a combined plan, or simply waiting.
The jawline is where many patients first notice change: softening of the contour and early jowls. Here the SMAS can sit deeper beneath lower-face fat. The marginal mandibular branch of the facial nerve also runs in this region. Imaging helps the doctor engage the right depth along the jaw while respecting the anatomy around it.
Under the chin, fat thickness varies widely between people. In some, the platysma muscle and its overlying tissue are close to the surface. In others, a fuller fat layer sits in between. The scan helps decide how deep lines should be and how much the area can usefully take.
Around the eyes and brow, the skin is thin, and bone lies close beneath. Precise depth selection is essential for comfort, safety, and effectiveness. Imaging helps the doctor stay within safe tissue and outside the orbital rim, using shallower transducers where appropriate.
Many clinics will say their device has imaging. The more useful question is whether imaging is used on you, in your session, before each zone.
You might ask:
A doctor who uses imaging routinely will be comfortable answering these questions and showing you what they see.
Ultherapy treatment is generally best suited to people with mild to moderate laxity who want gradual, natural-looking improvement without surgery. Good candidates often have:
It is less suitable for advanced laxity, significant volume loss, or where surgical-level change is expected.
Ultherapy relies on the body’s own collagen remodelling, so change is gradual. Patients often notice early firmness within weeks, with more visible lifting typically from two to three months. Clinical studies of microfocused ultrasound show measurable improvement in suitable patients, though the effect is more subtle than surgery and varies between individuals.
Imaging does not change the biology of collagen remodelling. What it improves is the precision with which energy reaches the intended tissue, which is a key part of getting a consistent result.
Every face has its own layers, and good Ultherapy starts by looking at them. At VIDASKIN, your Ultherapy PRIME treatment is planned by a doctor who scans first, explains what they see, and adjusts the plan to your anatomy.
If you’d like to see your own SMAS on screen, just ask during your assessment.
Book an Ultherapy assessment with Dr Kay Low.
Dr Kay Low is a Senior Aesthetic Physician at VIDASKIN. She graduated in medicine from the University of Cambridge (MA, MB BChir) and is registered to practise in both Singapore and the United Kingdom. Her special interests include early facial ageing in the 30s and 40s, skin quality and women’s skin across life stages.
This article is for general education and does not replace an individual medical consultation. Suitability and results vary between patients.
Dr. Kay Low is a UK-trained medical doctor with over 7 years of clinical experience across the UK and Singapore, specialising in aesthetic medicine. A graduate of the University of Cambridge, she has worked across multiple medical and surgical disciplines in the UK and Singapore before completing postgraduate training in Family Medicine and advanced training in aesthetic medicine.
