Is Ultherapy The Solution To Tighten My Sagging Jawline?

16 Sep 2013 at 9:00am


By Becca Smith

In early May, I vented about my Bermuda Triangle of Sag; that treacherous intersection of my chin dumpling, emerging jowls and jawline that seems increasingly unable to resist the siren song of gravity.

I’ve been told this gift from Mother Nature is a perfectly normal part of how the face ages. Just like menopause and oh, I don’t know … death. The difference is, I think I can do something about my sagging lower face (or at least I hope I can).

So earlier this year, I went on an adventure that I called “Laser, Needle, Knife or Nothing” to understand exactly what a girl is supposed to do. I wasn’t ready to confront the scalpel and thankfully, was told I was too young.  Lunchtime laser energy devices caught my attention, though ... Thermage! Gwyneth! But from what I had read, the results were mixed.

Finally, hope emerged in the form of a trade booth at the American Society for Aesthetic Plastic Surgery (ASAPS) '13 conference in NYC. It was Ultherapy, the only device FDA-approved for lifting and tightening of the skin around the neck. It works differently than Thermage which uses radio frequency.  Ultherapy uses ultrasound energy that reaches the SMAS (the muscular sheath that loosens as we age) -- with more precision, depth and heat, which radio frequency can't do.

So is ultrasound truly better than radio frequency? Not sure if we know the full answer yet, as science in the cosmetic setting is still in its infancy. Still, if I can get some noticeable lifting and tightening during my lunch hour, sign me up.

To find out, I made myself the guinea pig and underwent a full face Ultherapy treatment, gratis of Ultherapy and Dr. W. Matthew White in May. The full face Ultherapy is also designed to lift your eyebrows a smidge, but my real goal was to diminish my jowls and reduce my chin dumpling, that little pocket of fat.

Drum roll please…..



A few caveats and disclosures:

1. Before/after photography is tricky. Dr. White and I tried painfully to replicate the exact position of the head and exposure of the photograph. We came close, but I’ve noticed that even the slightest change in angle can make a result look better (or worse). 

Here's some helpful tips from the team at Ultherapy, who are keenly aware of the nuances of before-and-after photography:

• Eye alignment: Sometimes, photos are taken at different sizes. So when evaluating photos, look for ones where the eyes line up in the same position and are a similar size. If the eyes are aligned, chances are, the rest of the photo will be as well.

• Nose positioning: Often, the chin may be in a different position, or the angle may be slightly off when comparing the before and after. One tip is to look at the position of the nose, which can tell you if the patient is positioned similarly in the before and after photo.

• No make-up: Many times, patients want to look their best in the “after” photo, so they wear makeup. This does hinder the ability to objectively evaluate photos. If the patient is wearing makeup in one of the photos, look at the photos more closely.

• Look for consistent lighting: Different lighting in the before and after photo can pose a problem, as shadows in 2-D photography may not accurately portray results. If the lighting is different in the before versus after photo, take the time to look and see what impact the lighting has on the photos.

• Don’t rely solely on the photos: Many surgical practices excel in cosmetic procedures, but aren’t necessarily the best photographers. Ask about other patient experiences; many times, the practice will share patient testimonials or even put you in touch with another patient. Remember that 2-D photography often doesn’t show all of the benefits from a procedure.

2. Fillers and Botox can impact results.  In my case, I had Botox in my forehead and crows feet a week after my first Ultherapy treatment ... so it’s hard to tell what is Ultherapy and what is Botox, in terms of the lifting around my eyebrows.

Dr. White also gave me filler in my jawline and mid face. Not a lot, but as you can see in the first two pictures, I had notching along my jawline, that doctors refer to as the “pre jowl sulcus”. He used Radiesse to fill in the notch and Juvederm to take care of some of the marionette lines. This is why my face looks smoother and more rounded in the last photo; that is filler.

The subtle chin dumpling lifting however, was all Ultherapy.

3. Weight gain or loss can impact results. I’m a masochist so I’ve recorded my exact weight for all to see. But this is important, as you need to know that weight gain/loss does in fact impact the visible results. If you lose weight, laxity increases due to the volume loss, especially in older patients.

If you gain weight, it may be harder to appreciate the lifting and tightening that was accomplished.  However, this does not mean Ultherapy didn’t work. The new, more elastic collagen that Ultherapy created will still be there, so the tissue may have a higher likelihood of snapping back and tightening.

4. You may not be the right candidate for Ultherapy. For instance, I may have been a little less than ideal. While I’m the right age at 45 (many women get it as young as their mid thirties), I was told I didn’t have a great deal of skin laxity and my signs of aging weren’t as pronounced.

For context, here's an example of more dramatic results than mine.  As you can see in the below photo, there's more visible skin laxity:


Further, Ultherapy doesn’t replace a facelift.  It physically cannot do what a facelift can, rather, it’s a stop gap. Ultherapy cannot change your anatomy either. Some people are just made with a very short jawline, where the chin seems connected to the neck. Ultherapy will not address this issue in a meaningful way.

Lastly, because Ultherapy is so new, the medical community is still learning exactly what result each type of patient can expect.

5. Results take time, and sometimes aren’t visible for a full six months. I’ll be reporting back in November to see if my results have changed, but in the meantime, here’s more patients who saw results after a longer period of time (180 days to be exact).


So what do you think, would you give it a try? According to RealSelf, respondents seem bullish on Ultherapy, which is holding at a 73% Worth It rating.  Personally, I did notice a subtle lifting of my chin dumpling, and was encouraged after my one month photograph, but was hoping for more lift at the three month mark. And, my skin does feel tighter and firmer (even my eyebrow sculptress noticed but wasn’t sure what I had done).  My jawline looks smoother as well, but remember, I had filler.

If you are tempted by Ultherapy, remember to ask your doctor what type of result you can reasonably expect and if you’re an appropriate candidate. If your doctor has any pause, ask if they would consider a second treatment at a lesser cost (or even free) if the results aren’t measurable. This is not necessarily standard practice, but I think it’s a fair request.

And lastly, remember to ask about whether they use the "Amplify" setting, which is a newer indication that achieves the lift with less pain.

To be continued in November ... In the meantime, bring on the comments and questions.

Becca Smith is New York ad exec, RealSelf community member, mom, wife, and self-described “beauty veteran”.  Her blog,, deliciously and incisively examines the intersection of beauty, anti-aging, and life.