Would you consider me to have somewhat sagging skin? Will Ultherapy help? What treatments would you recommend? (Photo)

I have noticed my skin sagging from the under eyes/cheekbones causing a darkened hollowness area below my eyes. I've been told that I have underdeveloped cheek bones. When I smile the problem is worse. Hoping I can find a solution to help the problem.

Doctor Answers 7

Ultherapy and Dermal Filler

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As we age, collagen production is reduced, and as a result, our skin begins to droop and sag.  It is noticed initially in the cheeks, along the jawline, in the neck, and along the eyebrows.  With the use of ultrasonic energy, Ultherapy heats tissues and muscles under the surface of the skin, stimulating the production of collagen.  This regeneration of collagen is called neocollagenesis, which literally means that we begin using our own collagen to rebuild the skin’s framework.  Although the results of this ultrasound technology may not be seen initially, after 2 to 3 months, the new collagen produces firmer tone as drooping skin is restored to its original shape. 

Ultherapy may be a great option for you, however without an in person consultation it is hard to determine if you are a suitable candidate based on an image without knowing your age, lifestyle and skin type. Ultherapy is the best non-invasive method for tightening and lifting eyebrows, jowls, and necks.

For the hollowness around the eyes, I would suggest dermal filler injections to restore volume which makes the skin appear more youthful and rejuvenated. 

When you are exploring the options of a facial procedure, make sure that you also explore the right type of cosmetic surgeon to perform your procedure. A facial plastic surgeon is a cosmetic doctor that is an expert strictly in the head and neck which is where Ultherapy is indicated to treat.

Toronto Facial Plastic Surgeon
4.7 out of 5 stars 165 reviews

Ultherapy vs fillers

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Coincidence as I have noticed the same with my eyes, so, as outlined in the video below, fillers are the way to go to replace loss volume below your eyes. Your eyelids are excellent, so nothing needs doing there. Ultherapy can help lift, however with your hollowness, fillers such as Juvederm Volbella, Restylane or Belotero can make a difference.All the best, Dr Davin Lim. Brisbane. Australia. 

Filler to treat hollowness under the eyes

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Hi and thank you for your question!

From the photo it does look like you have hollowness (volume loss) under your eyes. When this happens, it makes the "dark circles" appear worse and we feel like we look tired all the time. Adding some filler to this area should improve these concerns significantly. We prefer Retylane when treating this area, usually 1-2 syringes to start. I don't see any concerns with sagging skin, at least from this picture.


Dr. Grant Stevens

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 152 reviews

Under Eye Circles, Under Eye Hollows - Tear Trough and Cheek Filler

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Hello, from your photo, it seems the first step would be to revolumize and lift under eye area (tear trough) and cheek bone with dermal fillers such as Voluma and Restylane. I would also get on a medical skin care regimen. Please schedule an appointment with a cosmetic dermatologist to get a consultation so you can move forward in your rejuvenating treatment.

Anita Saluja, MD
Melbourne Dermatologist
5.0 out of 5 stars 23 reviews

Fillers and Ultherapy Combo

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Thank you for your question. It's difficult to give exact recommendations without an in-person consultation. However, you seem to be a good candidate for under eye fillers. This will help add some volume to your "dark circles". Ultherapy or ThermiSmooth around the brow and eyes could also help tighten the skin and reduce this concern. You will need to have an consultation with a board certied plastic surgeon and expert injector for precise recommendations. 

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 106 reviews

Under Eye Darkness, Cheeks

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Thanks for your question. At least from the picture (not as good as face to face evaluation of course), I don't think you would be best served with Ultherapy. It would appear that you are looking for more volume. A combination of dermal fillers, to soften the deep tear troughs and lift and volumize the cheeks, would be more likely to get you the aesthetic appearance you are looking for. If you "just" fill the cheeks, your tear troughs might look even deeper. It is important to go to a very experienced provider. Your goals require "advanced technique" dermal filler by an expert, not to be done by someone who injects infrequently or is inexperienced. I would say a minimum of 5 years of experience assuming they inject multiple days of the week. 

Expect to require at least 2 syringes, possibly three. Down the road, if you love the cheek volume, you could then "graduate" to Bellafill if you wish, the 5 year filler, in order to maintain your results. It should not be used in the tear trough, but in the cheeks it is a great option. 


Lisa Vuich, MD

Lisa Vuich, MD
Nashua Physician
4.7 out of 5 stars 11 reviews

Skin Sagging/Under Eyes/Cheekbones/Dark Hollows--Fillers, Lasers, Microneedling/PRP, Sculptra, Implants

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A combination approach would be best. For under-eyes: Fillers, lasers, microneedling/PRP. For cheek augmentation: Fat, fillers, such as Radiesse, Voluma, implants and Sculptra can all be used.  Please see a professional for an evaluation.  Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 204 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.