Can Ulthera Droop the Corner of the Mouth Due to Nerve Damage? Should I Avoid Doing This Near my Mouth?

Can Ulthera droop the corner of the mouth due to nerve damage? Should I avoid doing this near my mouth? I have a marionette lines and droopy jowls. I want to get rid of it, but I've heart that if ulthera is done too close to the corner of the mouth, it will droop the mouth. Is this possible? Should I do just around my cheeks but not the chins and mouth?

Doctor Answers 4

Ultherapy causing nerve damage and nerve droop around the mouth

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The original protocols for Ultherapy called for aviding treatment to the marionette lines and the corners of the mouth.  With the development of the new 1.5 mm transducer, we can now safely treat these areas because the focused ultrasound energy does not penetrate deep enough cause nerve damage.

New York Dermatologic Surgeon

Ulthera and nerve damage

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Any trauma to facial nerves, even temporary is extremely rare and in fact if there was a temporary stunning of the nerve that normally lowers the cormer of your mouth, the result would be elevation of that corner, not depression since the nerve activates the muscle depressor angulis oris, which lowers the corner of the mouth and we normally inject that with Botox to temporarily paralize it so that the corners of the mouth would temporarily elevate for a few months, No chance of depression of the corner of the mouth with Ultherapy.


Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon

Ultherapy near the corners of the mouth is safe

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I have done Ultherapy since 2011 and have never seen this complication, although it is described with aggressive use. Typically, the physician is alerted to the problem because the patient will complain of excessive pain or sharp pain in the area. When this occurs, either energy settings are reduced or the transducer is switched to 1.5 mm to avoid this problem. In any case, if it does occur, it will be temporary and resolve spontaneously. 

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Ultherapy's new shallow transducers allow closer treatment to the mouth

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Neuropraxia, or a nerve that has gone into hibernation, has been reported very rarely after Ultherapy but all cases have spontaneously gone away as per discussion with Zeltiq most recently.  The new 1.5 mm deep transducer should not subject motor nerves to trauma and allow physicians to choose if they wish to treat the mouth and chin and close to the smile folds and marionette lines. Keep in mind that treatment of the cheek can help the smile folds and marionette lines without treating the lines as the lifting of the cheeks helps smoothen the folds to some degree. However, facelifts, which lift much more than the amount lifted by Ultherapy, are known not to induce major changes in the smile folds.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 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.