Targeting Sleep Lines
I am pleased to hear you had the Ulthera to improve the laxity and appearance of your jawline. For further improvement to the "etched in" sleep lines on your cheeks you have a few options. I often recommend to my patients to consider fractionated laser resurfacing. This can be done in an ablative or nonablative manner. Ablative fractionated laser resurfacing (AFR) uses lasers such as Lumenis Deep Fx, Lutronic eCO2, Sciton Profractional, Fraxel Repair, etc. These lasers create fine channels in the skin surrounded by a rim of heat which causes increased collagen production and lessens the appearance of fine lines, wrinkles, and scars. AFR typically requires 1-2 treatments 6 months apart and about 6-7 days of downtime. Alternatively, nonablative fractionated lasers (NAFR) which create small columns of heat to stimulate collagen production can be used. NAFR lasers include Lumenis ResurFx, Fraxel Restore, Affirm Multiplex, eMatrix, etc. These NAFR lasers require 4-6 monthly treatments, but have shorter downtimes of about 3-4 days. Lasers can take a few months to show improvement in fine lines, but the results can last for years. Finally, for a rapid improvement in the appearance of fine lines, I prefer to inject a hyaluronic acid gel called Belotero into these sleep lines. Belotero lasts about 5-6 months and may result in mild swelling after the injection.
Sleep wrinkles on face
Agree that the Ultherapy has helped with the laxity problem with your facial skin. These wrinkles that you show on the photo are rather stubborn to treat in general but a fractional laser may help. Another option is the Obagi Blue peel and you watch 2 videos of this procedure on the link provided below. Belotero is a third and less lasting and rather expensive option that needs to be repeated often.
You can improve the appearance of these lines with either laser or filler.
I think a combination of lasers works best: a nonablative laser, such as the 1540nm Palomar, or a fraxel laser for deeper collagen stimulation, and also a fractionated ablative laser such as the 2940 erbium or CO2. These will make you red for a few days, and the results won't be seen for several months. (similar to the Ulthera). You could also put some filler in here to smooth them out. However - if you continue to sleep on this side, you will never lose these lines.
Sleep wrinkles on cheeks
It is wonderful to hear that you are pleased with the results of your Ultherapy thus far. Around the 3-4 month mark you can anticipate seeing the results of your treatment take effect and improve from there! The wrinkles you are experiencing can best be treated with fractional ablative laser skin resurfacing which specifically targets fine lines and wrinkles. The treatment can be done in combination with non-ablative fractional laser resurfacing to minimize downtime. Peels will serve as a great maintenance treatment following the resurfacing, but do not compare to the results yielded from a single fractional ablative treatment. Lastly, be sure to review a comprehensive home care regimen with your clinician to be sure you take the appropriate steps to help maintain your results.