What are my choices for jowls and laxity of the lower face? Ulthera, Thermage, other? I am almost 50. (Photo)

I had Sculptra 2 1/2 years ago which caused overfilling of the face on the right side, producing an awful "chipmunk effect". Fillers were added to my cheeks to balance the overfilling of the lower face. Now, that effect is gone and my face seems deflated and jowling. What are my options?

Doctor Answers 6

Ultherapy is FDA cleared to treat laxity of the skin in the lower face, jowls and neck

Thank you for the pictures.

Ultherapy is FDA cleared to treat skin laxity of the lower face and jowls, as in your case. 

The pictures you show suggest that you are an appropriate candidate for skin tightening by Ultherapy.

Read the ebook about Ultherapy on the link below.

Dr. Karamanoukian

Best treatments for sagging jowls and tightening facial skin with Ultherapy, ThermiTight in my NYC practice

Every patient is different and an answer can not be obtained by looking only at photographs. A three dimensional examination is important when I see patients in my NYC practice for Ultherapy or ThermiTight consultation to help lift sagging faces, jowls, cheeks, necks, etc.
Some patients have significant fat loss below the muscle layer in the mid cheek that needs correction to help support and lift the face.  Others may do well enough by having a series of non invasive radiofrequency treatments such as Pelleve, Thermage or ThermiSmooth.  I find that Ultherapy is more effective than these, and ThermiTight is the most effective, however the latter is unlike all the rest, a minimally invasive, or in between treatment. Specifically, ThermiTight is in between nonsurgical procedures and facelifts. 
There are many other treatments, some very new, that claim they can help lift or tighten facial features. We continually explore all technology to see what is available, safe and effective for our patients.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice. The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 36 reviews


Dear patient, Ultherpay and a filler such as Voluma in the upper cheekbone area can give you the desired result without cutting. It is difficult to appreciate from the photos but I believe that most of the sagging in your case is from skin laxity. In patients with more fatty deposits I do suggest Smartlipo Triplex to suction off the fat in the Jowl area. I don't believe you need that. I offer Thermage CPT, Pelleve, venus Viva and Ultherpay. I do believe Ulthera is the most aggressive and effective modality for the neck and Jowl area.

A. David Rahimi, MD
Los Angeles Dermatologist
4.7 out of 5 stars 48 reviews

There is only 1 safe and effective treatment that is approved by the FDA for this use.

Ultherapy is an extremely safe treatment that carries little to no real risk when the treatment is performed by an experienced professional. Ultherapy is, without question, the best collagen-inducing device for facial rejuvenation. RF devices, such as Thermal, only heat the tissues up to 50-55 Celsius while a minimum of 60C is necessary for new collagen growth (Neocollagenesis). Thermal is, in my opinion, a very poor tool that has limited to no use in facial aesthetic. There is no other non-surgical device that does what Ultherapy does, despite their claims otherwise. Furthermore, Ultherapy has the first, and the only, FDA approval for non-surgical lifting. We feature Ultherapy as the basis for our Non-Surgical Face-Lifting program and we have achieved amazing results by combining Ultherapy with treatments such as toxins, fillers, fractional resurfacing, modified phenol chemical peeling, stem cell rich fat transfers, micro-needle radiofrequency treatments (the only useful RF based treatment available today), and excellent skin care regimen management.

Steven M. Gitt, MD, FACS (in memoriam)
Phoenix Plastic Surgeon
4.8 out of 5 stars 36 reviews

Loose Skin At Young Age -- venus legacy, thermage, sculptra, thermiRF, hi def liposuction

i suggest a formal consultation with a facial rejuvenation expert to evaluate all the options which include increaseing volume, skin tightening, and complexion/wrinkle improvement.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 158 reviews

Options for jowls and laxity of the lower face

 Looking at your pictures I think you would be a suitable candidate for ThermiTight to your lower face and jowls area.  Of the treatments you mentioned, in my opinion, it is by far the best.  Of course an in person consultation and evaluation will be needed to fully determine which treatments are most appropriate for you. 

Michael A. Zadeh, MD, FACS
Sherman Oaks General Surgeon
5.0 out of 5 stars 9 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.