Fillers or Ultherapy for area under eyes and marionette lines? (Photos)

You are a candidate for fillers and some type of facial tightening- the ultherapy will tighten the skin and will not really fill in areas of volume loss. Fillers are a great option for filling in areas under the eyes an in the marionette lines Different doctors will have different fillers they prefer to use in different areas of the face- there are fillers that better for certain areas than others- my preference for the under eye area is belotero- its designed for these areas that need a soft subtle fill- and it should not have any tindel effect. You have a combination of things that is happening, you have volume loss in the upper face- even though you have wonderfully full cheeks - especially on the sides/laterally, you do have volume loss in the under eye area and the upper cheek area close to the eyes- some filler to the cheeks and under eye area, then addressing the marionette lines will be your best option. keep in mind that the marionette lines are the hardest to completely improve- they are considered the bottomless pit of the face- as lots of fillers are required to make a good impact- however, too much filler down there can make you more jowly- so there is a fine line. Ultherapy will help with overall skin tightening, especially on the lower face and neck area. Facial rejuvenation using fillers and noninvasive options- is a total art and it will be hard to get an absolute consensus on what fillers to place where. 

Under Eye rejuvenation usually requires a combination of treatments. First, you need to be evaluated to see if surgical intervention (under eye blepharoplasty) is needed. From the photos, it looks like you do not need the fat pads treated at this time. Second - treatment for lines and laxity in the tissues around the eye. It looks like you would be a good candidate for Ultherapy "Eye's Wide Open" treatment. Meaning, Ultherapy for the whole eye complex, all around - including above the brows. You would want to have this done BEFORE any filler treatment. The other option for treating lines and laxity in this area would be a CO2 resurfacing procedure. If Ultherapy and/or CO2 aren't in the cards right now (cost, down-time) then you could consider going straight to filler. Otherwise, a combination of one or both of these procedures followed by filler would be great. Third - fillers for the tear troughs. It looks like this would be a good option. You have had Volite, Juvederm and Restylane as recommendations. Although I prefer to use fat transfer, or Belotero under the eyes, if you are not interested in a fat transfer, then the appropriate filler would be one in the Hyaluronic Acid family. Whether this is a Juvederm product, Restylane, or Belotero will depend on your physician's preference. I like Belotero because it is very supple, fills under the eyes well, and usually doesn't cause a "blue hue". 

Wrinkles on the face can be treated by a combination of treatment.  Filler are best for immediate appearing results.  Restylane is typically used for the lines under the eyes rather than Juvederm, since Juvederm can attract water and cause some later forming, post-injection swelling.  These fillers can also be used to treat the other wrinkles on the face.  Other treatments like Ultherapy, Fraxel, and microneedling help stimulate collagen in the skin which over the long term can help the appearance of facial wrinkles.  Good luck!

A combination approach will give the most improvement. I recommend fillers for the fs themselves but also lifting around the mouth and cheeks to build underlying anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments, J Plasma and peels to get the most conservative natural look. Please see a facial sculpting expert. Best, Dr. Emer

Both ultherapy and fillers would help your marionette lines and under eye area. In my practice, I generally prefer to use the filler voluma for the under eye area, which helps with dark circles, volume loss, and lifts the cheeks to improve the nasolabial folds. Ultherapy can be quite helpful for tightening the skin and improving the marionette lines in combination with filler. I would recommend seeing a board certified plastic surgeon for further evaluation. 

Both fillers and Ultherapy® can tighten and fill undereye loose skin and sagging in the lower face. 

Thanks for your question and photos. We always recommend that you have a consultation with a board certified dermatologist or plastic surgeon. We are the most knowledgeable about these concerns.  You have been to 4 doctors – that’s a lot, so if you had a report with one of them, let them do their thing.  You can doc shop for ever and eventually you need to pull the switch.  Teoxane is not available in the U.S., so take that one off your list.  I would not recommend that Ultherapy is needed for you. Your skin tightness appears to be good.  You need a filler. We use Restylane and Juvederm a lot in the tear trough areas – although there can be more swelling with Juvederm.  All of them work in the marionette lines – again, for you it seems you need to choose the right doc in your area and I think you will do fine --- Good Luck.