Is Ultherapy damage reversible? Do I need surgery? (Photos)

Any skin tightening procedure that produces heat, has the potential to damage the fat if not done properly. Ultherapy is very safe it you use the ultrasound and identify the level of the collagen properly and the proper transducer accordingly.

At this point, it appears that you have has volume loss. The best ways to restore volume is with a biostimulator (Sculptra) or a fat transfer. Those will give the longest lasting results.

Your photographs are from 2023 and it may be prudent to upload the appearance now so that one may assess the changes. The changes over the last two years may be a combination of further tissue changes (caused by the treatment or simple aging) and the laxity that naturally occurs on the lower part of the face, jawline and neck on our 40's and 50's (and beyond). Based purely on the photographs, fillers alone are most unlikely to give you the result you seek as lower facial fillers may make the jawline (jowls) actually look worse. With layered and repeated fillers, there is a phenomenon of "slide" of the fillers and the tissues, which can make the lower part of the face look "doughy", with worsening of the jawline and loss of the "V"-shaped female face that looks attractive. A deep plane facelift and neck lift together with nano fat grafts and fat grafts and also textural treatment of the skin surface should give you an excellent results as you have a beautiful bone structure (cheeks, jaw, chin). I know we all seek the "minimally invasive" techniques for cosmetic improvements, but always beware of asking or seeking for the "most aggressive" modalities. Sometimes, tissues just need repositioning and better support and, although I have all the other modalities (HIFU, RF, Needle RF, etc), surgical repositioning, firming, and appropriate filling with your own fat is the most efficient and long-lasting way. Wish you well.

Ultherapy is such a great modality but we do see this problem frequently when ultherapy is used incorrectly. Sometimes volume loss can be replaced with more volume; however, over the age of 40 (unsure how old you are) sometimes significant volume loss can make skin laxity look worse (e.g. ozempic face). I would see a facial plastic or plastic surgeon to see if fat injections would be an option, but you could need a modified deep plane facelift. Good Luck!

Hello Ann,
I believe that there are two options to help you. If you are wish to undergo facelift with fat transfer then that is the way to go. If you are not ready for surgical intervention then I would treat you with Sculptra and/or hyperdilute Radiesse with or without Profound RF and prp. Most importantly choose an expert facial plastic physician to take care of you. Feel free to contact me with any further questions or concerns, or even a virtual consultation. Good luck and be well.
Michael Persky, MD
Encino, CA

Thank you for sharing your experience. What you’ve described reflects an issue we often see in aesthetic medicine: when treatments are approached from a single angle—without acknowledging that biology is holistic and all anatomical layers are interrelated—unexpected side effects can occur. This is particularly true with high-intensity focused ultrasound at deeper settings, especially on lean facial structures.
You can think of the relationship between skin and the underlying fat like a pillow and its pillowcase. When volume is lost from the “pillow,” but the “pillowcase” remains the same size, the surface may begin to wrinkle, ripple, or sag in uneven ways. In cases like this, tightening the outer layer alone often isn’t enough—rebuilding structure or adjusting the skin itself becomes necessary.
The most definitive way to correct both volume loss and skin laxity is often facelift surgery.
If you prefer to stay non-surgical for now, treatment should focus on restoring volume strategically and stimulating skin repair without further harming remaining fat. This may include biostimulatory injectables, radiofrequency microneedling, or fractional treatments that avoid deep thermal injury. Small amounts of filler can still be helpful in selected areas, but need to be combined with technologies that support dermal remodeling.
A full consultation would help determine whether surgical or advanced non-surgical options align better with your anatomy and goals.
Warm regards,Op. Dr. Güray YeşiladalıBoard-Certified Plastic Surgeon

Since the problem is volume loss, a collagen stimulator like Sculptra, powdered stem cells of fat like Renuva, or a facelift surgery incorporating fat transfer would all be options. I recommend an in person consult with a few board certified plastic surgeons to get opinions since the surgeon will be able to manipulate the tissue which gives more information than just photos.

One other option that can help to tighten tissue and stimulate collagen is Radiesse and Sculptra injections. If Ultherapy treatment truly reduces the fat layer, the only way to restore fat is to do a fat transfer. But Radiesse and Sculptra can help bring back the volume and help tighten the skin to reduce the visible loss of volume in the tissues.

Hello; For volume needs; the best solution is; if you have enough fat; that is "autologous fat" transfer. Although this application provides for volume; it will not tighten the skin. For the needs about skin tightening; I recommend for you PLA (Sculptura or Lanluma treatments). Since it creates for a significant increase in subcutaneous collagen; provides for both overall volume; it creates for tightening as well.

Unfortunately, the only way to correct what you have is fat grafting and some fillers. The fact you had Ultherapy there makes the blood supply needed for the fat to take (Survive) lower that optimum. So, 2-4 sessions will be needed. An improvement is possible.

So sorry to hear about your experience with Ultherapy

Fat loss after Ultherapy has been reported and remains a controversial subject.

The company maintains that Ultherapy does not destroy fat, but other similar HIFU devices such as Ultraformer openly advertise their fat melting capabilities.

In your case, given your pre-existing facial volume loss, I would probably not have recommended you for Ultherapy, which I tend to reserve for patients with "medium" or "heavy" faces (plenty of fat to melt!)

Now that fat loss has occured, fillers, collagen stimulators or fat grafting would be the recommended option to address the lost facial volume and correct the "sunken" look

How does Ultherapy work?
Using MicroFocused Ultrasound with Visualisation (“MFU-V”), the Ulthera device delivers ultrasound energy to the deeper layers of skin to generate focal areas of heating known as Thermal Coagulation Points. Collagen rich layers of the skin- such as the superficial musculoaponeurotic system (“SMAS”) and deep dermis are targeted. The treatment causes existing collagen to contract and triggers new collagen production- as evidenced by immediate skin tightening that further improves over the next 2-3 months. Using the patented DeepSEE® technology, the Ulthera system provides real-time ultrasound visualization of the skin down to 8mm, allowing practitioners to deliver the treatment at the optimal tissue depth and avoid injuring structures such as blood vessels or bone.