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.

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.