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.

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.

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.

Thank you for providing photos. My advice will be based simply on the photos after the procedure where there is visible skin laxity that bothers you. I feel that these are your best non surgical options and I advise that you read about them and seek out an expert provider I your area or even ask the doctors in the clinic where you had your procedure.
1. Sculptra to jawline and pre auricular spacevs2. Radiesse to jawline and chinvs3. Renuva or fat graftingvs4. Ellacor
Now sure which option have been tried yet but you may even need a combination of Ellacor and any other injectable to replace the lost volume.
Best of luck in your journey.
Have a beautiful day. Best, Dr. Anna Avaliani, NYC

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.

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.

You would need an in-person exam for a definitive recommendation. Surgery would help but likely adding fat injections would be useful. These could be performed as an isolated procedure or in conjunction a facelift procedure. Likely the fat injections would be sufficient and you could do surgery later if you wished..