Sculptra vs Ultherapy for jowliness and face shape —what would you suggest? (Photo)

FaceTite can internally tighten the skin in the lower face and neck. After all the skin has been heated and contracted, we shape the neck with liposuction to give definition and remove stubborn pockets of fat. In one quick treatment, we can tighten skin, remove fat, and contour the lower face, jawline, and jowls with only a weekend of downtime. Keep in mind that combination approaches will give you a more significant improvement as opposed to a single procedure. I recommend getting a consultation with a board-certified cosmetic dermatologist and facial sculpting expert. Best, Dr. Emer

Thank you for your question and I understand your desire to address early signs of aging while sticking to your budget. Sculptra would effectively restore lost volume in the midface, which could improve the appearance of the jowls somewhat. Ultherapy is an excellent treatment for jowling, but won’t provide you with the volume necessary to improve the shape of the midface. 
Although you would do best with the combination approach, you will also see good results from either one of these treatments. I would likely recommend starting with the Sculptra for volume restoration, since that could slow the development of the jowls while creating more definition in the cheekbones. Make sure you work with a board-certified dermatologist no matter which procedure you choose, to ensure the best possible results. 

Being most cost effective ($3000 roughly) and dramatic improvement, then you really want the liposuction of the jawline/neck with the added benefit of Accutite to tighten the skin even more.  Those jowls will really improve .

I agree that both would give you a nice result, but sympathize with your budgetary concerns.  This is a common issue for dermatologists; the combo procedure would be best but not practical.  The Sculptra will create volume in the cheeks, reducing the "gauntness" that you complain of. If done artfully, the shape of your face should be improved to a more "upside down egg" or oval shape, which is more youthful.  Also, it should lift to a degree and give you a less jowly look.  However, ultherapy's best results are on the jawline, where it tends to give a better definition and sharper angle. It is good for your skin type and should give you a nice result.  However, it doesn't usually give you volume.  And there are 10% of patients who don't seem to get a result.I would consider a third option, a combo of Hyaluronic acid fillers and Sculptra. I personally would give you Voluma in your upper cheeks and jawline for definition and lift and some Sculptra to give you some mid cheek volume to make you look less gaunt.  As much as I love Ultherapy, I think fillers are more of a sure thing.

This is a really good question and one I am asked often in my practice. 
We know that facial aging leads to gradual volume loss. It is this process primarily that leads to a changing facial shape and sagging. For this reason, my response is always to start with volume replacement, whether with hyaluronic acid (HA) fillers, such as Juvederm, or with so called collagen stimulators such as Sculptra. Personally, I prefer HA fillers, as in my experience, they are more predictable and reproducible than Sculptra, which relies on the individual response of each patient. HA fillers are also reversible in the unlikely event of a problem. However some patients prefer the more gradual onset of Sculptra. It works by stimulating collagen but it is still essentially a filler. It just works a little differently. We offer both in my practice.
I tend to recommend skin tightening treatments such as Ulthera or radiofrequency, when there is already sufficient facial volume. These treatments are designed to lift and tighten by stimulating collagen and elastin production. They do not add volume, they tighten around the existing structure. For younger  patients, I usually recommend radiofrequency treatments such as Sublime or Exilis. These patients have more collagen to start with and radiofrequency thus works really well. For more mature patients, I recommend Ulthera. 
Using both volume replacement, such as with Sculptra and skin tightening, such as with Ulthera makes a lot of sense, as they should work synergistically. If I had to choose just one though, personally I would always start with volume replacement.

Best of luck with whatever you choose!