Hello, I'm Dr. Ho Lee, medical director of Glory Clinic, a dermatology clinic in Gangnam where I personally handle every one-on-one consultation and treatment.
Today I'd like to explain why cheek hollowing can happen after Ultherapy — something many people anxiously ask about in consultations — and how to prevent it.
Why does cheek hollowing happen after Ultherapy?
There are two main reasons.
1. Adding shots without designing each area
As Ultherapy has become less expensive, I hear of treatments planned at 600, 900, or even 1,200 shots. Too few shots can certainly leave the results lacking. But rather than simply adding more shots, it's important to design the treatment area by area. Ultherapy clearly needs a sufficient number of shots, but allocating too many can build up so much energy that the cheeks hollow. On the side of the cheek, the retaining ligaments hold the face in place and prevent sagging — which is why the side cheek can look a little sunken. If too many Ultherapy shots overlap on those ligaments, the ligaments contract, and a side cheek that already looks sunken can look even more so. Fat loss in the side cheek can make it look more sunken too. That's why the retaining-ligament area must be carefully designed so it doesn't receive too many shots.
2. Jaw Botox given carelessly, without design
Like Ultherapy, jaw Botox requires careful design, and the doctor needs to recognize patients who shouldn't have it. These days, though, at large dermatology clinics patients pick a treatment off a menu like at a convenience store, and get exactly that, cheaply. Rather than being pleased that it's cheap and easy, what really matters is whether the treatment suits your face — and whether, even for the same treatment, it was done properly. Ultherapy is usually combined with Botox treatments such as jaw Botox or salivary gland Botox to maximize the effect. But some face shapes shouldn't have jaw Botox, and even when it's appropriate, it has to be designed well at the right dose. When it's done carelessly, cheek hollowing gets worse. Ultherapy alone can't cause hollowing this severe; in many of the really severe cases, careless jaw Botox was the cause.
How can you prevent cheek hollowing after Ultherapy?
When you have Ultherapy, be sure to choose a clinic that recommends an appropriate number of shots and designs the treatment carefully. Above all, choose a clinic where the doctor who actually performs the treatment also does your consultation. I often see cases where the medical director does the consultation and a different doctor does the treatment, and many of those patients end up dissatisfied.
First, choose a clinic where the doctor responsible for your treatment recommends the number of shots
When the consultation is done by a coordinator or the medical director and the treatment by a different doctor, many patients end up dissatisfied. In my personal view, after 13 years of watching aesthetic dermatology treatments, most Ultherapy treatments fall within about 400 to 600 shots. Of course, other lifting devices are often combined for the best results, but increasing Ultherapy shots indiscriminately deserves a second thought. And because too many shots raise concerns about side effects with treatments like Ultherapy, extra caution is needed.
Second, be careful with jaw Botox alongside Ultherapy
Jaw Botox is seen as a relatively simple treatment, so people sometimes have it without their face shape and muscles being assessed. Even with the same treatment, the result depends on whether the dose and area were designed for your face.
Combining Ultherapy with Botox such as jawline skin Botox, jaw muscle Botox, or salivary gland Botox can maximize its effect. But because Botox has become inexpensive, many people get it just anywhere — please be careful. Especially if your face is slim and your jaw muscle shapes the outer contour of your face, careless jaw Botox can make your face look as if it has lost a lot of volume. Look for a clinic where an experienced doctor takes responsibility for both your consultation and your treatment.
Frequently Asked Questions
I'm scared of cheek hollowing from Ultherapy, so I think I should have Thermage instead.
Ultherapy and Thermage are lifting devices that don't do the same job. They complement each other rather than compete, so choosing Thermage because you're avoiding Ultherapy is the wrong way to decide. There's clearly a device that suits each person's needs, so decide after a thorough consultation with your doctor.
I already have slight cheek hollowing. Does that rule out Ultherapy?
No. As I explained above, if you have some hollowing, that area can be designed carefully and the Ultherapy shots allocated appropriately. If your side cheeks are sunken, the Ultherapy design matters — but so does the design of any jaw Botox. Because design is so important for Ultherapy, do your research and have it at a clinic where the doctor personally handles your consultation and treatment. Some people think jaw Botox can be done cheaply anywhere, but that's a real mistake. If you need Ultherapy, it can be done safely with careful design that avoids the hollow areas.
Key Summary
- Not everyone gets cheek hollowing from Ultherapy, so there's no need to worry.
- With enough design beforehand, even people with some hollowing can have Ultherapy.
- The number of Ultherapy shots and whether any jaw Botox is properly designed matter most.
- Choose a clinic where an experienced doctor handles your consultation and treatment.