Will it get more hollow? In general it can, but it can be avoided
In general, Ultherapy can make cheeks more hollow. With good treatment design and more careful technique, though, this can be avoided; I put extra effort into keeping the face from hollowing, so this is not something to worry about much. The zone-based approach below is how I avoid it.
Existing hollows with jowls: treat the two areas separately
Some people already have hollows under the cheekbones while the deep cheeks still contain fat and the jowls are sagging. This face has both missing volume and a fat layer that is sagging. I do not make the whole cheek off-limits for Ultherapy just because I see a hollow.
My approach is to divide the areas first. I do not use the 4.5 mm transducer in an area that is already hollow under the cheekbones, and I focus on the dermis there. In the deep cheeks that still have fat and the sagging jowl area, I cannot stop at the surface; deeper layers also need to be addressed. These areas look adjacent, but their treatment judgments must remain separate. So hollow cheeks don’t mean giving up on Ultherapy; how to choose between Ultherapy and Thermage is in Ultherapy or Thermage.
If the hollow is new after treatment, return to the original clinic first
If the cheek did not have this hollow before and it appeared only after Ultherapy, the zone-based approach above cannot be applied directly. Do not treat it as a reason to add more lifting or fat reduction. First gather the treatment date, when the hollow began to appear, the areas treated at the time, and before-and-after photos taken from the same angle and in the same lighting. Then return to the clinic that performed the treatment for an assessment.
Post-market reports in the manufacturer’s instructions for use have included fat or volume loss, but spontaneous reports cannot be used to estimate incidence. Photos alone also cannot determine an individual’s cause or recovery time. If the hollow is accompanied by severe pain, an unusual change in sensation or a change in muscle strength, seek medical assessment promptly.
Reducing the jowls may make the hollow less noticeable
When someone with hollow cheeks also has jowls, the heaviness and sagging below can make the hollow above stand out more and the whole face look more gaunt. Making the jowls neater reduces the step in the contour, so the face may look less hollow than before.
This means the height difference in the contour has decreased. It does not mean the hollow itself has gained volume. When viewing the result, keep “the hollow looks less noticeable” separate from “the missing volume was restored.” If the nasolabial folds have sunk in too, how to tell hollowing from sagging above is in can Ultherapy improve nasolabial folds.
If the whole face was already very thin, the answer is different
Another situation is a face that had almost no fat to begin with, rather than only a hollow under the cheekbones with jowls below. When the whole face is thin and already lacks volume, Ultherapy alone cannot address the missing volume. Volume support needs to be considered separately.
Conversely, some people are thin in other areas but still have clear fat and sagging in the deep cheeks and jowls. When the areas and layers are clearly separated, Ultherapy alone may still visibly improve the sagging. There is no need to rule out the whole treatment simply because the face looks thin.
