What is the best treatment method for sagging facial skin?
I am a 65 years old female. I have saggy jowls and loose, wrinkled skin under my chin. I would like to find out the best treatment method and available options to resolve my sagging facial skin.
Unfortunately, despite what industry players and device makers would have you believe, no one single tool or technique is better than the next.
Rather, each tool has its place. In choosing the best skin tightening or approach for you, there are several things to consider:
- How much downtime would you be willing to accept
- Your age, expectations and philosophy towards rejuvenation.
- Quality of your skin, and amount of facial soft tissue laxity or sagging your have.
- Face shape and volume.
- Are you looking at (a) a completely non surgical approach, (b) A minimally invasive approach, or (c) A surgical approach.
- Cost and Budget
Non-surgical approach (no needles, just topical cream Anaesthesia)
Suitable for younger patients with less laxity, who may be looking to start early prevention and maintenance. And for older patients who do not want surgery.
Energy based devices utilizing high intensity focused Ultrasound (HIFU Eg. Ulthera, Ultraformer, Doublo), Radiofrequency (eg. Thermage), Infrared (eg. BBL SkinTyte), and Lasers (eg. fractional CO2, Mosaic etc.) Different energy sources work at different depths and have different effects and so aren’t directly comparable. Many of our own protocols utilize multiple devices to tighten skin and soft tissue at multiple depths for optimal results.
Minimally invasive approach (some needles, usually under topical or local Anaesthesia)
Suitable for patients with some early laxity; for older patients who do not want surgery, or patients who may simply desire a more “natural refreshed look”.
- Rebalancing facial muscles with botox, Lessens the downward pull of specific facial muscles to allow the elevators to lift facial features.
- Replacing volume in critical facial areas with dermal fillers, also helps to restore youthful proportions and symmetry.-
- Improving tissue tone and tautness, redistributing sagging tissue using absorbable threadlifts or fiber optic delivered laser skin tightening.
A Combination approach
A combination of various minimally invasive techniques together with the non-invasive energy based devices, will optimize results for patients and generally provides the highest satisfaction. Treating skin laxity at multiple levels is naturally more effective.
Combination minimally invasive approaches have the benefit of rapid recovery and little downtime, and patients return for maintenance treatments and touch ups at intervals of approximately 1-3 years.
Every face is different and each patient has different desires.
Combining procedures in a Harmonious way, for natural looking results, to give you your desired effect, does require experience and sensitivity. An in depth and personal assessment is required. Speak to a doctor with the requisite experience and technical expertise, who understands your desires and whom you feel shares your aesthetic sensibilities.
Surgical Facelifts reposition saggy (ptotic) soft tissue in layers, and removes excess skin. These may be sometimes be combined with fat grafting to restore volume to deficient areas. These give much more dramatic improvements in one sitting, but as you would expect, downtime is longer, and surgical risks higher. Touch ups may still be required after 7-10 years on average.
Dr Jonathan Lee
The best treatment method for your sagging lower face skin is high intensity focused ultrasound (HIFU). This treatment helps to stimulate collagen at several layers of the skin to restore skin elasticity.
HIFU is particularly effective for treating skin laxity because targets the SMAS (superficial muscular aponeurotic system) layer, which is the same layer that plastic surgeons tighten in a traditional surgical facelift.
There are several brands of medical-grade HIFU machines including Ulthera, Ultraformer and Sygmalift. They vary in terms of price, discomfort and number of treatment sessions needed.
For example, both Ulthera and Ultraformer are once or twice yearly treatments, spaced every 6-9 months apart.
Price-wise, these treatments cost upwards of $2000 SGD for the lower face region.
There is no visible downtime (no skin redness/bruising/peeling) for HIFU treatments.
In addition to HIFU, I suggest superficial Skin rejuvenation treatments such as Fractional CO2 (Edge Fractional CO2, SmartXide), Picosecond Lasers and Fractional microneedling RF (Infini) to enhance the results. These treatments can be performed on a monthly basis for 3-4 sessions for optimal results.
Lastly, medical-grade skin care such as Revision skincare's Nectifirm cream helps to restore your skin's hydration and elasticity. Usually 3-6 months of continuous use is required to see good results.
Based on my clinical observation, a combination of treatments targeting different aspects of skin aging and laxity is required for optimal long-term results.
Do discuss further with your aesthetic doctor regarding the most appropriate treatment/s.
Dr Justin Boey
Thank you for your question!
Your description of a sagging lower face is very typical of an ageing face, with a combination of volume loss and soft tissue descent.
It is a very well-studied subject and treatment options are extremely varied, depending on your requirements and aesthetic goals, as well as your tolerance for downtime.
The non-surgical options have already been detailed well by the previous drs, so I shall not belabour the point.
However, given your age group, and depending on the severity of your volume deflation and drooping, these are unlikely to have a sustained long term effect or even a significant short term benefit. Many of my patients in this age group require a surgical correction of their jowling and wrinkling.
Not all patients require a full facelift and its longer recovery period; there exists many other surgical options that have a much shorter recovery period, such as a mini-facelift, a shortscar MACS lift or a hybrid facelift in combination with fat-grafting. The suitability for each of these smaller procedures have to be determined via a detailed consultation.
I hope this answers your question!
Dr Samuel Ho
Consultant Plastic Surgeon
Dear Christine ,
You are mentioning 2 facial aging issues. Let’s address them separately as to avoid confusion.
1. Saggy jowls - these are descent of the superior and inferior jowl fat pads coupled with skin laxity, laxity of the maxillary and zygomatic retaining ligaments and loss of volume of the deep fat pads of the mid face (Sub-Orbicularis Oculi Fat pad, Deep Medial Cheek Fat pad).
Suggested treatment: If the jowls are not too big, a combination of Ellanse in the SOOF, DMCF and maxillary and zygomatic ligaments to volumise and lift the midface support, and Korean strong molding threads / Silhouette Soft will be able to address at least 50-60% of the jowling at the first session.
A second session of threadlift may be needed 1 year later to further augment the results (Ellanse is not needed again as I prefer the E formulation of Ellanse that can last up to 4 years).
2. Loose wrinkled skin under your chin - this is likely a dermal and subcutaneous aging issue. The outer layer of skin loses collagen and elastin, and becomes loose and wrinkled with deep lines formed. The prominence of double chin fat exacerbates the issue.
Suggested treatment: First, ultherapy will be necessary to tighten and firm the neck muscle (platysma) and fats.
Then a Korean threadlift (with long barbs) or Silhouette Soft needs to be applied to physically cause contraction and tightening of the skin and soft tissues.
Lastly, a combination of Rejuran and Teosyal Redensity I are utilized to be injected intradermally into the problem areas, once a month for 4 times, for the best results. For deep neck horizontal lines, I am able to also use Ellanse with careful small injections to recreate the volume loss in the deep wrinkles as well.
The alternative to these, is surgical correction as Dr Samuel Ho expertly pointed out .
Hope this helps!
Sagging facial skin results from a combination of factors, including loss of volume of the face (the bony structures of the jaw and cheek, as well as the deep fat that helps give the face its youthful rounded was), as well as decreasing skin elasticity.
As such, interventions are multi-pronged.
Non surgical intervention aim at building collagen and tightening the skin and muscle, as well as restoring volume. This includes:
1. Hyaluronic acid and long term collagen stimulators to restore volume, sculpt and create lift in the face
2. High Intensity Focused Ultrasound devices (HIFU), such as ulthera and Ultraformer devices, which heat and stimulate deeper muscular layers of the face, producing a good maintainenece and lift over the years.
3. Fractional lasers (carbon dioxide, erbium, picosecond) for the rejuvenation of the superficial skin layers, reducing wrinkles and improving surface quality of skin.
4. Injectables to the skin, such as Rejuran or less viscous fillers to hydrate, rejuvenate and plump the skin.
5. Minimally invasive thread - lifts to help reposition sagging fat.
If sagging is particularly bad surgical intervention might be required to appropriately remove excess skin.
A physical consult would be best to determine the best combination of treatments for your concerns.
Thank you for your question. The answer really depends on the amount and degree of sagging you have.
If it is mild to moderate sagging, you can still consider non-surgical facelift procedures. If the sagging is severe, then surgical facelift will be the better option.
Non-surgical facelift can be achieved through a few methods. Usually a combination treatment will often give you the best result.
- HIFU/ Ultherapy
- Fillers (liquid facelift)
- Fractional ablative laser resurfacing/ Microneedling radiofrequency device (Skin tightening)
Personally I prefer to combine HIFU/ Ultherapy with fillers and thread-lift. Speak to a doctor/ plastic surgeon to find out more as all the methods above have their own pros and cons. Hope this helps.
Dr Jiwei Wu
Thank your for your question.
Saggy facial skin is a common complaint among women, especially the more matured age group.
With the absence of photos, it is difficult to give a targeted treatment plan.
I agree with Dr Samuel. Given your age, non invasive treatments are unlikely to give you longevity of results.
From my experience, here are key take home messages for you.
1. Your options are surgical vs non surgical
2. Non surgical would require a combination of threadlift, fillers and energy devices for optimum result
3. Be it surgical or non surgical, peak results should take place over 3 - 6 months. So there is unfortunately no quickfix.
Hope this helps.
Dr Daniel Chang