Author: Dr Branden Seow
Facial sagging is a natural and inevitable process of aging. As we grow older, we will notice changes in our facial appearance, including a loss of skin elasticity and firmness. This is due to a combination of factors that affect the skin, muscles, and underlying tissues of the face. In this article, we will explore more on facial sagging as well as discuss various treatment methods.
The loss of skin elasticity, which occurs as a person ages, is the main reason why facial sagging happens. Elasticity refers to the skin’s ability to stretch and bounce back to its original shape. Collagen and elastin fibers that are found in the dermal layer of the skin play an important role in maintaining skin elasticity. Collagen renders structural support to the skin, while elastin allows the skin to return to its original state after stretching. Both collagen and elastin production naturally decline as we age. This decline weakens the skin’s ability to resist gravity, therefore resulting in sagging, wrinkles, and fine lines.
Another reason for facial sagging is due to changes in the distribution of facial fat. When we are younger, fat is evenly distributed across the face, giving it a youthful outlook. However, as we age, facial fat can diminish or redistribute unevenly. This will lead to hollowed cheeks, and an overall loss of facial volume, contributing to the appearance of sagging skin. Facial muscles also play a crucial role in keeping a youthful appearance. Muscles provide support to the skin, and their shrinkage with age can lead to sagging. Repeated facial expressions, such as frowning or squinting, can further exacerbate these changes. Underlying facial bones undergo age related changes as well. The process of bone loss,otherwise also known as bone resorption, will happen as people age. This will affect the underlying structure of the face, contributing to sagging.
Extrinsic factors, such as sun exposure, smoking, and poor skincare habits, can also accelerate the aging process and make facial sagging worse. UV radiation from the sun can degrade collagen and elastin fibers due to oxidative stress, leading to premature aging. Smoking impedes blood flow to the skin, reducing oxygen and nutrient delivery to the skin. These external factors can further compromise the skin’s ability to keep its firmness and elasticity.
Prevention and Treatment
While facial sagging is a natural process of aging, there are various lifestyle changes one can adopt to slow its progression and minimize its effects. Wearing sunscreen and protective clothing can help prevent UV damage to the skin. Maintaining a healthy diet, staying hydrated, and avoiding smoking can protect skin health. Using skincare products with ingredients like retinoids, hyaluronic acid, and antioxidants can help improve skin texture and firmness.
At The Clifford Clinic, we also house several technologies that can help reverse sagging as well as enhance overall skin health.
Radiofrequency (RF) Therapy: Thermage FLX is a non-invasive treatment that uses radiofrequency (RF) energy to tackle skin laxity and help improve the appearance of sagging skin on the face. It’s effective for mild to moderate skin sagging. RF energy is delivered deep into the skin’s layers, specifically targeting the dermis layer. This controlled heating of the dermal tissue stimulates the production of collagen. As collagen production increases, the skin gradually tightens and becomes smoother, in the process making the skin less saggy. Thermage does not require any surgical incisions. Instead, a handheld device is used to deliver the RF energy to the skin’s surface, making it an appealing choice for individuals who want to avoid the risks and downtime associated with more invasive surgical procedures. Most individuals can resume their normal activities soon after a Thermage treatment. There may be some mild redness or mild swelling, but they typically resolve within a few hours to a few days.
High-Intensity Focused Ultrasound (HIFU): HIFU Sygmalift is also another popular treatment to treat sagging skin. HIFU delivers focused ultrasound energy deep into the skin, particularly the deep dermal and subdermal tissue. Neocollagenesis is triggered, where the body’s natural collagen production is stimulated. It is also non-invasive and most people can resume their daily routines immediately after a treatment. At The Clifford Clinic, we use Sygmalift, a brand of HIFU. It is pain-free, as compared to other forms of HIFU available in the market. Several sessions are needed to see improvement over time.
For non-invasive procedures, results may vary from person to person, and it will not produce the same level of results as more invasive surgical procedures like facelifts. For mild sagging, non-invasive procedures can work well. The degree of improvement also depends on the degree of sagging to begin with.
As compared to a traditional surgical face lift that is more invasive and requires general anesthesia to do, a threadlift is a minimally invasive cosmetic procedure that can aim to lift sagging tissue under local anesthesia. As such, its recovery is faster than a traditional surgical facelift. A threadlift involves the use of medical-grade threads, often made of materials like polydioxanone (PDO), that are inserted beneath the skin’s surface to create a lifting effect. These threads are biocompatible. During a thread lift procedure, the threads are strategically placed under the skin. These threads have tiny barbs or cones that anchor the skin and provide an immediate lifting effect. This is particularly effective for addressing moderate sagging in areas like the cheeks, jowls, and neck. There may be some mild bruising, swelling, or discomfort, but these side effects will typically go away after some time.
A traditional surgical facelift, also known as a rhytidectomy, is a cosmetic surgical procedure meant to treat sagging skin on the face and neck. This surgery is done usually under general anesthesia. Common incision locations include along the hairline, in front of and behind the ears, and sometimes under the chin. The choice of incision pattern depends on the patient’s specific requirement and concerns. After making the incisions, the surgeon lifts the skin and underlying tissues away from the underlying muscle and fat layers.The surgeon then repositions and tightens the underlying facial muscles and connective tissues to lift up the sagging skin tissue. There will be significant downtime after the surgery. Some bruising, swelling, and discomfort are expected. However, the lifting effect tends to be the longest among all the procedures.
There are a range of treatments to treat a sagging face and to help lift the face. The treatment for a sagging face varies depending on the severity, personal preferences, as well as budget. Non-invasive and minimally invasive treatments offer effective solutions with minimal downtime. Surgical options, like facelifts, provide more dramatic and long-lasting results but involve a higher level of invasiveness.