There was a time when it was said there was only one solution for those seeking to remedy the look of sagging facial skin: the Hollywood-style face lift.
The surgery that repositions and trims skin is still available and has been tweaked in the years since its hallmark was a somewhat stiff, mask-like visage thereafter. Yet newer approaches take a more individualised treatment method and while they give immediate and dramatic results, they still require costly and invasive surgical treatment that comes with not-insignificant risks and lengthy recovery periods.
It’s why ‘fighting the sag’ is the new frontier of non-invasive and minimally invasive appearance medicine. Injectable botulinum toxin treatments have changed the game as an option for minimising lines and wrinkles and injectable dermal filler now help improve or restore facial volume.
Used by experienced providers, in some cases these can be used carefully to provide subtle facial ‘lift’ – for example, improving slightly heavy or hooded eyelids – but it’s not their primary purpose. However, a number of new treatments have been developed to improve the appearance of what experts call the overall ‘sit and fit’ of the face as it ages, without needing a scalpel.
Skin rejuvenation
As we age, our skin’s underlying structure and volume changes and the overlying skin becomes looser as collagen and elastin levels decline, making it saggier and more prone to creasing.
Unlike wrinkles, which can sometimes seem to appear overnight, loss of skin firmness occurs gradually. Maybe you notice that your under eyes feel crepey, or you start to feel like gravity has a stronger pull on your jawline. Losing a lot of weight can also have an impact on the appearance of lax skin.
Most current non-surgical procedures used to target skin that’s started to become less firm, including laser, radio-frequency, and ultrasound, work by using energy to target underlying skin tissue without impacting its surface. This has been shown to stimulate collagen and elastin production and gradually improve skin tone and texture.
Microneedling treatments including Dermapen similarly incite skin’s natural healing responses for collagen induction but do it by creating micro-perforations in its surface. Profhilo, a new injectable hyaluronic acid treatment that distributes evenly beneath the surface of skin to give an overall smoother appearance, has also been shown to have a stimulatory effect on the cells producing collagen and elastin.
Another option called a thread lift involves inserting small dissolvable sutures with barbs or cones beneath the skin. These are designed to cause tension beneath the skin’s surface, repositioning skin and giving a lifting and tightening effect in treated areas, but can also reportedly stimulate the production of collagen.
Given it takes time for the body to produce new collagen, these options often require more than one treatment – sometimes several – over a number of months to deliver results and their impact on the firmness and tautness of skin also varies.
Fresh approaches
Charmaine Moukarzel, About Face Sylvia Park Clinic Manager and High Tech Training Manager, says a number of aspects play into how our skin ages and what treatments suit.
These should be taken into account during an initial consultation, such as how long the issue has been a concern, which skincare is being used at home and your medical history. Moukarzel says About Face offers two treatments to address sagging, Fraxel Laser and Ultraformer III.
She calls Fraxel a gentle, ‘age correction’ laser. “It targets and addresses skin plumping, promotes even skin tone, stimulates collagen production, improves the sit and fit of the skin and more. It’s suited to someone looking for overall skin rejuvenation as well as addressing the firmness of the skin,” she says.
But for tackling lifting and firming ‘head on’, she recommends Ultraformer III, which uses micro-focused ultrasound energy delivered at precise skin depths, a process she says feels a bit like ‘pins and needles’.
“It’s a non-invasive, face lifting and tightening, body tightening and contouring device that provides a customised treatment procedure for the entire face and neck. There is no post-treatment downtime, you can walk right out of your appointment and return to your day. Your skin and face will feel like it’s had a solid HIIT workout.”
Moukarzel says in-clinic they see the most transformative results treating the cheeks and jowls.
“We also see great results with jawline contouring. Smaller areas can also be targeted, for example just the eyes, fine lines and crow’s feet,” she says.
Ellie Yousefi of Acacia Skin Health and Beauty in Christchurch says what’s useful about Dermapen microneedling treatments is that it can have a wide range of benefits in addition to treating skin sagging and is suitable for all skin types for men and women.
“Anyone not happy with their skin, be it from acne, new or old acne scars, sunspots, stretch marks or the general fading of youth from skin, it’s an ideal non-surgical facial rejuvenation,” she says.
New arrival
Emface is one new arrival gaining attention thanks to its new approach and needle-free appeal. Created by BTL Aesthetics, famous for its body-contouring Emsculpt treatments said to mimic thousands of ab ‘crunches’, Emface uses a combination of synchronised radiofrequency (RF) and high intensity facial electromagnetic stimulation (HIFES) energies to simultaneously treat facial skin and the muscles beneath. Treatment is delivered from a machine attached to single-use adhesive pads placed on the forehead and cheeks.
“The treatment is designed to increase the density and quality of the muscles to restore and elevate the support of the facial tissues, reversing the sagging of the muscles and facial tissues that occur with age, explains Dr Catherine Stone, owner of The Face Place, and the first to offer the treatment in New Zealand.
“It is unique in that it targets the lifting muscles of the face – those used in smiling and lifting the brows – with selective hyper-contraction via high intensity electrical stimulation. The muscle is contracted thousands of times in one session.”
She says she personally enjoys the sensation the treatment provides through the pads and there is no downtime after treatment. “The RF feels warm on the skin, and the HIFES feels like caterpillar feet at first, and then the muscle contractions made me giggle.”
Dr Stone says a standard course of treatments is one 20-minute treatment a week for four weeks, with full results expected to be achieved about three months after the course of treatments ends. Clinical studies cited by the manufacturer say Emface increases muscle tone by 30 per cent, reduces wrinkles by 37 per cent and offers a 23 per cent lifting effect.
“We initially looked at it for treating mild-moderate sagging of the face, but it has been found to achieve facial contouring – lifting and volumising the cheeks and enhancing the jawline – in both younger and older patients. Many of my international colleagues have noted that their filler volumes have reduced in patients who have had a course of Emface treatment,” says Dr Stone. She says another promising use of Emface is to help Bell’s palsy patients, stimulating the muscles to improve function on the affected side of the face.
“Our first Bell’s palsy patient is already noticing improvement after just a couple of treatments,” she says.
Buyer beware
Experts we’ve spoken to say that while the scope of treatments are exciting, it’s important treatment providers are honest about – and patients understand the limitations of – each type of treatment as well as any risks. They say there are still plenty of instances where only surgery will help achieve the results some might be seeking, particularly when addressing moderate to severe sagging. As with all appearance treatments, do your own research and seek out an experienced provider with proof of their own work, not just images provided by the company providing the technology used. You should be offered a full consultation, given a chance to ask questions and consider whether you are happy to proceed.
In general, there are some easy steps that you can take to minimise the impact of sagging skin.
“Lifestyle factors play a huge part in the health of our skin and how quickly we show signs of ageing,” points out Moukarzel.
“Smoking, alcohol and excessive sun exposure will always speed up the ageing process of the skin, so avoiding these things is top of the list.”
Vaping can also have an impact as nicotine and other chemicals expose your skin to free radicals that can speed up the signs of ageing. In addition, wearing SPF is essential.
“If clients aren’t using a good full spectrum SPF daily, then none of the expensive active serums, topical or treatments are worth doing. It all starts with protecting the skin,” says Moukarzel.
She also suggests considering ingestible supplements that support skin health, in particular good-quality sources of zinc and Vitamin C.
