Facial Laxity

Facial laxity at a Glance

  • Best Results 1-4
  • Treatment Recovery0- 6 days
  • Procedure Time10-80 min
  • Skin SpecialistNurse, Davin Lim
  • Duration of Results12-60+ months
  • AnaestheticAs per procedure
  • Back to WorkNext Day- 7 days
  • Cost$$-$$$$

Facial Laxity

The ideal facelifting or skin tightening treatment depends on many factors including the degree of laxity, the amount of background sun damage, your age, dermal thickness, lower face volume, ethnicity, lifestyle, downtime, budget & expectations. I employ surgical as well as non-surgical procedures to lift the face, neck, & eyelids.

FactsFacts on Facial Laxity

  • Non-surgical facelifting can yield good results if performed correctly
  • Laser resurfacing is useful if there is background sun damage & poor skin quality
  • Dermal fillers can displace volume, providing a lift. This is termed a liquid face lift
  • HIFU or Ultherapy can be a useful treatment for lifting the lower face
  • RF or radiofrequency energy can be delivered on the skin’s surface
  • RF can also be focused to specific areas; namely FaceTite RF
  • RF Microneedling can be useful for lifting the lower face & neck contouring
  • Thread lifting can give a good result in some patients with facial laxity
  • PRP does not provide any lifting (contrary to though and advertising)
  • Majority of patients will benefit from a combination approach to facelifting

When do I use non-surgical procedures?

Non-surgical face lifting & skin tightening is used in the following scenarios-

  1. Patients who have mild to moderate skin laxity who are not yet candidates for surgical face lifting. This group of patients are usually between the age of mid 30s to late 50s. 
  2. Patients who are candidates for surgical face lifts but choose not to undertake a surgical procedure.
  3. Patients who have had surgical procedures including face & neck lifts, however would like further improvements.

The MOST important factor in determining what is the best treatment is based upon a complex algorithm as outlined below.

What is the ideal non-surgical treatment for facial laxity?

In reality the algorithm is very complex. Put simply it is NOT one device, or one method. I take into consideration factors such as the grade of laxity, dermal thickness, background skin quality, degree of volume loss, ethnicity, downtime, & patient expectations.  

This table is a quick summary of non-surgical options. Read more on the specific treatments for more information.

TreatmentLaxity GradeSkin 

Quality

Dermal 

Thickness

Number of 

sessions

Duration of effects
Liquid liftsMild to

moderate

All typesAll thickness2-32-4 years
LasersMild to severePoor skin

quality

All thickness1-23-10 years
ThreadsMild to

moderate

All typesModerate to thick1-23 -8 months
RF Bipolar

RF FaceTite

Mild to

moderate

GoodModerate1-42- 3 years
HIFU- UltherapyMild to moderateGoodThick1-22-4 years

 

What is a laser face lift?

Laser resurfacing using both ablative erbium & CO2 lasers can provide collagen stimulation & contraction. This can improve the jowls, marionette lines as well as eye wrinkles, & laxity. In most cases lasers can provide an upper eyelid lift as well as marked tightening of the lower lids.

Lasers should be reserved for patients with significant sun damage with poor skin quality. The downside with laser resurfacing is the downtime of 5 to 10 days. Laser resurfacing only addresses skin quality & tone, volume should be addressed with dermal fillers or fat transfer.

What are liquid face lifts?

Liquid face lifting is a term to describe dermal fillers. Placed in strategic locations, dermal fillers displace volume loss, in turn creating lift. The exact placement of fillers depends on your facial shape, & area of concern.

In the context of lifting, the most commonly displaced areas include your cheeks, chin & jawline. The art of filling is to provide traction & counter traction in key vectors (area of pull). This displacement of volume tractions soft tissue & skin in an upward & backward vector. This causes lifting.

I use both hyaluronic acid & collagen stimulating dermal fillers to achieve this lift. In most cases I combine fillers with HIFU, RF, threads, injectables & lasers. 

Refer to the section on dermal fillers for a better understanding on what specific areas can be targeted.

Davin’s Viewpoint on treating Facial Laxity

The ideal treatment or combination of treatments follow an extremely complex algorithm. If it was that easy, everyone would be having a low downtime, affordable, predictable procedure that negates surgery & reverses aging. Fact of the matter is that one single treatment does not exist.

For a good, predictable non-surgical face lifting result I take into consideration background skin quality. This is one of the most important factors to consider when using energy devices such as Ultherapy, Ultraformer, Thermage, & Tempsure. If you have broken collagen, or elastosis, chances are, deeper treatments as above will not work. In this case, addressing skin texture with an ablative laser will be required.

For super-powerful devices such as Ultherapy, Ultraformer III and other HIFU/Microfocused ultrasound, one has to take into consideration facial volume & dermal thickness. If one has a ‘slight’ facial build, with low volume (especially of the lower face/jawline area), I don’t recommend these treatments. Whether it actually ‘melts’ fat or not is really dependent on how this energy is delivered. (Much akin to a pair of scissors, namely the scissors can give you a great haircut, or used in the context of a weapon can cut the ear, or worse still, cut your jugular artery. Same device, different outcomes. Context is paramount). There is so much misinformation on this device on the internet, including denial of side effects from companies themselves. If you contract lax skin on someone who is volume depleted, the volume will decrease because the skin is tighter. If the operator pulses too deep, with too many ‘shots’ and overlaps, one may decrease fat & cause too much collateral damage. Always apply the device accordingly in the correct skin type.

In the context of low facial volume with associated laxity, I do prefer slower heating devices over fast heating-high energy devices. My pick is Tempsure or Pelleve over Thermage, purely based upon safety, efficacy & cost effectiveness.

Thread lifts, again pick your candidate. Ideally, good dermal thickness (or the thread will be visible; especially suspension threads, less so monofilament). The downside with threads is not that they do not work, it is their longevity (3 to 8/9 months for most). I often combine threads with devices such as Tempsure as they give a synergistic effect.

Dermal fillers or liquid face lifts is actually volumetric displacement of skin in a certain vector. In the context of ‘lifting’ using a high viscosity, high G prime filler can ‘lift’ certain areas. The ideal placement is dependent on the patient’s profile. Additionally hyper diluted collagen stimulating fillers are underutilized.

In summary, the algorithm of optimal treatments is complex. In most patients, there are multiple causes of laxity including age related, sun related as well as volume loss. The answer does not lie on one procedure, it certainly does not lie in one device. Finding the correct combination of treatment/s is the key to predictable non-surgical face & neck lifting.

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