[제이준성형외과·피부과] From Botox to Facelifts: How to Choose the Right Lifting Treatment for Your Degree of Sagging

Facial aging is not simply a loss of skin elasticity. It progresses as multiple tissues—including the skin, subcutaneous fat, retaining ligaments, and SMAS layer—change gradually over time.

“Do you always get better results from the strongest lifting treatment?”

Not necessarily.

Aging does not progress at the same rate for everyone, and the causes and degree of sagging also vary from person to person.

The important thing is not to find the “best lifting treatment,” but to choose a “lifting treatment suited to your current stage of aging.”

In this article, we will take a detailed look at which treatments are appropriate at each stage, based on the progression of aging:

① Botox · Fillers → ② EBD lifting (Ulthera · Thermage, etc.) → ③ Thread lifting → ④ Mini facelift → ⑤ Facelift surgery

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1. Stage 1: Early aging, when volume loss and fine lines begin

Botox · Fillers

From the late 20s to the early 30s, expression lines or localized volume loss often appear before noticeable skin sagging.

During this period, treatments that create a natural balance can be more appropriate than lifting treatments designed to pull the face upward.

If skin sagging is not severe and expression lines or changes in facial volume are the main concerns, Botox or fillers may be considered.

Botox can be used to help reduce expression lines caused by repeated muscle movement, while fillers can help supplement lost volume and improve overall facial balance.

This stage generally has a high level of satisfaction with relatively simple treatments because the skin itself is not significantly sagging.

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2. Stage 2: When skin elasticity begins to decrease

EBD Lifting (Ulthera, Thermage, etc.)

In the 30s and 40s, collagen levels in the skin decrease, elasticity declines, and facial contours begin to look less defined.

EBD (Energy-Based Device) lifting may be helpful.

EBD stands for Energy-Based Device, meaning energy-based equipment.

Representative devices include Ulthera and Thermage. They work by delivering ultrasound or radiofrequency energy to the skin and subcutaneous tissue to promote improved elasticity.

Ulthera: Uses ultrasound (HIFU) to deliver energy to the SMAS layer and promote a lifting effect.

Thermage: Uses radiofrequency (RF) to promote collagen regeneration in the dermal layer and improve skin elasticity.

Recently, it has also become common to use both devices together or combine them with other energy-based devices, depending on the individual’s skin condition.

At this stage, it is important to focus on reduced skin elasticity and mild sagging.

In particular, even with the same device, the appropriate energy level and treatment method may vary according to skin thickness, degree of sagging, and facial area, making an individual assessment important.

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3. Stage 3: When sagging of the skin and fat layers becomes noticeable

Thread Lifting

After the 40s, not only the skin but also the fat layer shifts downward, making nasolabial folds, sagging in the mid-cheek area, and loss of jawline definition more pronounced.

The lifting treatment recommended at this stage is thread lifting.

Thread lifting involves inserting medical dissolvable threads (PDO, PLLA, PCL, etc.) beneath the skin to pull sagging tissue in the desired direction.

However, it has limitations when tissue sagging is severe. Rather than simply assuming that “more threads are always better,” it is important to choose a lifting method suited to the current condition of the facial tissues.

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4. Stage 4: Moderate or greater sagging

Mini Facelift

Once skin sagging becomes pronounced and the jawline begins to lose definition, it may be difficult to achieve the desired improvement through nonsurgical methods alone.

A mini facelift uses relatively small incisions around the ears to lift both sagging skin and the SMAS layer.

Compared with a conventional facelift, it improves sagging tissue through incisions and dissection performed over a relatively limited area.

However, its effects may be limited when there is neck sagging or extensive aging.

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5. Stage 5: Severe skin sagging and changes in facial contours

Facelift

When aging has progressed considerably and not only the skin but also the subcutaneous tissue and the supporting structures of the face have sagged overall, a facelift may be considered.

A facelift is not simply a procedure that pulls the skin. It also corrects the SMAS layer while removing excess, lax skin.

However, because the surgical area is extensive, factors such as the recovery period, scarring, and the possibility of complications should be carefully considered before making a decision after consulting with a specialist.

The Most Important Thing Is Choosing According to Your Stage

Choosing an expensive treatment or the latest device is not what matters most in lifting.

It is most important to accurately assess your current degree of aging, skin condition, fat volume, and facial structure, and then choose a treatment suited to that stage.

For early aging, Botox and fillers alone may be sufficient. Once elasticity begins to decline, energy-based laser lifting may be considered.

As sagging progresses, the options may extend to thread lifting or a mini facelift, and in cases of severe aging, a facelift.

Taking a gradual approach can lead to more natural and satisfying results.

Above all, the first step toward successful lifting is to have your condition accurately assessed through a thorough consultation with a medical professional and establish a treatment plan that is most appropriate for your current stage.