Wrinkle and Sagging Treatment– wrinkle and sag –


Types of Wrinkles and Treatments

Wrinkles require different treatments depending on their type. For detailed information, please consult with a physician during your examination.

Expression Lines

Wrinkles around the corners of eyes

The wrinkles around the corners of your eyes when you smile, the wrinkles on your forehead when you raise your eyebrows, and the wrinkles between your eyebrows when you frown are all created dozens of times every day depending on your facial expressions. As the dermis loses its elasticity with age, it gradually deepens.

Botulinum toxin injections are effective for wrinkles caused by facial muscles. Improves wrinkles by relaxing the muscles that cause wrinkles. Even if wrinkles have already formed, if they are still shallow, botulinum toxin injections can be enough to improve them.

At our hospital, doctors examine muscle movements and wrinkle formation, and then inject botulinum toxin into the appropriate areas to preserve a natural facial expression.

The injection site and dose will be recorded in the medical record each time, and if the effect is insufficient, an additional injection will be given free of charge after two weeks.

Botulinum toxin treatment is recommended as a preventive treatment before wrinkles become deep.

Deep wrinkles

Nasolabial folds

Deep wrinkles such as nasolabial folds, tear troughs, and forehead wrinkles are caused by decreased collagen in the dermis, decreased fat, bone atrophy, and ligament sagging.

Hyaluronic acid injections are effective for deep wrinkles. Hyaluronic acid lifts wrinkles from within and plumps them up.

Botulinum toxin injections two weeks before hyaluronic injections are particularly effective for wrinkles on the forehead.

At our clinic, we focus not only on the skin, but also on the related supporting ligaments, bone atrophy, fat tissue reduction, and sagging, and use hyaluronic acid injections to balance the entire face and aim for natural rejuvenation.

Fine wrinkles

Fine wrinkles around the eyes

For fine wrinkles and a decrease in skin firmness, Sunekos and U Revs Pro 32Rx, which promote an increase in collagen and elastin (extracellular matrix) in the dermis, are recommended.

When hyaluronic acid is injected into shallow wrinkles, they may become unnaturally raised or uneven, but Sunekos and U Revs Pro only stimulate your own collagen production, and the preparations are quickly absorbed, so they do not look unnatural.

U Revs Pro is a weakly heat-crosslinked hyaluronic acid with high diffusivity, so it can be used as point injections to maintain skin firmness.

The recommended treatment for fine wrinkles on the neck is Sunekos + Coretox injection. Pure hyaluronic acid has the effect of stimulating collagen production, and botulinum toxin has the effect of relaxing muscles, so you can expect not only wrinkles but also texture improvement.

For slightly deeper wrinkles, we perform a soft hyaluronic acid injection called Belotero Soft. It is characterized by being less prone to unevenness than conventional hyaluronic acid.

If facial muscles are affected, botulinum toxin injections are also used. We also recommend preventive use of tretinoin, retinol, and placenta injections, which promote dermal regeneration and rejuvenation.

To be more effective

Although botulinum toxin injections and hyaluronic acid injections can be performed on the same day, it is ideal to perform hyaluronic acid injections two weeks after the botulinum toxin injections. Applying hyaluronic acid while the muscles that cause wrinkles are relaxed will improve wrinkles more easily and give a natural-looking finish.

Facial sagging treatment

Wrinkles and sagging are two sides of the same coin. Wrinkles are formed due to sagging of the dermis and subcutaneous tissue.

Sagging skin is caused by multiple factors, but the main causes are:

Causes of facial sagging
  1. Atrophy of facial bones
  2. Loosening of ligaments
  3. Facial muscle weakness and facial fascia sagging
  4. Reduction in subcutaneous tissue (fat)
  5. Decreased dermal tissue (collagen and elastin)

Atrophy of facial bones

Bone atrophy due to aging. Black areas are especially prone to atrophy.
Bryan Mendelson,Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation1

Bone atrophy, which is the shrinkage of facial bones, is one of the major causes of sagging skin.

Changes in the facial skeleton due to aging
  • Frontal bone・・・When the forehead bone atrophies, the skin on the forehead becomes sagging and wrinkles become noticeable. As a result, the eyebrows are lowered and the eyes become smaller.
  • Temporal bone・・・When the temple bone atrophies, the temple becomes sunken and the face looks gaunt.
  • Orbital socke・・・When the bones around the eye atrophy, the eye socket becomes larger, the upper eyelid becomes sunken, and the skin under the eye becomes sagging.
  • Anterior cheekbones・・・When the cheekbones atrophy, the position of the cheeks drops and the face becomes flat. The cheeks become sagging and the smile lines become deeper.
  • Apertura piriformis (nostrils)・・・Due to atrophy of the nasal bones, the nostrils widen and the nose opens laterally.
  • Maxilla/mandible・・・When the jaw bones atrophy, the skin around the mouth and jaw sag. Nasolabial folds, marionette lines, plum wrinkles on the chin, and wrinkles above the lips become more noticeable.

The volume lost due to bone atrophy is treated by replacing it with hyaluronic acid injections.

While looking at the overall balance of your face, we restore volume to naturally rejuvenate your face.

Loosening of ligaments

Loosening of ligaments due to aging GALDERMA4

The skin of the face is supported by true ligaments that run from the bones to the dermis. Ligaments stretch and sag as we age.

As we age, ligaments loosen and sag, causing facial sagging.

Sagging appears due to drooping of the ligament GALDERMA4

Hyaluronic acid lift is recommended to prevent ligaments from sagging.

Hard hyaluronic acid is injected under the ligament to lift and support the ligament. The position of the cheeks is raised, giving a natural lifting effect to the entire face.

Hyaluronic acid lift is recommended for young patients in their late 20s to 40s. By supporting the ligaments with hyaluronic acid before they stretch and become sagging, it is possible to suppress the stretching of the ligaments due to gravity.

On the other hand, if the ligament is already severely loosened, placing hyaluronic acid under the ligament will not lift it up, so there may be little effect.

Muscle weakness and fascial sagging

HIFU machines that lift the fascia

Many people know from experience that when muscles weaken, the skin also sag, and when you strengthen your muscles, the muscles become firmer and the skin above them becomes firmer as well.

The same goes for facial muscles; when they weaken and lose volume, the fascia, subcutaneous tissue, and skin also sag.

During full-body exercise such as sports, you use a lot of facial muscles. Daily full-body exercise and facial muscle training are recommended to prevent sagging.

The most effective treatment for sagging fascia is facelift surgery. The facial skin is removed, the SMAS fascia is pulled up, and the excess skin is excised and sutured. However, there is long downtime and scarring.

At our hospital, we have introduced HIFU as a non-invasive treatment for sagging skin.

HIFU is a treatment that uses high-intensity ultrasound to apply powerful heat to the fascia and subcutaneous tissue, causing them to contract and improve sagging.

Although the effect is only mild compared to surgery, it is a treatment with almost no downtime.

Reduction of subcutaneous tissue and dermis

As we age, subcutaneous tissue (fat) in various areas decreases. The skin sag due to the loss of volume, so hyaluronic acid injections are used to compensate for the volume.

Sagging of the dermis is caused by a decrease in extracellular matrices such as collagen and elastin. As a result, fine lines and sagging pores become more noticeable. The treatment policy is similar to the treatment of fine wrinkles mentioned above, and the main treatment is to improve the firmness of the skin.

For injection-based treatments, we recommend Sunekos, Sunekos + Coretox, and U Revs Pro 32Rx, which increase the extracellular matrix of the dermis and improve firmness.

For laser and peeling treatments, we recommend HIFU Shower, Double Leser, and Tranex Reti Peel, which target the dermal layer.

We also recommend tretinoin, retinol, and placenta injections, which promote dermal regeneration and rejuvenation, as preventive daily care.

Sagging treatment by age

For those who do not want to undergo surgery or thread lift, we have summarized non-invasive sagging treatments by age group. The degree of sagging varies greatly from person to person even at the same age, so it cannot be generalized, but we recommend the following treatments as a guide.

Sagging skin in your 20s

People in their 20s have less sagging skin, so performing a hyaluronic acid lift every 1 to 2 years can prevent the supporting ligaments from stretching and loosening due to aging and gravity, and prevent future sagging. Sunekos and U Revs Pro 32Rx are also recommended to prevent deterioration of the dermis.

Usually no HIFU is needed.

Sagging skin in your 30s

If you are in your 30s and have mild sagging, perform HIFU once every 6 months to a year, and Hyaluronic Acid Lift every year. For dermal maintenance, we recommend Sunekos and U Revs Pro 32Rx.

If the volume of the subcutaneous tissue has decreased and the nasolabial folds and depressions in the midface become noticeable, we can fill in the wrinkles and depressions with hyaluronic acid injections.

By treating the skin before it becomes severe, you can prevent the progression of sagging and wrinkles and maintain a youthful appearance.

Sagging skin in people over 40

For sagging skin after the age of 40, first perform HIFU three times every three months, then continue every six months to a year.

Hyaluronic acid injections are used to compensate for areas where bone atrophy and fat loss have occurred.

Many people over 40 already have loose supporting ligaments, and although hyaluronic acid lift has no visible effect, it does have the effect of preventing the ligaments from stretching further. Therefore, hyaluronic acid is injected only into the necessary ligaments.

To improve sagging and wrinkles, use 4 to 12 mL of hyaluronic acid for the first time*. By first creating a solid foundation by balancing your face as a whole, you will prevent sagging later on, and you will also need less hyaluronic acid for maintenance.

*The amount of hyaluronic acid can be adjusted according to your wishes, so you can receive injections starting from 1mL.

List of references/websites
  1. Mendelson B, Wong CH. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthetic Plast Surg. 2012 Aug;36(4):753-60. doi: 10.1007/s00266-012-9904-3. Epub 2012 May 12. PMID: 22580543; PMCID: PMC3404279.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404279/figure/Fig6/
  2. Mendelson B, Wong CH. Changes in the Facial Skeleton With Aging: Implications and Clinical Applications in Facial Rejuvenation. Aesthetic Plast Surg. 2020 Aug;44(4):1151-1158. doi: 10.1007/s00266-020-01823-x. Epub 2012 May 12. PMID: 32844267.
  3. Shaw RB Jr, Katzel EB, Koltz PF, Kahn DM, Puzas EJ, Langstein HN. Facial bone density: effects of aging and impact on facial rejuvenation. Aesthet Surg J. 2012 Nov;32(8):937-42. doi: 10.1177/1090820X12462865. Epub 2012 Sep 24. PMID: 23012659.
  4. GALDERMA 医療従事者向けサイト レスチレンシリーズ https://www.lookgood-feelgood.jp/professional/index2.html 最終アクセス:2023/1/11

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