Starting to Notice Facial Sagging?
There are moments when you look in the mirror and feel like "something is different from before." The cheeks begin to droop, the corners of the eyes and mouth descend, and the jawline becomes less defined — this is what is commonly called facial sagging (age-related ptosis, facial ptosis).
This article organizes the causes of facial sagging and medical approaches to it according to the consultation framework of Dr. Kim Gun-woo, Medical Director of Cellinique on Dosan-daero in Gangnam. It covers an overview of lifting procedures (Ultherapy, thread lifting, etc.) as well as lifestyle management. Whether a specific approach is suitable for you and how to proceed must always be determined during a prior consultation.
3-line summary
1. Facial sagging is an aging process in which decreased collagen and elastin, migration of subcutaneous fat, and relaxation of the SMAS (fascia) act in combination. Research suggests that collagen in the dermis decreases by approximately 1% per year from the late thirties onward.
2. Approaches fall into energy-based lifting (Ultherapy and similar HIFU devices), thread lifting (PDO / PLLA / PCL threads), and lifestyle management; which combination is right depends on each person's skin condition and degree of sagging.
3. Ultherapy is a device that has obtained FDA 510(k) clearance — it went through the clearance process with the U.S. FDA, not the "FDA approval" process. The effects and duration of all lifting procedures vary significantly between individuals, and results cannot be guaranteed.
1. Causes of Facial Sagging — The Combined Action of Skin Aging
Facial sagging cannot be explained by a single cause. Medically, it is understood as a complex process in which the following three changes occur simultaneously.
Decreased Collagen and Elastin
As we age, the production of collagen and elastin — which are responsible for the elastic structure of the dermis — decreases and their quality changes. This is why the skin gradually loses its ability to "hold firmly in place."
Migration and Redistribution of Subcutaneous Fat
The subcutaneous fat distributed around the forehead, eyes, and cheeks migrates downward or atrophies over time, making the upper face look hollow and the lower face look heavier.
SMAS Relaxation
When the SMAS (Superficial Musculo-Aponeurotic System) — the fascial layer beneath the skin — becomes lax, the structural support that holds the entire skin in place diminishes. This is precisely why lifting procedures pay close attention to the SMAS layer.
💡 Fact-check ✓
Source: PMC10527789 (Cells, 2023) · Korean Dermatological Association (KDA) clinical guidelines
- A study on high-intensity focused ultrasound (HIFU) confirmed decreased expression of collagen and elastin fibers in aged skin, and observed increased collagen expression, decreased MMP-1, and increased TIMP-1 in the HIFU treatment group (PMID 37759497, Cells 2023).
- Dermal collagen loss progresses from the late thirties onward, and SMAS relaxation is widely reported as the core mechanism of facial ptosis (per Korean Dermatological Association (KDA) guidelines).
- Individual differences, lifestyle habits, and UV exposure influence the rate of sagging progression.
| Aging mechanism | Key change | Example observation areas |
|---|---|---|
| Collagen & elastin decrease | Weakening of dermal elastic structure | Fine lines and sagging around the eyes and mouth |
| Subcutaneous fat migration | Upper cheek atrophy, heavier lower cheek | Drooping cheeks, deepened nasolabial folds |
| SMAS relaxation | Loosening of skin support structure | Blurred jawline, neck wrinkles |
2. Overview of Lifting Approaches — Energy-Based vs. Thread Lifting
There are two main categories of procedures for addressing facial sagging. Because which approach is right depends on the degree of sagging, skin condition, and daily schedule, please read this section only as an overview for understanding the general principles of each approach.
Energy-Based Lifting — Overview of Ultherapy
Ultherapy uses HIFU (High-Intensity Focused Ultrasound) to concentrate energy all the way to the SMAS layer beneath the skin. Without creating wounds on the skin surface, it forms thermal coagulation points in the deep layer, which are known to induce tissue contraction and collagen regeneration.
💡 Fact-check ✓
Source: FDA accessdata (510(k) K072505, 2009) · PMC10527789 PMID 37759497 (Cells, 2023)
- Ultherapy (the Ulthera System) is a device that has obtained FDA 510(k) clearance. The 510(k) clearance is a procedure in which the U.S. FDA reviews the safety and substantial equivalence of a medical device and permits its marketing — it is a different concept from "FDA approval (FDA approved)." ⚠️ The expression "FDA approval" is not accurate — "FDA 510(k) clearance" or "FDA cleared" is the correct term.
- In Korea, Korea's MFDS has cleared it as a high-intensity focused ultrasound stimulation system (based on the manufacturer's official guidance — direct verification of the exact clearance number and indication text in Korea's MFDS primary database is recommended).
- There is cell- and molecular-level research showing that HIFU increases collagen and elastin synthesis in aged skin and decreases MMP-1 (collagen-degrading enzyme) expression (PMID 37759497, Cells 2023). Clinical lifting effects and duration vary between individuals.
Overview of Thread Lifting
Thread lifting is a method of inserting absorbable threads beneath the skin to lift sagging tissue and induce collagen production around the threads. Depending on the thread material used, it is classified as PDO (polydioxanone), PLLA (poly-L-lactic acid), or PCL (polycaprolactone), each with different absorption periods and mechanisms of action.
| Category | Ultherapy (HIFU type) | Thread lifting (PDO / PLLA / PCL) |
|---|---|---|
| Mechanism | Ultrasound energy creates thermal coagulation in SMAS layer → induces collagen regeneration | Physical lifting via thread insertion + collagen stimulation |
| Invasiveness | Non-invasive (no surface wounds) | Minimally invasive (small puncture for thread insertion) |
| Effect onset | Gradual changes over weeks to months after the procedure | Immediate lift + subsequent collagen stimulation effect |
| Duration | Varies considerably depending on individual condition, age, and lifestyle; not guaranteed | |
| Suitability | Decided during the consultation based on individual factors including degree of sagging, skin condition, and downtime availability | |
💡 Fact-check ✓
Source: PMID 40236886 (Aesthetic Surgery Journal Open Forum, 2025) · PMC7507174 (PMID 32983572)
- In a clinical study of PDO thread lifting (randomized controlled, n=22, 2024), the volume change seen at 20 days had largely diminished by 60 days. The number of threads used did not make a significant difference to lasting effect (PMID 40236886, 2025). This is a small-scale, short-term study; individual variation and long-term data are needed.
- Reported side effects of thread lifting include skin dimpling, thread extrusion, and asymmetry (PMC7507174). Rare, but management may be needed if they occur.
- Effects and duration vary between individuals, and all outcomes cannot be guaranteed.
3. Lifestyle Management That Influences Sagging Improvement
Independent of procedures, studies suggest that lifestyle habits influence the rate of skin sagging and post-procedure outcomes. The following are generally recommended lifestyle management points.
Sun Protection
UV radiation increases MMP (matrix metalloproteinase) activity that breaks down collagen in the dermis. Consistent use of sunscreen (SPF 30 or higher, PA++) is known to influence the rate of skin aging.
Using Retinoid-Type Ingredients
Retinol and retinoic acid (retinoid) type ingredients have been reported at the research level to support collagen synthesis and inhibit MMPs. However, since they can irritate the skin, the concentration and usage method are best decided in a consultation.
Sleep Posture and Habits
Observational studies suggest that sleeping on one side can influence facial asymmetric sagging over the long term. Sleeping on the back is believed to help reduce mechanical pressure on the face.
Nutrition and Hydration
Antioxidants (vitamins C and E), adequate hydration, and a balanced diet are included in general health recommendations as contributing to overall skin health. Claims that specific nutrients directly "treat" sagging vary widely in evidence quality and should be approached with caution.
4. Who Does Cellinique Evaluate for Lifting Procedures?
Cellinique does not recommend the same lifting procedure to everyone. Through a consultation, we assess the degree of sagging, skin thickness, fat distribution, and expectations together, and then guide you on the appropriate approach.
These are common concerns people bring in
- Those who feel that the jawline has become blurred when looking in the mirror
- Those who feel their cheeks have dropped and nasolabial folds have deepened
- Those who have been told the corners of their eyes and mouth have descended and they look tired overall
- Those who want to explore non-surgical options for sagging improvement first
Cases where we are especially careful
- If you are pregnant, breastfeeding, or planning a pregnancy
- If there is active infection or skin inflammation at the treatment site
- If you are taking anticoagulants or immunosuppressants
- If there are metal implants (dental implants, surgical metal plates, etc.) at the treatment site
- If you have a history of autoimmune disease
If even one of the above applies to you, please be sure to let us know in advance during the prior consultation. We will work together to find an approach that may be possible.
5. How a Lifting Consultation Proceeds at Cellinique
With sagging improvement procedures, how the individual's sagging pattern is assessed and addressed has a far greater influence on outcomes than which device is used. At Cellinique, consultations and procedures proceed in the following order.
- Skin and sagging assessment — Dr. Kim Gun-woo, Medical Director, directly evaluates the SMAS layer, subcutaneous fat distribution, and skin thickness. Ultrasound and visual examination are combined, and the cause of sagging and the primary areas to address are determined.
- Approach selection and design — We suggest energy-based (Ultherapy, etc.), thread lifting, or a combination, tailored to your individual conditions. A design combining both is also possible.
- Schedule and recovery planning — We coordinate together your available downtime, daily schedule, and intervals between procedures.
- Procedure — Carried out according to the design. Energy output, thread insertion depth, and areas treated are based on your individual design.
- Follow-up check — We track how changes evolve and guide you on additional care if needed.
※ Cellinique is located on Dosan-daero, Gangnam-gu. Dr. Kim Gun-woo, Medical Director (specialist in laboratory medicine), personally handles everything from the consultation to the procedure and follow-up check. This is based on clinic guidance; details of available procedures and equipment will be provided during the consultation.
6. Post-Procedure Care and Side Effect Information
Lifting procedures are medical procedures and therefore carry the possibility of side effects. These differ depending on the type of procedure, and reactions also vary depending on individual skin condition.
Commonly communicated reactions after energy-based lifting (Ultherapy, etc.)
- Temporary pain or heat sensation during and immediately after the procedure (individual variation)
- Temporary swelling or redness after the procedure (usually subsides within a few days)
- Rare: temporary sensory abnormalities related to nerves, skin nodules
Commonly communicated reactions after thread lifting
- Swelling, bruising, and pain at the treatment site (usually subsides within 1-2 weeks)
- Skin dimpling — may appear in the initial period after thread fixation; usually resolves over time
- Rare: thread extrusion, asymmetry, infection
Cases requiring immediate contact
- If severe swelling, heat sensation, or redness persists after the procedure
- Fever or chills
- If skin dimpling persists for more than 2 weeks or worsens
- If you feel as though a thread is coming through the skin surface
The occurrence and severity of side effects vary between individuals. If you experience any unusual reaction, please feel free to contact Cellinique.
7. Reference Points When Choosing a Lifting Procedure
Cellinique does not make definitive statements about "which procedure is better." The following are reference criteria that may be helpful when you are considering a sagging improvement procedure.
| Checkpoint | Considerations |
|---|---|
| Degree of sagging | Mild to moderate sagging vs. severe sagging → the range addressable with non-surgical procedures is assessed during the consultation |
| Skin thickness and elasticity | If the skin is thin or elasticity is severely diminished, the approach to energy-based procedures may differ |
| Downtime availability | Thread lifting may involve swelling and bruising, so schedule flexibility is needed |
| Treatment history | Previous procedures (fillers, botulinum toxin, energy procedures) influence the order and design of the approach |
| Medications and health status | Anticoagulant use, autoimmune disease, etc. affect whether procedures are possible → must be disclosed in advance |
In Korea's cosmetic and regenerative procedures, the practitioner's proficiency, experience, and safety management system for the relevant procedure significantly influence outcomes. In addition to specialist qualifications, it is advisable to confirm during the consultation whether the doctor personally handles the consultation and procedure, and whether a post-procedure care protocol is in place.
Frequently Asked Questions (FAQ)
Q1. Is Ultherapy "FDA approved"?
To be precise, it is a device that has obtained FDA 510(k) clearance. In the U.S. FDA's medical device review process, 510(k) clearance is the procedure by which a device is recognized as having safety and effectiveness substantially equivalent to a previously marketed device, and is thus permitted for marketing. "FDA approval (FDA approved)" refers to a separate review process called PMA (Premarket Approval) for high-risk devices — the two terms have different meanings. Ultherapy had indications sequentially cleared through 510(k) clearance, starting with brow lifting (2009, K072505), followed by jawline and neck lifting, and décolletage wrinkle improvement. In Korea, it is cleared by Korea's MFDS as a high-intensity focused ultrasound stimulation system.
Q2. How long do thread lifting effects last?
The effects and duration of thread lifting vary considerably depending on the thread material used, the insertion method, and each person's skin condition, age, and lifestyle. The literature reports a tendency for the initial effects of PDO threads to diminish over time (PMID 40236886, 2025). A specific duration cannot be definitively stated or guaranteed, and it manifests differently in each individual. Please confirm realistic expectations together during the prior consultation.
Q3. Can Ultherapy and thread lifting be done together?
Whether to combine them is decided by considering the current skin condition, degree of sagging, and the recovery period of each procedure. As a principle, it is not done on the same day or with overlapping procedures without an interval. When combining two procedures, the order and interval design is important, and this is tailored to each individual during the prior consultation.
Q4. Will sagging go away after one treatment?
Lifting procedures are not about reversing the aging process — they are about slowing the progression of sagging or helping to improve it within a certain range. Sagging does not disappear permanently with a single procedure, and results and duration vary between individuals. It is realistic to consider this within the context of long-term care combined with lifestyle management.
Q5. Is surgery needed if the sagging is severe?
If the degree of sagging is significant, it may be difficult to expect sufficient change from non-surgical procedures alone. How much falls within the scope of non-surgical approaches, and whether surgical lifting (surgery) is more appropriate, is assessed during the consultation. Cellinique guides you within the scope of non-surgical procedures, and if it is judged that the sagging exceeds that scope, we will communicate this honestly.
Q6. Can sagging be improved with lifestyle management alone?
Lifestyle care such as sun protection, retinoid ingredients, and hydration management can influence the rate of sagging progression, but it is difficult to reverse sagging that has already developed through lifestyle management alone. Lifestyle management is realistically approached as a role that complements procedures or maintains preventive benefits.
Q7. What should I do if side effects occur after a lifting procedure?
Mild swelling and redness usually subside within a few days. If they persist for more than 2 weeks, or if there is severe heat sensation, fever, or skin dimpling, please contact Cellinique (02-6203-3434). Thread extrusion symptoms after thread lifting should also be brought in immediately for assessment.
Q8. Can I just get a consultation?
Of course. Regardless of whether you proceed with a procedure, if you just want a consultation, please feel free to reach out by phone (02-6203-3434) or KakaoTalk. We recommend first talking through the causes of sagging and the appropriate approach thoroughly before making a decision. Consultation and procedure fees vary depending on individual condition and design, and will be communicated during the consultation.
Closing
Facial sagging is an aging process in which decreased collagen and elastin, subcutaneous fat migration, and fascial relaxation act in combination. Energy-based lifting (Ultherapy and similar HIFU devices) and thread lifting (PDO / PLLA / PCL threads) each have different principles and characteristics, and which approach is right must be determined through an individual assessment.
At Cellinique (Gangnam, Dosan-daero), Dr. Kim Gun-woo, Medical Director, directly assesses each person's sagging pattern and provides personalized guidance on energy-based procedures, thread lifting, and lifestyle management directions. If you are interested in sagging improvement, we recommend starting with a consultation before committing to a specific procedure.
✅ Fact-check completion report
The key medical information in this article was verified against the following sources.
- FDA 510(k) K072505 (2009, Ulthera Inc.) — Ultherapy's FDA 510(k) clearance (initial indication: brow lifting). ⚠️ "510(k) clearance" is the accurate term, not "FDA approval." Additional clearances: K121700 (jawline / neck), K134032 (décolletage). This article uses only "FDA 510(k) clearance" and does not use "FDA approved."
- PMC10527789 / PMID 37759497 (Cells, 2023) — Cell- and molecular-level research showing HIFU increases collagen and elastin synthesis and decreases MMP-1 in aged skin. Individual variation and non-guarantee of results stated.
- PMID 40236886 (Aesthetic Surgery Journal Open Forum, 2025) — Randomized controlled clinical trial of PDO thread lifting (n=22). Initial effect at 20 days diminished at 60 days. Limitations of small-scale, short-term study noted.
- PMC7507174 (PMID 32983572) — Literature reporting side effects of thread lifting: skin dimpling and thread extrusion.
- Korea's MFDS (MFDS) + manufacturer's official guidance (Merz Aesthetics Korea) — Ultherapy's Korean clearance name: "high-intensity focused ultrasound stimulation system" (exact clearance number can be verified at emedi.mfds.go.kr).
- Verification items: distinction between FDA 510(k) vs. approval; domestic clearance expressions; Ultherapy mechanism; thread lifting clinical evidence; side effects; individual variation. No definitive effect figures or duration stated. "FDA approval" 0 times. Efficacy guarantee expressions 0 times.
- Exact regulatory approval numbers can be verified at emedi.mfds.go.kr or confirmed during consultation.
Medical disclaimer
This content is for the purpose of providing general health information; individual diagnosis, suitability for procedures, and expected effects must be determined through a prior consultation with a specialist. All medical procedures carry individual variation and the possibility of side effects.
Results, maintenance, and suitability vary depending on each person's skin condition, age, and lifestyle, and the same result cannot be guaranteed.
Procedures carry the possibility of side effects such as temporary redness and swelling, and contraindications may apply, so these are confirmed during the prior consultation.
Cellinique consultation and booking
228 Dosan-daero, Gangnam-gu, Seoul, Yeonseung Building
Phone 02-6203-3434
Hours Mon–Fri 10:00–19:00 / last Saturday of each month 10:00–16:30
