The degree of sagging decideswhich treatment or surgery you need

Face & Anti-aging Guide

Face Anti-Aging: Where and How to Start

Face anti-aging is staged not by age but by the degree of sagging: botulinum toxin and filler at the wrinkle stage, Ulthera, thread lift and Facela at the loss-of-elasticity stage, and facelift once sagging is pronounced.

Faces of the same age do not age the same way. In some people expression lines deepen first; in others there are few wrinkles, but the cheeks descend and the jawline blurs. This is why Atelier Plastic Surgery does not choose treatments by age. We stage the face by how far the skin, the fat and the SMAS (fascia) layer beneath them have descended, in other words by the degree of sagging.

When there is little sagging and the main issues are wrinkles and volume loss, injectable treatments such as botulinum toxin and filler are often enough. When elasticity has declined and the jawline is starting to blur, energy-based treatments such as Ulthera and Facela or a thread lift tighten and lift the tissue. When there is so much excess skin that some remains even when you push the cheek up by hand, we consider a facelift and neck lift, which pull and fix the skin together with the SMAS layer.

Order matters too. Repeating filler alone at the stage of pronounced sagging can make the face look heavy, while having surgery first at the wrinkle stage means giving up more than you gain. The purpose of this guide is to sort out what is needed now at each stage and what is not needed yet.

Dr. Juyoung Go is a board-certified plastic surgeon and a steering committee member of the Minimally Invasive Plastic Surgery Society (MIPS), and personally performs both minimally invasive treatments such as injectables, energy devices and threads and surgery such as facelift. Because she handles both treatment and surgery, she does not start from a particular method; she first looks at which stage you are at. Consultation, treatment, surgery and follow-up are all carried out by the director herself.

Based on what the concern is

Wrinkles show first when you make expressions — the wrinkle stageAt this stage, what bothers you are lines that appear with movement, around the eyes, between the brows and on the forehead, or shadows in hollowed areas such as the nasolabial folds and chin. The skin and fat have not yet descended much. We approach this stage with injectable treatments that modulate muscle movement or replace volume. Even when adding volume, we look at the structure and balance of the whole face rather than just the hollow.

Botox (botulinum toxin)When muscle is the cause, as with expression lines, a square jaw or enlarged salivary glands FillerFor volume in hollowed areas such as the nasolabial folds, chin and forehead, and for the balance of the whole face Skin BoosterWhen fine lines, dryness and loss of elasticity are problems of the skin itself

The border between cheek and jawline is starting to blur — the loss-of-elasticity stageFrom the front there may seem to be little change, but from the side the jawline is blurring and the cheeks have begun to descend. Elasticity in the skin and fat layer has declined, but there is not much excess skin, so we consider treatments that tighten or lift the tissue without incisions. The three options act on different layers in different ways and are used alone or in combination.

UltheraWhen you want to tighten from the deep layers by delivering ultrasound heat down to the SMAS layer FacelaWhen broad-area loss of elasticity and facial-line shaping are addressed together Thread LiftWhen you want sagging lines physically lifted and fixed in place

Sagging is pronounced — the surgical stageAt this stage, excess skin is visible when you push the cheek up by hand, and jowls and neck sagging are present together. When there is a large amount of excess skin, energy-based treatments or threads alone have limits; surgery is needed to pull and fix the skin together with the SMAS layer and then remove the excess skin. Atelier Plastic Surgery performs only one surgery under general anesthesia per day.

FaceliftWhen sagging of the cheeks, jawline and jowls is pronounced Double Chin · Neck WrinklesWhen submental fat or neck sagging is the main problem

Skin texture and tone stand out more than saggingPigment problems such as melasma and blemishes, and texture problems such as pores, scars and fine lines, are a separate axis from the sagging stages. They may be treated at the same time as lifting or on their own. If there is no sagging but the face still looks older, check here first.

Pico ToningWhen melasma, blemishes or pigmentation make skin tone uneven Pico MLAWhen skin texture is the problem, as with pores, scars and fine lines Skin BoosterWhen dryness and reduced skin regeneration occur together

Age shows on the hands and knees before the faceThe backs of the hands, the knees and the elbows have thin subcutaneous fat and are often exposed, so they show age before the face does. We approach them by considering volume replacement and skin regeneration together.

Hands · KneesWhen tendons and veins stand out on the backs of the hands, or the skin over the knees and elbows looks loose

At a glance

Surgery · Treatment	Main concern	Incision · Approach	Anesthesia	Recovery
Facelift	Pronounced sagging of the cheeks, jawline and jowls	In front of and behind the ear (temple depending on extent)	General	About 2 weeks
Double Chin · Neck Wrinkles	Submental fat · neck sagging · platysmal bands	Small submental incision · behind the ear for a neck lift	Sedation or general	About 3 days to 2 weeks
Ulthera	Loss of elasticity · blurred jawline · body skin laxity	None (focused ultrasound)	Topical cream (sedation if needed)	Back to daily life the same day
Thread Lift	Sagging lines of the cheeks, nasolabial folds and jawline	None (needle insertion)	Local	About 3–7 days
Facela	Broad-area loss of elasticity · facial-line shaping · body	None (radiofrequency · low-frequency)	Topical cream or none	Back to daily life the same day
Botox (botulinum toxin)	Expression lines · square jaw · salivary glands	None (injection)	Topical cream	Same day
Filler	Nasolabial folds · chin · forehead volume and contour	None (injection)	Topical cream · formulations containing anesthetic	Same day (swelling 2–3 days)
Skin Booster	Dryness · fine lines · skin regeneration	None (injection)	Topical cream	Same day (needle marks 1–3 days)
Pico Toning	Melasma · blemishes · pigmentation	None (laser)	Topical cream	Same day
Pico MLA	Pores · scars · fine lines	None (laser)	Topical cream	About 2–3 days (redness)
Hands · Knees	Volume and skin texture of the hands · knees · elbows	None (injection)	Topical cream	Same day (swelling for several days)

Recovery periods are typical ranges and vary by individual.

Procedures

Atelier Lifting

Facelift

Surgery that lifts and fixes the skin together with the SMAS layer. Deep plane, SMAS or mini lift depending on the extent of dissection

Double Chin · Neck Wrinkles

Distinguishes submental fat from neck sagging and approaches accordingly with liposuction, neck lift and more

Ulthera

Non-surgical lifting that delivers high-intensity focused ultrasound to the dermis and SMAS layer. Face and body

Thread Lift

Fixes sagging tissue with barbed absorbable threads. Lifts sagging lines without incisions

Facela

Non-invasive lifting that stimulates collagen in the fascial layer with radiofrequency and adds shaping with low-frequency stimulation

Atelier Touch

Botox (botulinum toxin)

Reduces muscle movement and bulk to address expression lines, a square jaw and enlarged salivary glands

Filler

Volume design that fills hollowed areas while looking at the structure and balance of the whole face

Skin Booster

Injects skin-regenerating ingredients such as PDRN, exosomes and hADM into the dermis. Ingredient chosen by skin condition

Pico Toning

Breaks down pigment in the epidermis and dermis with a picosecond laser. Melasma, blemishes and pigmentation

Pico MLA

Applies a lens array to the pico laser to create fine stimulation beneath the skin, improving pores, scars and fine lines

Hands · Knees

Volume and skin-texture care for the hands, knees and elbows, where age shows before the face

After surgery

After surgery and recovery care

Most injectable and energy-based treatments allow a return to daily life the same day, and after a thread lift, swelling and bruising generally take about 3–7 days to settle. Facelift and neck lift are performed under general anesthesia or sedation; you recover in a private recovery room and return to daily life over about 2 weeks. After surgery, aftercare such as ultrasound checks and SmartLUX is provided alongside, and the director personally checks your progress. Recovery time varies by individual, and the care standards for each stage can be found on the Safety Care System page.

Safety Care System · Aftercare schedule

Related treatments in other categories

Ulthera

Often the first treatment considered at the early stage of loss of elasticity. It sits outside the face menu, so we link it here directly.

CoolSculpting

An option that reduces fat without incisions when submental fat is the cause of a double chin. Listed under Body, but also performed on the face.

Facela

Non-invasive lifting that combines radiofrequency with low-frequency energy; it works at a different layer from Ulthera, so the two are often combined.

Related research

Dr. Juyoung Go's academic activity in this field

ConferenceSpeaker

Lower Face Contour Design: Current Treatment Strategies for Safety and Natural Results

39th Minimally Invasive Plastic Surgery Society (MIPS) Symposium · 2025.11 · Hotel Samjung, Seoul

Opening presentation of a session shared with speakers from Malaysia, Thailand, France and the UK. The lecture covered how to design the lower-face contour from the standpoint of safety and natural results.
ConferenceSpeaker

A Structural Approach to Facial Filler Injection

Korean Academy of Anti-aging Dermatology (KAAD) 13th Winter Conference · 2026.01 · Seoul Dragon City Hotel

Invited by a dermatology society to lecture on facial filler injection from a structural perspective.

Each treatment page lists the items relevant to it; the full list is on the Academic Activities page. View all academic activities

FAQ

Q1At what age should I start lifting?

We do not decide by age. Two people in their 40s, one with almost no sagging and one whose jawline has already blurred, need different treatments. In consultation we check how far the skin, fat and SMAS layer have descended, and first determine whether you are at the wrinkle stage, the loss-of-elasticity stage or the stage of pronounced sagging.

Q2Which is better: Ulthera, Facela or a thread lift?

They act on different layers in different ways. Ulthera delivers focused ultrasound heat down to the SMAS layer to tighten from the deep layers; Facela uses radiofrequency and low-frequency stimulation to address broad-area elasticity and the facial line; a thread lift physically lifts and fixes sagging tissue. Rather than one being better, we choose one or combine them according to the pattern of sagging.

Q3I have had filler for years and my face looks heavy. What should I do?

When sagging has progressed, continuing to add volume alone can make the face look heavy. In this case, the first step is to move the descended tissue back into place rather than to fill. After checking the amount and location of the remaining filler, we consider changing direction toward a lifting treatment or surgery.

Q4If I keep up non-surgical treatments, can I avoid surgery?

At the loss-of-elasticity stage, energy-based treatments and thread lifts can be expected to slow the progression of sagging. Once the amount of excess skin has grown, however, treatments cannot reduce the skin, and surgery with skin removal comes into consideration. This varies by individual, and which method is right at which point is decided together in consultation.

Q5Can I have surgery and treatments together?

Yes. Combinations include botulinum toxin for fine lines that remain after a facelift, filler for volume loss, and Ulthera or Facela for maintenance. Order and spacing matter, though. Treatments proceed after the surgical site has stabilized, and the director sets the timing based on your progress.

Q6Which stage does a double chin belong to?

It depends on the cause. When submental fat is the cause, we approach it with liposuction or CoolSculpting; when sagging of the skin and platysma is the cause, with Ulthera, a thread lift or a neck lift; and when the position of the jawbone is the cause, with chin augmentation. The double chin and neck wrinkles page covers the distinctions in detail.

Q7Who handles aftercare and follow-up?

Dr. Juyoung Go personally handles everything from consultation through treatment, surgery and follow-up. After surgery, aftercare such as ultrasound checks, SmartLUX, pico laser and Omega Light is provided alongside, and the care standards for each stage follow the Safety Care System.

Q8Should skin tone or pore concerns be considered separately from lifting?

They are a separate axis. Pigment and texture create an older-looking impression regardless of sagging, so if there is no sagging but the face looks tired, we consider pico toning, Pico MLA or a skin booster first. They can also be done at the same time as lifting.