Understanding Saggy Skin: Causes and Contributing Factors
It is unavoidable for our skin and bodies to change with time, and usually, it happens in a way we don’t find pleasing.
A lot of factors are involved when it comes to making you look younger or older – from your skin tone, texture, and volume to the formation of wrinkles and sagging of skin. These are all affected by aging, genes, lifestyle, and environmental factors.
Sagging mainly happens because the production of collagen, which is your skin’s structural support, decreases over time.
In fact, research has shown that we lose 1-2% of collagen per year after the age of 25 years old.
Loss of this nutrient in your skin causes your skin to sag, and what comes with saggy skin are more unpleasant features you might find frustrating to deal with.
The Science Behind Skin Aging
The aging process isn’t just skin-deep—it involves changes across multiple facial layers including:
1. Skin Layer Changes
There is a loss of collagen and elastin, which translates to a reduction in the elasticity and firmness of the skin.
The skin’s ability to retain moisture diminishes, leading to dryness and a decrease in natural oils that keep skin supple.
Fine lines appear first, gradually deepening into more permanent wrinkles.
Read more: Which Skin Tightening Treatments in Singapore is Right For Me?
2. The SMAS (Superficial Musculoaponeurotic System)
SMAS, or the Superficial Muscular Aponeurotic System, is the facial muscle between your bone and fat. As you age, this deep facial muscle loses elasticity, while fat pads and facial muscles lose their volume.
This is why facial aging extends beyond skin deep. This important fascial layer provides structural support and connects the various layers of the face. When it weakens over time, it contributes significantly to sagging.
3. Fat Redistribution
As you age, fat rearranges itself slowly to new pockets which are usually located around the chin, jaw, and neckline.
This results in wrinkles and sagging skin over time. The defining features of your youth are also disrupted due to lack of soft tissue support.
The volume loss at the deep fat layer is a major contributor to the change in the contours of the face with time.
Examples of this would be the appearance of eye bags, tear troughs, and Indian lines (prominent palpebromalar groove) that become more prominent when the deep fat component shrinks, and the ligaments that separate these deep fat compartments become more obvious.
4. Bone Structure Alterations
Just like other areas of your body, your facial bones also undergo osteoporosis and lose their shape and volume as you age.
This results in significant changes in your facial bone structure. Loss of bone mass can result in narrowing of your temples and shortening of your jawline.
As bones lose density, your eye sockets widen which give your eyes a more sunken and ‘hollow’ appearance.
Related article: What Treatment is Best for Anti-Aging?
Common Signs of Facial Aging
Sagging typically manifests as loose skin or excess tissue/fat around certain face areas.
This could give rise to the appearance of the following:
- Jowls
- Less defined jawline
- Double chin
- Loose skin on the neck
- Under eye hollows, dark eye circles
- Droopy eyelids and eyebrows
- Sagging cheeks
- Prominent nasolabial folds/smile lines
The ageing process changes the appearance of the face from the triangle of youth to the pyramid of ageing.
This transformation refers to how a youthful face typically has fullness in the upper and mid-face regions, creating an inverted triangle shape with the point at the chin.
As aging occurs, volume is lost in the upper face and gained in the lower face, reversing this triangle into a pyramid shape.
Risk Factors That Accelerate Skin Sagging
Intrinsic Factors
Intrinsic factors include:
- Ageing: elastin and collagen, responsible for skin elasticity and firmness, diminish with age, resulting in saggy skin, wrinkles, and fine lines.
- Weight fluctuations: weight fluctuations, such as significant and sudden weight loss with pregnancy, can accelerate skin sagging.
- Genetics: our genetic makeup determines how our cells replicate in response to injury, how our in-built DNA repair systems fix damages that accumulate over time, and how well our body defends itself against harmful molecules (free radicals) that damage cells. All these genes contribute to how fast we age with time.
External Factors
Excessive Sun Exposure: Sun exposure is a huge contributor for signs of aging, which are wrinkles, pigmentations, and lack of firmness of the skin.
UV rays breakdown collagen and elastin production, which are essential nutrients to keep the skin healthy, tight, and glowing. Excessive exposure to the sun will damage your skin cells and sabotage your skin.
External factors: external factors such as UV exposure, environmental pollutants, smoking, poor nutrition, and excessive alcohol contribute to the skin’s deterioration and sagginess.
Hormonal Imbalance: An imbalance in your hormones may be the culprit of your sagging cheeks. Lack of elastin is also one of the main reasons for losing skin elasticity.
These hormones are responsible for stimulating fibroblasts to produce the two essential nutrients for healthy skin; elastin and collagen. The production of these nutrients is disrupted when your hormone balance is broken.
Prevention Strategies: How to Slow Down Sagging
Adopting a holistic approach that focuses on lifestyle modifications, dietary habits, and skincare routines is critical to slowing down sagging. Here are effective strategies to implement:
1. Lifestyle Modifications
Keep stress at bay: Telomeres are responsible for the rate at which you age. It is an enzyme that gets shorter as it divides cells.
Chronic stress and depression affect your telomeres directly, which can speed up your aging. Besides grey hair, fine line and wrinkles, it can cause your face to lose its condition and lead to sagging skin.
Meditate and get involved with activities that may reduce your stress – like exercising, self-care, or making time for your hobby.
Moderating weight changes: ensure any weight loss is gradual, ideally not exceeding 0.5 kg per week.
This helps prevent the skin from losing elasticity too rapidly, which often results in sagging.
Limiting harmful habits: cut down on smoking and excessive alcohol intake, as these can accelerate the ageing process. Both habits generate free radicals that damage skin cells and break down collagen.
2. Skincare Regimen
Proper Skincare: The earlier you start, the better. People begin to show signs of aging in their 20’s – this is the reason why you should start a skincare routine by this age.
Be sure to apply sunscreen every day as sun exposure is a big contributor to skin aging. Know which products work best for you and stay consistent with using them.
Refining skincare products: integrate proven skincare ingredients into your routine, emphasising the use of vitamin C and vitamin A derivatives (retinol, retinoids).
Vitamin C is a powerful antioxidant that helps protect against UV damage and brightens the skin, while retinoids increase cell turnover and stimulate collagen production.
Protecting against UV exposure: UV exposure accumulates over time, and photoprotection can slow ageing and protect against skin cancer.
Use broad-spectrum sunscreen with SPF 30 or higher daily, wear protective clothing, and seek shade during peak sun hours.
3. Nutrition
Eat more healthy fats: Avoiding fatty foods can lead to sagging of cheeks and dropping of jowls because you don’t get enough fatty acids that the skin needs.
Omega-3s are powerful anti-inflammatories which may control how the body responds to UV rays, minimizing its damage.
Also, they support the skin’s structure by producing collagen and elastin, which reduces wrinkles and help with skin tightening.
Optimising nutrition: select a diet rich in antioxidants and nutrients and reduce the consumption of processed food.
Foods high in antioxidants such as berries, leafy greens, and nuts help combat free radical damage, while protein-rich foods provide the building blocks necessary for collagen production.
Comprehensive Guide to Saggy Skin Treatments in Singapore
Addressing sagging skin involves a comprehensive strategy combining skincare, effective treatments, and lifestyle adjustments.
Advocating for a tailored approach ensures treatments match individual skin types and concerns.
You might be interested: Guide to Seeing a Dermatologist in Singapore
Non-Surgical Treatment Options
1. Advanced Skincare
Skincare regimen optimisation: utilising scientifically supported ingredients is key. From hydration to renewal, a personalised skincare plan can significantly improve skin health.
Consulting with a dermatologist is crucial to selecting the most effective products.
Key ingredients to look for:
- Peptides to stimulate collagen production
- Hyaluronic acid for deep hydration
- Antioxidants to fight free radical damage
- Retinoids to increase cell turnover and collagen production
- Vitamin C for brightening and collagen synthesis
- Niacinamide for improved skin barrier function
Read more: Types of Non-Surgical Facelifts in Singapore
2. Laser Treatments
Laser treatments: lasers offer a versatile solution to skin rejuvenation.
Options range from fractional ablative lasers (Deka Smartxide) for intensive repair to non-ablative fractional lasers (MOXI), and picosecond lasers.
Each technology has unique benefits, from texture improvement to pigmentation to reducing the appearance of fine lines and wrinkles.
Different laser treatments available in Singapore:
- Fractional CO2 lasers: Best for moderate to severe skin laxity
- Non-ablative fractional lasers: For mild sagging with minimal downtime
- Picosecond lasers: Address both sagging and pigmentation issues
3. High-Intensity Focused Ultrasound (HIFU)
HIFU: high-intensity focused ultrasound (HIFU) is a noninvasive option that targets the dermis, subcutaneous fat, and SMAS to lift and tighten sagging skin.
It is particularly effective for enhancing firmness and improving contours.
HIFU is a non-invasive option for skin tightening to reduce the appearance of loose and saggy skin.
It is especially useful to address double chins and saggy jawlines. One benefit of HIFU treatment is that it can target many layers of the skin at one go- 2mm, 3mm, 4-4.5mm and 9mm.
HIFU works by delivering focused ultrasound energy to deep layers of the skin, causing thermal coagulation points.
This controlled damage stimulates collagen production and results in a gradual lifting and tightening effect over 2-3 months.
You might be interested: The Ultimate Guide to HIFU Treatment in Singapore
4. Injectable Treatments
a. Skin Boosters
Skin boosters: skin boosters offer deep hydration and improve skin texture and luminosity. A combination of hyaluronic acid and PLLA skin boosters can be used.
These micro-injections of hyaluronic acid or other biocompatible substances improve skin quality from within, addressing dehydration and improving elasticity.
b. Polynucleotide Treatments
Polynucleotide treatments: polynucleotide treatments help enhance hydration, boost skin renewal, and reduce inflammation.
Polynucleotides are fragments of DNA that stimulate tissue regeneration, improve microcirculation, and enhance overall skin quality when injected into the skin.
c. Bioremodelling Treatments
5-point bioremodelling HA treatment: 5-point bioremodelling HA treatment supports natural collagen and elastin production, producing visibly firmer, smoother, and hydrated skin.
This innovative treatment involves strategically placing hyaluronic acid in five key points of the face to stimulate collagen and elastin production for overall skin rejuvenation.
d. Dermal Fillers
Dermal fillers: fillers work by replacing the volume loss in the deep fat or by strengthening bone that resorbs with ageing.
Depending on your preference and skin type, hyaluronic acid fillers or collagen-stimulating fillers, e.g. PLLA or PCL, may be suitable.
Different types of fillers serve different purposes:
- Hyaluronic acid fillers: Provide immediate volume restoration
- Poly-L-lactic acid (PLLA): Gradually stimulate collagen production
- Polycaprolactone (PCL): Provide both immediate and long-term results through collagen stimulation
Read more: Dermal Fillers in Singapore: The Comprehensive Guide
e. Botulinum Toxin
Botulinum toxin: Botulinum toxin can be injected superficially at strategic areas of the face to effect a natural lifting. This is known as dermalift.
When used strategically in small doses across the face rather than just for wrinkle reduction, botulinum toxin can create a subtle lifting effect by relaxing downward-pulling muscles.
5. Radiofrequency Microneedling
Radiofrequency microneedling can address changes in the subcutaneous fat layer. This treatment combines the collagen-inducing benefits of microneedling with the tissue-tightening effects of radiofrequency energy, delivering powerful results for skin laxity.
The microneedles create controlled micro-injuries while simultaneously delivering radiofrequency energy to deeper skin layers, stimulating collagen and elastin production while tightening existing fibers.
Related article: The Ultimate Guide to Microneedling in Singapore
Layered Approach to Treatment
Different layers of the face can be effectively targeted with different non-invasive treatments to result in holistic and natural rejuvenation.
For optimal results, treatments should be tailored to address all affected layers:
- Skin Layer: Medical grade skincare, lasers, radiofrequency microneedling, polynucleotides, and bioremodelling treatments
- Subcutaneous Fat: Radiofrequency microneedling, HIFU, and strategic filler placement
- Facial Muscles: Botulinum toxin injections and myomodulation techniques
- SMAS Layer: HIFU treatment specifically targeting this deeper layer
- Deep Fat: Carefully placed dermal fillers to restore volume
- Bone: Strategic filler placement to enhance receding bony structure
Special Considerations for Different Areas
Sagging Cheeks
Smooth and plump cheeks are caused by abundant amounts of collagen tissues in the skin.
However, as you age, you also lose collagen, which leads to less prominent cheeks and the presence of excess skin, particularly in the lower areas of the face.
Sagging cheeks are easily identified with the lines that develop in the middle cheek area (malar area).
The main culprits that affect your cheeks are the loss of foundation in the major support mechanisms under the skin – your bone, muscle, and fat.
Besides aging, the damage done to these areas are caused by several factors that lead to sagging cheeks.
Effective treatments for sagging cheeks include:
- HIFU to target the SMAS layer
- Dermal fillers to restore volume loss in the mid-face
- 5-point bioremodelling to stimulate collagen throughout the cheek area
- Radiofrequency microneedling to improve skin texture and tightness
Jowls and Jawline Definition
Jowls form when skin along the jawline begins to sag, creating a droopy appearance. This is often one of the first and most noticeable signs of aging.
Targeted treatments include:
- HIFU focused on the lower face and jawline
- Strategic botulinum toxin injections to relax the muscles that pull downward
- Dermal fillers to strengthen the jawline and provide structural support
- Radiofrequency treatments to tighten the skin around the jaw
Neck Sagging
One of the first signs of ageing is sagging skin, especially at the neck.
The neck skin is thinner and has fewer oil glands than facial skin, making it more prone to sagging and showing signs of aging earlier.
Effective neck treatments include:
- HIFU specifically calibrated for the thinner skin of the neck
- Radiofrequency treatments to improve skin tightness
- Botulinum toxin to relax the platysmal bands that contribute to neck sagging
- Collagen-stimulating fillers to improve skin quality
Frequently Asked Questions
Can weight loss cause sagging skin?
Rapid fluctuations in weight can generally cause sagging skin. This is due to the rapid distension of the skin with weight gain, which causes the skin to stretch and lose elasticity.
The skin cannot retract fully when subsequent weight is lost, leading to the appearance of overhanging loose skin. A common example of this is weight fluctuations during pregnancy.
Weight loss and gain often lead to fat redistribution in the fat compartments of the face. Rapid weight loss associated with weight loss medications (e.g., semaglutide) is an example.
This has led to the description of an “Ozempic face,” where the profound loss of facial volume and fat results in a hollowed-out and gaunt appearance.
Can I get non-surgical treatment for sagging skin?
Yes, there are non-surgical options available for sagging skin. Laser treatments, radiofrequency microneedling, dermal fillers (hyaluronic acid, PLLA, PCL), and HIFU can enhance collagen production and tighten the skin. However, the results of surgery, which lead to a significant lift in sagging tissues and restoration of contours associated with youth, cannot be replicated with non-invasive treatments. Consult with a qualified practitioner to explore the most suitable non-invasive solution for your specific needs.
Is sagging skin preventable?
We can’t alter our genetics or stop the clock on ageing, but lifestyle and skincare choices can significantly impact the rate at which our skin ages.
This includes adopting a reasonable and efficient skincare routine that incorporates important active ingredients.
We can also do our best with sun protection measures and a healthy lifestyle that incorporates good nutrition, exercise, and sleep. These little things go a long way in slowing the ageing process, and it will show on our skin.
You can also consider professional treatments, as non-surgical options can help prevent and treat skin sagging by stimulating collagen production.
These include laser therapy, microneedling radiofrequency, fillers, and HIFU.
When should I start anti-aging treatments?
You start to age in your 20s – at the cellular level. Your first true aging wrinkle will show in your late 20s or early 30s.
As you age, these fine lines become deeper and longer, which will lead to new wrinkles. Age spots may also appear especially to those who spend a lot of time under the sun.
The mid-20s is the right time to start with an anti-aging skincare routine. Moisturizers and sunscreen should be your skin’s best friend if you want to slow down your skin aging process.
By your 30s, you will see more sun damage appearing if you didn’t make it a habit to apply daily sunscreen.
As your collagen production decreases, the chances of lines from forming become higher. You may start to notice crows feet and laugh lines beginning to appear.
In your 40s and beyond, your skin slowly starts to lose its ability to retain its moisture and continuously reduces the production of natural collagen.
It’s best to stick to a skin care routine with anti-aging and hydrating ingredients.
How do I choose the right treatment for my sagging skin?
The best approach is to consult with a qualified dermatologist or aesthetic doctor who can:
- Assess your skin condition and identify which facial layers are most affected
- Consider your age, skin type, and specific concerns
- Take into account your lifestyle and ability to commit to downtime
- Recommend a combination of treatments tailored to your specific needs
Most practitioners recommend a multi-modal approach that addresses all layers of facial aging for the most natural and comprehensive results.
How long do results from non-surgical skin tightening treatments last?
Results vary depending on the treatment:
- HIFU: Results typically last 12-18 months
- Radiofrequency microneedling: 6-12 months with maintenance treatments recommended
- Dermal fillers: 6-24 months depending on the type used
- Botulinum toxin: 3-6 months
- Collagen-stimulating treatments: Up to 2 years with proper skincare maintenance
Your lifestyle choices, genetics, and how well you maintain your skin will also impact how long results last.
Are there any side effects or downtime with these treatments?
Most non-surgical treatments offer minimal downtime compared to surgical options, but temporary side effects may include:
- Redness and swelling (common with most treatments)
- Bruising (especially with injectable treatments)
- Temporary numbness or tenderness
- Mild discomfort during treatment
More intensive treatments like ablative lasers may require 7-10 days of downtime, while treatments like HIFU or radiofrequency might only cause temporary redness for a few hours.
How do I maintain results after treatment?
To extend and optimize your results:
- Follow a consistent skincare routine with prescribed products
- Use daily sun protection
- Stay hydrated and maintain a healthy diet
- Follow recommended maintenance treatment schedules
- Avoid smoking and excessive alcohol consumption
- Manage stress effectively
Conclusion
Addressing sagging skin requires understanding that facial aging occurs across multiple layers, from the skin surface to the underlying bone structure.
With a wide range of non-surgical treatments available in Singapore, it’s possible to effectively target each layer for comprehensive rejuvenation.
The key to successful treatment lies in a personalized approach that combines preventative measures, targeted treatments, and consistent maintenance.
By consulting with qualified practitioners and adopting healthy lifestyle habits, you can significantly slow the aging process and maintain a more youthful appearance for years to come.