By Dr Peter Peng, Dermatologist, Taiwan

Volume loss, wrinkles, folds, laxity, sagging, pigmentations, and changes in skin texture are all signs of an aging face.

We can treat these aging signs with many different methods, either surgical or nonsurgical. Sagging, in particular, is usually treated with surgical intervention of face-lift procedures. There are many kinds of surgical facelift techniques and most of them involves the treatment of one of the key structures—the submuscular aponeurotic system (SMAS) layer.

According to the ASAP 2015 statistics on cosmetic surgery, nonsurgical procedures account for 85% of a total 12.8 million procedures. Toxin injection and HA filler injection account for about 50% of total procedures and have increased by 21% since the year 2014. With a 58% increase, skin tightening is the procedure with the most increase. This data reflects a rising trend of patients opted for minimal invasive or noninvasive approaches to solve aging and aesthetic problems in recent years.

There are several key structures that are involved in the aging process which we could address for rejuvenation, including bones, muscles, SMAS, ligaments, fat, and skin.

There are many technologies such as radiofrequency that have been cleared for tightening the skin, but to date, micro-focused ultrasound with visualization (MFU-V) remains the only energy-based device that has received the indication for nonsurgical lifting of the brow, face, and neck in the U.S.

Micro-Focused Ultrasound with visualization is unique because it provides precise energy to a target area. The thickness and depth of the skin, subcutaneous layer, and SMAS layer are all different from one another. On the other hand, there are also differences among the structure and thickness of SMAS over different facial areas.

In order to get the best lifting result, physician should target precisely over the SMAS layer and deliver personalized treatment to each patient. The accuracy of the visualization system is very important for the best clinical result. The visualization of ulthera system also received US FDA approval.

Moreover, some doctors call the use of injectables to achieve lifting effect “liquid lift”. One famous example is the Brazilian plastic surgeon, Dr. Maricio De Maio who developed the so-called “8-point lift” using HA filler injection over 8 different areas of midface and lower face to achieve lifting effects.

I have developed an injection technique to lift the face by filler injection, which I called the “GPS lift”. The GPS lift method, or Ground Position Stimulation lift, involves the use of stimulatory filler, such as CaHA, to stimulate new collagen formation in some areas to achieve lifting effect. There are two kinds of focus points for GPS lifting: the supporting points for areas of bone loss, or the congenital bone deficiency area (such as retruded chin), and the lifting points, such as the temporal hairy areas, temporal areas, zygomatic process etc.

Another kind of injectables—botulinum toxin—can also contribute to lifting the face. Botulinum toxin injection over the depressor muscles of the face and neck can produce a more defined jawline and achieve some lifting effects. One typical example is the so-called “Nefertiti lift,” which injects toxin over platysma bands and along the jawline to relax the depressor muscle, making the elevators relatively more powerful and achieve lifting effect. Recently, Dr. Woffle Wu, a plastic surgeon from Singapore, published his technique of microbotox treatment for platysma muscle with about 100 highly superficial injections over the area of lower face and neck, which produces excellent results.

However, we as physicians must keep in mind that non-surgical face lift is not trying to replace surgical procedures, but rather a suitable method for mild to moderate severe sagging cases.

In conclusion, we can target different pathologies of aging by combining the HIFU technology and filler and toxin injectables, which creates synergistic effect and great results.