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Your Face Is Losing Volume. Here’s What Actually Works in 2026 to Stop Jowls — Transcript

by Dr. Sam Ellis · 6,053 words · 872 segments · language en · Watch on YouTube

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0:00Do you need a facelift? Maybe
0:01eventually, but there's actually a lot
0:03you can do before you get to that point.
0:04So, today I'm going to walk you through
0:06what really works for facial sagging and
0:08volume loss, and also what doesn't.
0:13[music]
0:15If you're new around here, welcome. I am
0:17Dr. Sam Ellis. I am a board-certified
0:19medical and cosmetic dermatologist
0:20practicing in the San Francisco Bay
0:22area. And one of the biggest drivers of
0:24people coming in for a cosmetic
0:26consultation with a dermatologist rather
0:28than a surgeon is they are seeking
0:30non-invasive ways to improve facial
0:33sagging and to help with volume loss.
0:35One of the reasons I created this
0:36channel was to give people a peak behind
0:38the curtain of what a conversation with
0:40a dermatologist who specializes in
0:42aesthetics might look like. What are the
0:44things we talk about? Why do we talk
0:46about them? So, I'm going to walk you
0:47through this the same way I would walk
0:48through a cosmetic consultation with one
0:50of my patients who has these concerns.
0:52We're going to start with what's
0:53actually happening underneath the skin
0:55because understanding why your face is
0:58changing will then help you understand
1:00which treatments are going to be worth
1:02your time and money. Then we'll talk
1:03about things you can do at home cuz I'm
1:04not just thinking about what I can do
1:06for you, but what you can do for you,
1:08things you can do in the office. And
1:09then at the end, we'll talk about where
1:10a facelift fits into this entire
1:12picture. And I assume you clicked on
1:13this video because this type of
1:15information is of interest to you. So
1:17hopefully this goes without saying that
1:19nobody needs any of this. You are
1:21allowed to age exactly as you please.
1:24But I do find at a certain point some
1:26people don't love that how they look
1:29does not match how good they feel. And
1:32that does something to your psyche. So
1:34this is just information. You can take
1:35it or leave it. But if you are going to
1:37make decisions about your appearance or
1:39about your health, I'd prefer as a
1:41doctor that you're making informed
1:43decisions. So that is what I am here
1:44for. Skincare and aging and aesthetics
1:47can all be very nuanced and complicated
1:49topics. And I'm here to break that all
1:51down for you in a way that is
1:52digestible, that is non-judgmental. So,
1:54if that sounds good to you, make sure
1:56you give this video a thumbs up, you are
1:57subscribed to the channel, and let's get
1:59into it. Sagging to me is one of the
2:01most misunderstood aspects of facial
2:04aging. It is not uncommon during a
2:05cosmetic consultation for a patient to
2:08pull up on their cheeks or on their
2:10jawline or even to like pull out on the
2:12skin and say, "My skin is getting
2:14loose." And that totally makes sense.
2:16Like the skin is the part that you see
2:18and that you touch. But your face isn't
2:20just skin. You have bone at the
2:22foundation. Then you have muscles. Then
2:24you have fat compartments and connective
2:26tissue. And then draped over the top of
2:28that is your skin. Longtime viewers have
2:30probably heard my table tablecloth
2:32analogy cuz I think it's one of the
2:34easiest ways to understand facial
2:36sagging. And I think about all of the
2:39deep structures of your face as the
2:41table. And your skin is just the
2:43tablecloth. And as we age, the table
2:47shrinks down and so it makes the
2:49tablecloth look bigger and become more
2:51ill-fitting. That's why you start to see
2:53jowls and folds and saggginess. It's
2:55because you have your bones kind of
2:57resorbing or shrinking down. Your fat
3:00pads are also shrinking down and
3:01descending. And so if you have a
3:03beautiful table when you're 20 and then
3:06all of the sudden, not only is the table
3:08underneath shrinking, but also that
3:10tablecloth is getting some stains on it.
3:12So that's like the spots you get when
3:13you age and it's starting to stretch out
3:15a little bit. That's going to give you
3:17an impression that the tablecloth no
3:20longer fits, but it's really because the
3:21table underneath is now not substantial
3:24enough. So when a patient says, "Oh, my
3:26skin is sagging or my skin is loose."
3:28Sometimes it is just that, like they
3:30just have a little bit of skin laxity
3:32due to the weakening and the thinning of
3:34their skin over time. But often it is
3:37that in conjunction with bone and fat
3:40loss and a little bit of weakening of
3:41that connective tissue that is causing
3:43things to slide down on the face. And it
3:45is so fundamental that my patients
3:47understand this aspect of facial aging
3:49because if you're thinking about
3:51treatments, which we'll talk about in a
3:52second, if you just think it's a skin
3:54problem, you might not think beyond skin
3:57interventions. But once you recognize
3:58that there's volume issues, that there's
4:00weakening tissue issues, that there's
4:02support issues, then it allows you to
4:04take a much more holistic approach to
4:06the face and get a much better
4:08improvement. The other thing that's
4:09really important to understand is why
4:11does your face age like this? Because
4:12some of it's going to be out of your
4:14control like the passage of time,
4:16gravity, genetics, but there are things
4:19that absolutely accelerate this facial
4:21aging and we have control over that. So,
4:23for example, UV radiation or chronic sun
4:25exposure. I will never stop talking
4:27about this as a dermatologist. Not only
4:29because UV radiation predisposes you to
4:31skin cancers, some of which can be
4:33life-threatening, but also UV radiation
4:35accounts for 80 to 90% of skin aging. I
4:39mean, think about how modifiable that
4:41variable is. Other things that are going
4:43to make a big negative impact are
4:45smoking, chronic exposure to pollution,
4:48poor sleep, poor diet, chronic stress.
4:51All of these things will expedite your
4:53collagen breakdown. Another big
4:55contributor to facial sagging. And I'm
4:57seeing a lot more of it in my practice,
4:59especially over the past 5 years or so
5:01is rapid weight loss, especially in the
5:04setting of using GLP-1 agonist
5:06medications. And this is definitely no
5:08hate to the GLP1s. love what this is
5:10offering for my patients in terms of
5:13weight loss, confidence, help with
5:15inflammation, lowering some of their
5:16chronic disease profiles, but it does
5:19come with a cosmetic consequence because
5:22you don't get to choose where you lose
5:23weight. And when you lose even a small
5:26amount of fat from the face, it can have
5:28a huge impact on your appearance. Not
5:30only that, but when you are losing
5:32weight that quickly over the course of
5:34months instead of perhaps over years,
5:36that change is going to be much more
5:38noticeable. You've probably heard this
5:40called ompic face and it has this very
5:42classic appearance of hollowing out in
5:43the temples and around the eyes and some
5:45pretty significant flattening of the
5:46cheeks. The other thing that's happening
5:48with GLP1 use that people don't
5:50necessarily talk about or even realize
5:52because they're so focused on the fat
5:53loss is that the skin itself actually
5:56thins out. So your dermis or kind of the
5:59thicker upper layer of your skin gets
6:01thinner and that can lead to a very aged
6:04appearance quite quickly. So, what can
6:06you actually do to fix some of these
6:08undesired changes that you're seeing in
6:09your skin and also prevent some of the
6:12changes? Because when I'm talking with
6:13my patients, especially the ones who are
6:15in their 40s, 50s, they still have a ton
6:18of life left to live. So, I'm not just
6:20thinking about reversing what we're
6:21seeing, but we're thinking about their
6:22aging trajectory and what are
6:24interventions that we can do now so that
6:275 years from now, 10, 15 years from now,
6:30they have shifted how their face is
6:32aging and they are dealing with a lot
6:34less than they might have otherwise if
6:36they had never made those preventative
6:38interventions. Let's start with skincare
6:39because with my patients, I really think
6:40of that as maintenance or how you
6:43protect your investment. It's kind of
6:45like brushing and flossing your teeth.
6:47There are going to be some people who
6:48just do skinincare their entire life and
6:50they are genetically blessed and they
6:52will never want for a cosmetic
6:53procedure. The same way some people will
6:55brush and floss their teeth their whole
6:56life and they will never need uh a
6:58cavity filled or need a root canal. But
7:01the vast majority of people are going to
7:02do those things and still want or desire
7:05a little bit of help along the way. But
7:07if you could do just two things for your
7:09skin that would set you up for success,
7:11the equivalent of brushing and flossing,
7:13it would be excellent sun protection.
7:15So, wearing sunscreen everyday,
7:17reapplying when you're outside, not just
7:20relying on sunscreen, but using widebrim
7:22hats and sunglasses. I don't ask my
7:24patients to fear the sun. I live in
7:26beautiful Northern California. My
7:27patients golf and swim and hike all the
7:30time, but you can kind of respect that
7:33the sun can do some nasty things to your
7:35skin and protect yourself appropriately.
7:38The other thing I would expect every
7:40patient to do if they want to sort of
7:41like have their skin age optimally is to
7:44use a topical retinoid. Retinoids are
7:46absolutely the best anti-aging thing you
7:48can do or put on your skin besides
7:51sunscreen. They help promote new
7:52collagen formation. They help slow down
7:55the destruction of collagen. They help
7:57with cell turnover. So, that's going to
7:58help with things like dullness and
7:59irregular pigmentation. They make the
8:01skin brighter. They make the skin
8:03thicker. They do so many good things for
8:05your skin. because they are so
8:06incredible. I have a lot of videos here
8:08on YouTube dedicated to talking about
8:10various types of topical retinoids,
8:12whether that's retinol and
8:13retinaldahhide, which are forms that you
8:14can buy at a drugstore or at Sephora
8:17versus prescription retinoids like
8:19tininoan and tazaritene. And if you're
8:21curious about how to start a
8:22prescription retinoid like tenino or
8:24tisarotene, I have an entire YouTube
8:26video dedicated to that because
8:27retinoids can be a bit irritating when
8:29you first start. And I always want
8:30people to be set up for success when
8:32they're bringing in such an important
8:34part into their skincare routine. Now,
8:36particularly if you're actively losing
8:37weight, I'd love for you to think beyond
8:40skinincare. When people undergo weight
8:42loss, and particularly if it's more
8:43rapid weight loss, you're going to be
8:45more prone to loss of muscle mass. So,
8:47it's really important that you're
8:48getting enough protein in your diet and
8:50that you incorporate resistance training
8:52to keep your muscle mass intact. And for
8:54women going through permenopause or
8:56menopause, it's really important to keep
8:58in mind that estrogen also has a huge
9:00impact on our skin and on our collagen.
9:03And as estrogen levels decline,
9:05particularly in those first five years
9:06of menopause, if your estrogen levels
9:09are not repleted or supported, you can
9:12see some very rapid changes in how your
9:15body ages, including in how your skin
9:17ages. So, I always encourage having a
9:19conversation with your primary health
9:21care provider about whether or not you
9:22are a good candidate for some type of
9:24hormone therapy. So, we're going to
9:25optimize our skinincare. We're going to
9:27be nutritionally optimized. We're going
9:28to be hormonally optimized. Now, let's
9:31talk about at home tightening devices
9:33because I always get questions about
9:35these and really my stance remains
9:36unchanged if we're talking about
9:38microcurrent or radio frequency devices
9:40like the new face or the zip where you
9:43are sort of stimulating the skin over
9:45and over on some type of daily routine
9:47basis. The data just isn't really there.
9:50Like the before and afters to me are
9:51quite unimpressive. [clears throat]
9:53You have to do it very consistently.
9:54Now, every time I talk about devices, I
9:56get a slew of comments, which I always
9:58appreciate, whether you've had a good or
9:59bad experience with something. And some
10:01say, "Yep, felt like a waste of time."
10:03And some say, "No, actually, my new face
10:04has been like very helpful." Or, "I love
10:06my Zip device." And I think both of
10:08those can be insightful because even if
10:12I wouldn't personally use it or wouldn't
10:13put it in my routine, that doesn't mean
10:14it's not worth trying. The risk of these
10:17things is incredibly low. It's really
10:18just a financial risk. But then again,
10:21if we're thinking about like the cost of
10:22inoff treatments, the price of one of
10:24these at home devices is like less than
10:26a session of Botox. So, if you feel like
10:28you have the time to commit to something
10:30and you want to try it, I actually think
10:32there's very little harm in doing so. I
10:34just think you have to understand
10:35whether or not you're the type of person
10:37to be consistent and you also have to
10:39understand that it might yield
10:41unnoticeable results. And if you're okay
10:43with that, then feel free to proceed. If
10:45you use a new face or some type of at
10:47home skin tightening device, please let
10:48me know what your experience has been in
10:50the comments. I truly read all of my
10:52comments and I think other people who
10:54are part of this community really enjoy
10:56hearing about other people's experiences
10:57because I think a lot of us are
10:58interested in the same things. So those
11:00insights are very valuable and I really
11:02appreciate them. But now, let's pivot to
11:04things that you can have done in the
11:05office because if you have true sagging
11:07or hollowess or volume loss, this is
11:10where you have the most to gain or stand
11:13to see the largest improvement. And one
11:15thing I'll say before we get started in
11:17talking about all of the different tools
11:18that I have in my toolbox or the general
11:20tools that a cosmetic dermatologist
11:22would have in their toolbox is that it
11:24is rarely a single intervention that
11:26makes the difference. When you think
11:28about an aging face, as I talked about
11:29in the beginning of this video, it's
11:31volume changes. It's skin quality
11:33changes, its proportion changes. And so
11:36when you're going to reverse that, you
11:38can't go all in on just adding volume
11:40with filler or fixing lines with Botox
11:43or tightening with some type of
11:44tightening device because that's not the
11:47entire picture and you really need to
11:49address the entire picture in order for
11:51the rejuvenation to look natural and
11:53balanced. Let's start with the layer
11:55that everyone can see, which is the
11:56skin. We know that your skin gets
11:58thinner as you age. And certain laser
12:01treatments, whether it's CO2 or Herbium,
12:03less intense like Fraal Duel or Halo or
12:06even like what I would consider like
12:07baby treatments like Moxy and Clear and
12:09Brilliant, still effective, but all of
12:11those lasers work to stimulate collagen
12:13and stimulate a thicker outer layer of
12:16skin. Now, those don't replace lost fat,
12:18nor do they tighten the skin in a very
12:21significant way. So, if you have true
12:22like jowls or sagging, no CO2, no urban,
12:25even the most aggressive lasers are not
12:27going to do a ton of tightening for the
12:29skin, but they improve the quality of
12:31the skin so much. And I really think
12:32about when I'm talking with patients,
12:34the skin envelope. And if you're going
12:36to invest in other treatments down deep,
12:38whether you're going to get a facelift
12:39in the future or you're going to be
12:40doing fillers and tightening devices,
12:42you want that outer skin envelope to be
12:45as thick and as resilient as possible.
12:47The thing I really like about lasers,
12:49and also this is true of medium-depth
12:51chemical peels and also micro needling,
12:53essentially any resurfacing treatment
12:55that's stimulating more collagen, is
12:56that if someone is on a budget or they
12:59can only afford to do a couple of
13:01interventions, it will never look bad to
13:05laser your skin. Of course, this is
13:07assuming you are going to someone who
13:08knows what they're doing that's going to
13:09keep your skin safe, but you will always
13:11still look like yourself when you have a
13:13laser procedure. you will just look
13:15healthier. And that is something when I
13:17have a patient who is very nervous about
13:18injectables or they're really nervous
13:20about looking different from a
13:21procedure, you can never go wrong with
13:23just improving the quality of your skin.
13:25Now, if I'm trying to address deeper
13:27laxity in the skin, like a true early
13:29jowel or some true early sagging, that
13:32is where energy- based devices enter the
13:34conversation. Essentially, all
13:36energy-based devices have the same
13:38guiding principle. Whether you're
13:39talking about radio frequency devices
13:41like Zerf which has recently come out of
13:44South Korea or Thermage or radio
13:46frequency micro needling devices like
13:48Morpheus 8 or Patenza or
13:51ultrasound-based devices like olapy or
13:54softwave all of these are considered
13:56energy- based devices for skin
13:59tightening and the way that they do that
14:00is they deliver energy deep in the
14:02tissues to create a controlled focus of
14:05damage and that damage essentially
14:08stimulates the skin to build itself back
14:10stronger and more resilient and in turn
14:13you may get some tightening out of that.
14:15I have some very important things to say
14:16about this because I get asked about
14:17energy- based devices all the time on
14:20Instagram and on Tik Tok, but I think
14:21there's so much nuance to it that it
14:24doesn't really lend itself to a
14:27discussion on those platforms which is
14:28why I'm talking about it here. First and
14:29foremost, if there was truly one best
14:32tightening device, whether it was Ulapy
14:35or Softwave or Zurf or Morpheus 8, all
14:38of the dermatologists and plastic
14:40surgeons would sell whatever other
14:42device we have and offer that one. But
14:45because there is no single one that has
14:47been shown to be the best, that is where
14:50all this ambiguity lies. I tend to think
14:52about energy based devices as
14:54fortification of the tissue. So they are
14:56very good in my opinion for patients who
14:58have very early or mild laxity because
15:02in those cases stimulating new collagen
15:05and tightening of the deeper structures
15:06is actually going to have a visible
15:09clinical result or it will help maintain
15:12somebody before they start to sag.
15:14You'll often hear cosmetic providers
15:15talk about the aging face in two
15:17categories. People who sink in and get
15:20hollow like that's me. I get like hollow
15:21in my temples, hollow around my eyes,
15:23hollow under my cheekbones. And then
15:25there are people who sag. So they don't
15:26get hollow, but they tend to get a
15:28little bit heavy in the lower face.
15:30They're more prone to like a jowl or a
15:32turkey neck situation. And when I have a
15:34younger patient in my office, maybe in
15:36their 30s, early 40s, and they say, you
15:38know, I'm just starting to see some
15:40heaviness or when I look at my mom or I
15:42look at my dad, I like see where my face
15:44is going to descend to and I'm not so
15:46pleased with that. Can I reverse that or
15:49slow that process down? That is where
15:51consistent energy- based devices used
15:54thoughtfully by someone who knows what
15:56they're doing can actually be helpful.
15:58For example, in Korea where they have a
16:00very strong aesthetic culture and they
16:02are considered to be sort of on the
16:04forefront of anti-aging interventions,
16:06you will see that they do a lot of radio
16:08frequency and micro focused ultrasound
16:11like therapy interventions for their
16:13general population. And that is because
16:16Asian faces tend to retain volume really
16:19well, but that volume tends to sag over
16:21time. So, a lot of their anti-aging
16:23focus is going to be on what can we do
16:26to tighten and lift the skin.
16:28Ultimately, I find that a lot of
16:30patients just want me to tell them, will
16:32theapy or will Z surf feel worth it to
16:35me? And I can never tell you what's
16:36going to feel worth it because I don't
16:38know what your priorities and your goals
16:41and your budget are. But what I can tell
16:44you is I think it is more worth it when
16:45you are slightly younger. Now age is
16:48just a number. So I really should think
16:50about more on your features. When you
16:51have very early or mild laxity when you
16:54would be okay without seeing a visible
16:56lift but you understand that you are
16:58tightening things so that as time goes
17:00on your face and your features will
17:03descend more slowly. But if you are
17:05already at a place where you are a
17:07candidate for a facelift, you have saggy
17:09skin under your neck or on your jowls, I
17:12think you are going to feel like an
17:14intervention such as therapy is less
17:16worth it because even if you get
17:18fortification at that point, you're not
17:19going to have significant visible
17:22reversal. Sometimes that happens, but
17:24that's not the common outcome. And if
17:26that happened to you, would you be okay
17:28with it? Would you be okay knowing,
17:29okay, I didn't see much of an
17:30improvement, but I might age slower
17:32moving forward. or were you trying to do
17:35that instead of having a facelift in
17:37which case you will be very
17:39disappointed? Two things before we move
17:40on from energy based devices because I
17:42think these questions come up a lot is
17:44one can they melt your facial fat in
17:46theory yes. Like if you were to leave
17:49the probe in the wrong plane for a long
17:51enough period of time you could heat the
17:53fat to a level where it essentially
17:55sends a death signal to the fat and it's
17:57like peace I'm out of here. That is not
17:59common and should not happen if you are
18:01being treated by an experienced
18:03professional. But unfortunately what
18:05happens a lot is these devices end up in
18:08less than experienced hands and that is
18:10when complications are way more likely
18:12to occur. The other question that I
18:14sometimes get is well if I've had theapy
18:16or thermage or morphus 8 in the past can
18:19I still get a facelift down the line?
18:21And you absolutely can. One it's not
18:24going to prevent sagging completely. So,
18:27you might get to a point where you're
18:28sagging enough that you're like, "Yeah,
18:30I do want to pursue a surgical
18:32intervention for this." And if you do
18:34get to that point, you can still have
18:36one very successfully. I could talk
18:37about that for a very long time. So, I'm
18:39sorry if that is too much. But moving
18:41on, I do want to spend a second to talk
18:43about Botox in the lower face because it
18:46can be incredibly helpful for reducing
18:48the appearance of sagging. the strongest
18:51depressor of the lower face. So the
18:52thing that brings down the lower face
18:55actively is something called the
18:57platisma which is this sheetlike muscle
18:59that wraps from about your collar bones
19:01up your neck and onto your jawline and
19:03it pulls on your face like this. Now
19:06everyone's muscles have a different
19:07strength. So everyone's platisma is
19:09going to exert a different amount of
19:11impact on their face. But one thing you
19:14can do is use Botox along the jawline.
19:16So, right above the jawline and also
19:19down the platismal bands. Try to show
19:21you. God, mine are mostly gone.
19:25Can barely do it. Okay, I'm going to put
19:26a picture in of what the platismal bands
19:28look like. But if you do Botox along
19:30these bands and along the jawline, it
19:32essentially allows things to kind of
19:34suction up to the jawline and you can
19:36get a lot more definition. The other
19:39thing that can happen is your platismal
19:41bands can get quite bulky as you age.
19:42So, some people get really stringy
19:44platismal bands. And some people with
19:46thicker necks will get these like thick,
19:48heavy platismal bands that blunt the
19:51appearance of their jawline. And when
19:53you inject the top part of those
19:54platismal bands, they shrink over time.
19:57And it takes volume away from the
19:58jawline in a way where the jowl actually
20:01gets smaller. Because your jowlel is not
20:03just fat and loose skin, it can also be
20:05a bulky platisma muscle sitting in
20:08there. And if you cause that to shrink
20:09away by injecting it with Botox, you can
20:11actually make the jawline look more
20:13defined. With a very minor intervention,
20:16we can also place a little bit of Botox
20:17in something called the DAO, which
20:19stands for the depressor anguli orus,
20:21which is the muscle responsible for
20:22causing the corners of your mouth to
20:24turn down. So mine are not injected
20:25right now. So I can show you it's this
20:28muscle right here that makes this really
20:30attractive face. But over time, if you
20:33are constantly having this muscle be
20:35active, it can give this appearance to
20:37the face, which I would say most people
20:39would agree is like not the most
20:40pleasant resting tone for the face. So,
20:43we can put a little bit of Botox here.
20:44And when you combine that with
20:46injections along the platismal bands, if
20:49you're a good candidate, it can really
20:51help with the appearance of the neck and
20:52with the lower facial sagging without
20:54having to do a major intervention. While
20:56we're on the category of injectables, I
20:58do want to talk about fillers. And
20:59there's kind of two categories of
21:00fillers. We'll start out with the
21:02hyaluronic acid based fillers. So these
21:04are going to be things like Juvéderm and
21:07Wtolin that are essentially gels that we
21:10inject into the skin to give structure
21:12and support. Now fillers have gotten a
21:14really bad wrap because if you look out
21:16in the world, you might see people that
21:17have like really puffy, overdone, weird
21:20looking faces. And usually that is from
21:23too much filler sometimes combined with
21:25other aesthetic treatments. But when
21:27filler is done properly, it is truly
21:30undetectable. The reason you don't see
21:32good filler out in the world is because
21:34you can't tell it's there. The way I use
21:36filler in my practice, and I think the
21:37way you keep it looking the most
21:38natural, is to really use filler to give
21:41appropriate structure or restoration to
21:44the face. So, for example, appropriate
21:46structure. Some people as they age will
21:49find that their cheek starts to really
21:50flatten out or their temple gets really
21:53hollow. And so, you can give that volume
21:56back. You're essentially restoring
21:58something that was once there. You're
22:00not trying to give someone a feature
22:01they never had. Same thing goes for the
22:03jawline or the chin. You lose a little
22:04bit of that bony mass as you age. And so
22:06you can just restore it a little bit to
22:09essentially bring it back to what it
22:10once was. And some people are born with
22:13weaker chins or weaker or more petite
22:15jaw lines. And in those cases, you can
22:17use filler strategically to also give
22:19them a little bit more support and
22:21structure where they never had it. The
22:23main thing that filler cannot do and
22:25what so many people want it to do is
22:28pull the face up. Filler does not lift.
22:31If you were to squirt filler out and
22:33kind of like put it on your palm, it's
22:35like jell-o. So, you cannot have jell-o
22:37and expect it to lift up a heavy fatty
22:41jel. It just won't work. So, you have to
22:44understand that we can use filler to
22:45balance proportions. We can camouflage a
22:48gel. can camouflage certain shadows to
22:50make someone look more youthful and more
22:52rested. But once you start asking filler
22:55to truly lift up on tissues is where you
22:58run the risk of being overfilled because
23:00you get so focused on the lifting and
23:03the improvement of the jowlel. You don't
23:05realize that now your cheeks are
23:07starting to look feline or your jaw is
23:10starting to look masculine. So, it's
23:12really important to have an injector
23:14that is keeping your entire face in mind
23:16and not chasing a feature, but rather
23:19treating the entire face holistically
23:21and understanding that filler cannot
23:23make up for all of the aging changes in
23:25the face. So, although it can improve
23:26things, it's not going to completely get
23:28rid of things like saggy skin. The other
23:30flavor of fillers, if you will, aside
23:32from the hyaluronic acid based gels, are
23:34the bio-stimulatory fillers. So, these
23:37are fillers, but they are not gels that
23:39you can inject into the skin that
23:42stimulate collagen and elastin
23:43formation. So, they are not purely there
23:45to add structure, and some don't add any
23:47structure at all. And we'll talk about
23:49that in a second, but they're really
23:50there to improve the quality of the
23:53tissue. These are going to be products
23:54like Sculptra and RADS, and I'm happy to
23:56do deeper dives on these or compare them
23:59for you in the future, but they are
24:01essentially different types of molecules
24:02that can both stimulate tissue
24:05regeneration. So when you dilute them
24:07and make them a bit more liquidy and
24:09inject them throughout the soft tissues
24:11of the face, you can fortify the skin
24:13there. You can get collagen and elastin
24:15formation. With sculpture specifically,
24:17you can get some repopulation of the fat
24:20stem cells, which is very cool, new,
24:22more emerging research. But both of them
24:25are better for people who have more
24:27diffuse thinning of the skin and diffuse
24:29fat loss because you can revolmize in a
24:32very natural looking way. So, in my
24:34practice, I really prefer these
24:35bio-ostimulatory injectables for
24:37patients that fall more into that
24:39sinking category where they're losing
24:41volume kind of throughout their face.
24:43And by adding a small amount of volume
24:45everywhere, we're going to make them
24:46look refreshed, but without making them
24:49look puffy. That doesn't mean people who
24:52sag can't get these bio-stimulatory
24:54fillers, but you have to think, what am
24:55I trying to achieve here? Because you
24:58don't have a volume problem if you're
24:59sagging. You have a volume in the wrong
25:01place problem. So things that are going
25:03to be more beneficial for you are things
25:05that help lift and tighten rather than
25:08volumize or thicken the skin. Sculptra
25:10has been so great for my patients who
25:11are losing weight and particularly if
25:13they are losing weight rapidly. A lot of
25:15times people want to know, well, should
25:17I just wait to get to the end of my
25:18weight loss journey before I start
25:20replenishing? And you could do that, but
25:23you might end up looking really gaunt,
25:25kind of sickly and unwell, which is so
25:27unfair because usually when you've
25:28gotten to that point in your weight loss
25:30journey, you actually like feel really
25:31good because you've lost the weight, but
25:33then you don't look good and you've aged
25:35several years in your appearance. And so
25:37what I like to do is every few months
25:40just kind of touch base with like my
25:41GLP1 patients just kind of see how their
25:44facial volume is doing. And sometimes
25:45we're doing one to two vials of Sculptra
25:48every 3 to 6 months to just keep up with
25:51their weight loss so that as they lose
25:53weight, they still look like themselves
25:56and they look healthy. One thing these
25:57bio stimulatory fillers don't do is like
26:00pull up and back on the skin. Yes, they
26:02can help you make new collagen, but new
26:03collagen doesn't necessarily equate to
26:06tightening, and you can get some kind of
26:08subtle firming, but sometimes people
26:09will come in and they're like, I want
26:11sculpture, and they're pulling up and
26:12back on their face. And I truly believe
26:15if you are pulling up and back on your
26:17face and you are looking at that
26:18aesthetic outcome and you are like this
26:20is what I really want to achieve and why
26:22I scheduled this appointment and what is
26:24going to satisfy me. That is where we
26:27start to land in facelift territory.
26:29Even though all of the treatments I have
26:30talked about are effective. They can
26:32make someone look rejuvenated, refreshed
26:34and natural. They are not the same as
26:37getting a surgical facelift. If they
26:40were, and honestly, if they could offer
26:42anything that's close to getting a
26:43surgical facelift, facelifts wouldn't be
26:45a thing. Who wants to pay tens of
26:48thousands of dollars and go under
26:49general anesthesia and have their face
26:52carved open and go through all of those
26:54risks? You would only do that if you
26:56couldn't achieve it another way. When
26:58you have significant laxity or tissue
27:00descent, or if you just have very high
27:03expectations of what your treatments are
27:05going to offer, that is when a facelift
27:08is on the table. I've had plenty of
27:10patients get facelifts in their 40s,
27:12which I personally wouldn't recommend,
27:14but they were bothered enough and felt
27:17like the non-surgical things weren't
27:18going to tighten them enough that they
27:21were going to be satisfied. Now, I would
27:23say most of my patients in their 40s and
27:24even early 50s are like, "No, let's try
27:26these non-surgical, more affordable
27:28things. These things aren't cheap, by
27:30the way, but they're certainly cheaper
27:31than a facelift, and let me try that
27:35first. And if we get to a point where I
27:37don't think I can deliver results that
27:38are either going to be effective or that
27:40are going to look natural, we stop. I
27:43always say it is better to look old than
27:45weird. So, we will never do a filler or
27:48a tightening treatment or any other type
27:50of injectable if we feel like it's going
27:52to make you look odd. It should either
27:54be restorative or not done at all. If
27:57you take one thing away from this video,
27:59you should understand that the face ages
28:01in layers. And what you perceive as
28:03sagging is often a combination of volume
28:06loss, tissue descent, and skin laxity.
28:09At home, the best thing you can do is be
28:11proactive. Protect the collagen that you
28:13already have. Optimize your nutrition.
28:15You're going to be lifting weights,
28:17especially if you're rapidly losing
28:18weight, and you want to make sure that
28:20your hormones are in check. In the
28:21office, we are thinking comprehensively
28:23and somewhat proactively as well. So,
28:25we're thinking about lasers or micro
28:26needling for strengthening the skin.
28:28We're thinking about tightening devices
28:30to fortify the skin and get some mild
28:32skin laxity in check. We're thinking
28:35about fillers to give structure and
28:37balance to the face where we've either
28:39lost it or never had it to begin with.
28:41And we're using bio stimulatory fillers
28:43to help volumize places more globally
28:46for a natural looking rejuvenation. And
28:48when there is substantial laxity in
28:50descent, a facelift is still the gold
28:51standard for the biggest and most
28:53predictable improvement in a sagging
28:55face. Thank you so much for being here.
28:57I hope you found this helpful. Again, I
28:58know these videos have gotten a bit more
28:59chatty, but I just feel like that nuance
29:02and how I really talk to my patients in
29:04the office is how I want to talk to all
29:06of you. So, if you like that style, let
29:08me know in the comments. Give it a
29:10thumbs up. Make sure you're subscribed
29:11to the channel. And also, let me know in
29:13the comments, what has your experience
29:15with facial aging been? Are you noticing
29:17more hollowess, more laxity? Has that
29:19been associated with menopause or weight
29:21loss or just the general process of
29:23getting older? Also, if you have done
29:25any of the treatments that I've talked
29:26about, including a facelift, let me know
29:28in the comments. I love to hear from
29:30this community. Thank you again for
29:32being here and I will catch you in my
29:33next video.
29:42>> [music]

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