Many people start to have sagging cheeks in their mid-forties and above. This is due to reduced skin elasticity, bony resorption of the skull and the descent of fat pads in the face.
The signs of sagging cheeks are: deep naso-labial folds (smiling lines) on the face, prominent jowl fat pads at the lower half of the cheeks and a loss of the sharp jawline definition, resulting in the loss of the ‘V’ shape of the face.
Thermage is a non-invasive treatment for treatment of wrinkles and rhytides on the face.
Technology:
It uses monopolar radiofrequency to cause volumetric heating of the tissue on the face up to depths less that 3mm of the skin. The Thermage CPT uses a patented technology call Comfort Pulse Technology to deliver doses of energy that is safer and more comfortable for the patient. The vibration technology and the cryogen spray assist in increasing patient comfort and protecting the top layer of skin whilst delivering the heat to the dermal and sub-dermal level.
Clinically proven:
● Thermage was U.S. FDA cleared in 2002 for electrocoagulation and hemostasis of the skin.
● In 2009, it was U.S FDA cleared for the noninvasive treatment and periorbital wrinkles and rhytids, including upper eyelids and lower eyelids.
● Mode of action: Volumetric heating causing denaturation and contraction of the collagen fibrils in skin. This ultimately leads to production of new collagen in the skin.
It is another non-invasive treatment to tighten the skin using focussed ultrasound technology.
The ultrasound energy focusses between 1.5-4.5mm below the skin level and results in focussed and fractional heating of the dermis of the skin.
Clinical proven:
U.S. FDA approved for browlift in 2009.
U.S FDA approved for lift of lax submentum and neck tissue in 2012.
Mode of action:
The focussed ultrasound waves spares the superficial skin of burns. The focussed heat injury of 60-70°C denatures and contracts the collagen fibrils. This leads to production of new collagen over 4-5 months.
Thermage and Ulthera are non-invasive energy devices that are applied to the entire face to cause ‘lifting’ of the soft tissues and stimulation of collagen and elastin to the skin. They are done under topical anesthesia and can be repeated yearly. Results are evident over a period of 3-5 months and can last up to 18 months.
Hyaluronic acid filler with good lifting capacity is placed in specific points on the face to support the bony framework of the face. This helps in lifting the soft tissue on the face, giving a ‘V’ shape appearance. These fillers are done under topical anesthesia and can last for 12 months. They are natural in feel and appearance and have an immediate effect.
Introduction – hyaluronic acid fillers are naturally occuring sugar molecules that are produced in the laboratory. They are injected into the face and are temporary lasting, usually between 12 months to 24 months.
Dissolvable threads with barbs are inserted to strategic points on the face to lift the soft tissue of the cheeks. The insertion is done using fine needles and is done under local anesthetic. Normally 2-4 threads can be inserted into each cheek. Bruising and dimpling of the skin can occasionally occur and take 2-3 weeks to resolve spontaneously. Thus, we advise patients against excessive facial movements and massage for the first 4 weeks.
The results can last for 12-18 months and can be repeated every 18 months. Threads are particular useful when the sagging cheek is heavy.
| Thermage | Ulthera | Fillers | Threadlift | |
| TREATMENT TIME | 60 minutes | 60 minutes | 30 minutes | 45 minutes |
| DOWNTIME | None | None | Usually none. Sometime slight bruising can occur. This can last for 10d and resolves uneventfully. | Sometime slight bruising can occur. This can last for 10d and resolves uneventfully. For the first 4 weeks after the treatment is normal to feel: ‘dimpling’ of the skin, a ‘pulling’ sensation on the face |
| PAIN | Mild to moderate pain. Combination of anesthetic cream and oral anxiety medication manages the discomfort well. | Slight injection pain, that is manageable with majority of patients. | Some injection and needle pain can be felt during the procedure. Pain is managed using oral sedative and painkillers and local anesthetic injections. | |
| REPEAT TREATMENTS | 1-2 years. If severe skin laxity, can repeat in 3 months for better results. | 1-2 years. If severe skin laxity, can repeat in 3 months for better results. | As most of the fillers last for between 12 months to 24 months, re-treatments can be done 1 year apart. Sometimes, partial top-ups can be done 6 months apart. | Thread procedures can be repeated every 12 months as the threads are dissolvable sutures and do not last forever. |
| RESULTS | 4-5 months to show the maximum results. Visible cheek tightening and “lifting” of the jawline can be seen immediately. The high repeat rates serves a good testimonial that this treatment is effective and safe. | Best results seen in the sharpening of the jawline and lower cheek. Tightening of the “double-chin” and lifting of the brow rejuvenates the aging face. | Lifting results on the cheeks are immediate. There is visible lifting under the eyes and at the lower cheeks. The sharpening of the lower cheeks is evident and the ‘smiling line’ or naso-labial folds are lighter. | Lifting results on the cheeks are immediate. There is visible lifting under the eyes and at the lower cheeks. The sharpening of the lower cheeks is evident and the ‘smiling line’ or naso-labial folds are lighter. |
| RECOMMENDATIONS | Patients in their early forties or older who have started to notice deeping of the naso-labial folds, blunting of the jawline definition and sagging of the lower cheeks. | |||
