Dr. Wally's Column ·
From your 50s through your 80s, the order of your treatments changes the result. First lift sagging skin with a thread lift, then use a minimal amount of filler only where the face still looks hollow, and only after that move on to skin tone, radiance and pigmentation.
Hello, I'm Dr. Wally (Kim Jungsoo), and I explain how treatments work.
Everyone ages, but after 50 many people start to notice facial aging much more, and sometimes their self-esteem and confidence drop along with it.
That's when some people turn to aesthetic treatments. The trouble is that if you've never had any before, it's hard to know where to begin.
If you're unhappy with your whole face and don't know what to do first, I'll explain which treatments work best and in what order.
Here's what I'll cover today.
Setting your treatment goal
Deciding the order of treatments
1. Setting your treatment goal
When you start treatment, the most important thing is actually deciding on your goal.
You might think, “Isn't my goal simply to look younger?” But even if you do look younger, how you look younger matters a great deal.
If you're over 50, you've probably come across someone who had surgery and did look younger, but whose face now looks unnatural or even harsher than before.
The best outcome is to look younger with a softer, gentler expression. So how do you get there?
For a softer look, you shouldn't go into treatment aiming to “smooth out every wrinkle” or “pull every bit of sagging all the way up.”
Instead, set your goal as getting back the face you had five years ago, or seven years ago.
2. Deciding the order of treatments
Several factors drive aging at the same time. They can be divided into five:
Skin sagging
Deep fat loss
Surface wrinkles and dull skin caused by aging of the skin itself
Age spots
Hair loss
Before 50, it doesn't matter what you treat first. But at 50 to 60, the order becomes very, very important. Your skin can't produce collagen the way it used to, so if you're treated the same way as someone in their 20s to 40s, the results won't be as good.
1) In your 50s to 80s, always lift sagging skin first (reducing unwanted volume)
For people in their 50s to 80s, there are two non-surgical ways to lift sagging skin. The first is a thread lift, and the second is ultrasound lifting (Ultherapy, SHURINK and similar devices).
Ultrasound lifting works less well the older you are (because collagen regeneration slows down), and after 60 the noticeable effect is often much smaller.
So rather than relying on collagen regeneration, you should start with a thread lift, which physically lifts the tissue and anchors it to firmer structures.
Once sagging skin is properly lifted, heavy deep cheek fat, uneven cheekbones and nasolabial folds can all look softer, without being filled with filler or skin boosters.
63-year-old woman · Before (left) and immediately after (right) a thread lift on July 11, 2023. As the sagging above the nasolabial folds and in the deep cheek fat was lifted, unwanted volume in the face decreased and the contours became smooth again, as they were when she was younger. Bruising and swelling may occur, and results vary from person to person.
2) If hollow areas (deep fat loss) still show after the thread lift, fill them with the smallest amount possible
Sagging isn't the only cause of aging, so even after a thread lift or facelift surgery you may still be bothered by hollowing such as nasolabial folds, marionette lines, fine vertical lines above the upper lip and frown lines between the brows.
In these cases, adding just a very, very small amount of filler can make your expression much softer.
If you skip the thread lift that reduces unwanted volume first, and instead keep having fillers or skin boosters (especially collagen boosters such as Sculptra, Juvelook and Radiesse) over and over in excess, the face can become even more uneven.
63-year-old woman · Before (left) and immediately after (right) same-day treatment, May 2023. A thread lift lifted the face and reduced the volume of the deep cheek fat and cheekbones, and then 1 cc of filler was injected into each area: the nasolabial folds and the marionette lines. The outer contour of the face became smaller and smoother, and her expression softened. Prominent cheekbones can make a face look severe, and reducing the volume around the cheekbones with a thread lift plays a decisive role in softening the expression. Results vary from person to person.
3) Finally, treat skin tone, radiance and pigmentation
Once steps 1 and 2 have gone well, it's time to start on the skin.
Of course, if your facial contours aren't sagging and your skin is the bigger concern, it's fine to treat pigmentation first.
But after 60, most people are concerned about sagging and hollowing around the mouth. Thread lifts and fillers tend to show a change quickly, often after just one or two sessions, whereas pigmentation usually needs many treatments over a long period. So if you're spending the same amount, it's better to have the thread lift and filler first.
(If you really don't like the idea of filler, there are other options, such as Sculptra.)
Dr. Wally's mother · Age 64 in July 2016 (left) → age 70 in September 2022 (right). After a thread lift and filler, she kept up pigmentation treatment and stem cell treatment once or twice a year. Results vary from person to person.
The same patient from the front · July 2016 → September 2022. Six years have passed, yet her skin actually looks younger. Results vary from person to person.
Pigmentation is treated with lasers, and dull skin tone can be treated with Re2O, a newer ECM skin booster, or Rejuran, as well as collagen boosters such as Sculptra, Radiesse and Juvelook.
Summary: treatment order for your 50s to 80s
If you're in your 50s to 80s, it's best to follow these three steps.
Lift sagging skin first with a thread lift
Fill any hollows that remain with a minimal amount of filler
Treat skin tone, radiance and pigmentation
A consultation with the doctor who will treat you is essential before anything else. Once these steps are done to your satisfaction, you can move on to neck lines and wrinkles on the backs of the hands and around the knees.
Today we looked at how to decide the order of treatments in your 50s to 80s. I'll be back next time with more. Thank you.