Where skin firmness gives way

Aging & Elasticity

The phrase loss of firmness contains several different changes. Separating the layers makes it clear what needs to be addressed.

The skin is made up of several layers

From the outside inwards lie the epidermis, the dermis, the subcutaneous fat and the supporting structures beneath them. The face also has a fibrous and fascial layer called the SMAS, connected to the muscles of expression. The feeling that firmness has been lost has different causes depending on which of these layers it began in.

Three changes overlap

First, the supporting fibres of the dermis decrease. Collagen provides the thickness and support of the skin, elastin the property of returning after being compressed. As age and accumulated sun exposure add up, production falls and existing fibres degenerate. Elastin in particular is produced in very small amounts after adulthood, so recovery is slower.

Second, volume decreases. When fat and bone volume shrink in areas that were originally full, such as the temples, front cheeks and under the eyes, shadows form and the face can look more tired and older than it is. This is closer to hollowing than to sagging.

Third, tissue descends. When the supporting structures weaken, the cheeks, jawline and area around the neck are the first to change noticeably. The nasolabial folds and the lines running from the corners of the mouth to the chin looking deeper is also largely connected to this process.

To lift, or to fill

Sagging and volume loss have different causes, so the approaches differ as well. Using only lifting methods on a hollowed area can make the face look gaunt, whereas filling alone on sagging tissue can make it look heavy. In most cases both changes are present, so a step of judging which one weighs more is needed first.

Not starting without an assessment

Even in the same area, skin thickness and the thickness of the fat layer differ from person to person. That is why checking the state of the layers before a procedure, with ultrasound for example, is meaningful. Confirming the layers makes it possible to reduce unnecessary procedures and to design treatment for the depth that actually needs it.

Change appears slowly

Many procedures related to firmness aim at the process by which collagen is newly formed. This process generally proceeds gradually over weeks to months rather than immediately. Rather than judging from the appearance right after a procedure, it is more accurate to review the course at the point you were advised to. The speed and degree of response vary from person to person.

This column is general medical information provided to aid understanding. It does not guarantee the results of any specific treatment and does not replace a medical consultation. Treatment results and the course of recovery vary from person to person. Please confirm what is appropriate for your own condition through a consultation.