Skin sagging woes: How ageing affects your face shape in more ways than you think

When it comes to ageing, the appearance of wrinkles and pigmentation often get the most attention.

But there's another major sign that can contribute to making you look older than you actually are: skin sagging, and that's usually how your face shaped like an inverted triangle (or V-shaped) turns into a triangle-shaped face.

The main cause of this is the loss of collagen. For the uninitiated, collagen is the most abundant protein found in the body, and it keeps our skin looking plump and youthful. But after the age of 20, the dermis layer produces one per cent less collagen each year, and over time, the once-lifted facial features start showing the effects of gravity due to laxity.

According to Dr Isaac Wong, founder and medical director of The Artisan Clinic, medical research has shown that the ageing of the face happens in "all five layers of the face - bone, deep fat, the muscular aponeurotic system (SMAS), superficial fat and skin."

And while a big contributor is bone loss (there is good reason why doctors warn of the dangers of osteoporosis and stress the importance of getting enough calcium daily), Dr Wong says that in the rest of the four layers, collagen loss is the key contributing factor to making one look older.

"Collagen is the building block of almost all the tissues," Dr Wong says. "The loss of it has profound ageing changes to the face, [which can result in] fine lines, wrinkles, deep folds, dull skin and sagging."

When it comes to looking younger, Dr Wong says that many Asian and Singaporean patients prefer to opt for a "did-she-or-did-she-not" look - referring to whether a person has had treatments done.

"It's strange, but they love it the most when nobody can tell that they've had anything done," he shares, adding that many of his patients' main goal is to look younger and fresher for themselves. "They want their nearest and dearest to wonder if they've had a good night's sleep or perhaps started using better skincare."

Led by the philosophy of "Look yourself. Look younger", Dr Wong aims to help patients achieve just that. He believes in thoroughly understanding the science behind the various treatments to be better equipped to advise on the treatment and its placement to achieve the final outcome one desires.

"Our day-to-day work is very procedural, so you may get many doctors who become 'technicians'. They can perform the procedure without knowing the deepest science and also the patient application," he warns.

This led him to focus on helping patients achieve younger-looking skin by boosting the production of collagen. "I realised that these collagen-boosting treatments can help my patients still look like themselves - just younger, fresher and rejuvenated."

So what are the most common requests? Dr Wong says that his patients fall largely into two camps.

One group suffers from volume loss on multiple parts of the face, making them look "hollow" and "bony", which results in them looking older than they actually are, and also more severe and less friendly. According to Dr Wong, these patients would benefit from fillers, specifically collagen-stimulators, which aim to boost collagen production and have a longer-lasting effect of 24 months.

The other group is affected by sagging more than hollowness, with smile folds and jowls that sag downwards and obscure the jawline and neck. These concerns, he explains, would benefit from lifting treatments like HIFU (high intensity focused ultrasound), Potenza, Cynosure 5D and Brighten-Lift.

And while many patients are getting more acquainted with lifting treatments like HIFU, not much is known about fillers, except badly done jobs that we've seen on TV shows like Botched where patients' faces are puffy beyond recognition.

According to Dr Wong, this is called "facial overfilled syndrome", and has been written in many clinical papers by renowned aesthetic doctors, surgeons and dermatologists. "This is obvious when the face looks puffy and swollen after too much fillers. A tell-tale sign is when they smile because the cheeks swell up like two golf balls and look highly unnatural," he explains.

This is why at The Artisan Clinic, Dr Wong chooses treatments that stimulate the building of new collagen in the face, as it is an important factor in achieving a natural look. For this, he recommends treatments like Ellanse and Silhouette Soft, which he has been performing for the last five years.

Ellanse is a collagen-building filler that helps restore volume in the hollow parts of the face, like the temples, cheeks and jawline. More importantly, it stimulates Type I Collagen, which is known as the "youthful collagen". This differs from other collagen stimulators, which stimulate Type III Collagen to help with wound healing. The effects of one Ellanse treatment can last up to two years.

The minimally-invasive Silhouette Soft treatment also aims to boost collagen production but with the use of collagen-building threads. These perform dual functions: Lifting heavy sagging tissues in the jowls and behind the deep smile lines, and also encouraging natural collagen production to get you looking more youthful. Results are said to last up to two years, says Dr Wong.

As with all filler treatments, Dr Wong says there will be some discomfort involved. However, The Artisan Clinic prides itself on patient comfort. In addition to numbing cream application, local anaesthesia can also be done, if necessary, "to further improve the comfort level for our patients."

Post-procedure, Dr Wong says there is minimal downtime. This can include mild bruising and/or mild swelling, which is common with injection-type treatments, and usually goes away after two to three days.

However, he does caution that unlike other fillers that use hyaluronic acids, Ellanse fillers cannot be removed immediately if the patient is unhappy with the results. This is why Dr Wong says that it's "imperative to go to a doctor who is well-versed in facial anatomy, injection skills and is experienced with Ellanse treatments." On the flip side, if done well, Ellanse treatments give long-lasting, natural anti-ageing results.

Ultimately, it's about ageing gracefully, no matter the treatment you opt for. But more importantly, Dr Wong recommends doing your homework and asking the right questions, because you should always find out what works best for you.

Now that you've got your "new" look, it's important to maintain it. Here's what you should do: