Jowls, laxity, lost volume: The non-surgical approach that lifts, restores and rebuilds ageing skin from within

Long before the first wrinkle appears, ageing has already begun beneath the surface of your skin. It is a quiet, structural shift. Starting in the mid-20s, skin starts to lose about 1 per cent of collagen every year, the very scaffolding that keeps it bouncy, resilient and firm.

“Collagen is the protein that gives our skin its structure and firmness. You can think of it like the internal support system that keeps skin smooth, bouncy and resilient,” says Dr Philip Dong, founder and medical director at Hera Clinic.

Once collagen production dips, some of the earliest changes you will observe are the early formation of jowls – where the skin and tissue around the lower cheeks begin to shift slightly downward – as well as laugh lines that appear deeper than before.

“There are also other subtle changes that people don’t usually associate with collagen loss. Pimples take longer to heal than before, or pores appear more visible,” adds Dr Dong.

He notes that having a deeper understanding of how the face ages has shaped how treatments are formulated, and these have moved beyond surface fixes to procedures that support the skin’s underlying structure and stimulate collagen production.

“Aesthetic medicine today is not about dramatic reconstruction, but instead, about fine-tuning what you already have – softening certain areas, restoring subtle support where it’s needed, and allowing the person’s own features to shine through,” says Dr Dong.

Targeting deeper layers of the skin

Rather than offering a standard menu of treatments, Dr Dong’s philosophy centres on customisation as the essential first step. 

“No two faces age the same way, so no two treatments should be identical,” he says.

“Achieving a result that looks natural – where friends notice you look ‘well-rested’ rather than ‘done’ – requires a tailor-made strategy. It’s not just about choosing a treatment; it’s also about the precise placement of energy, the specific depth of an injection, and how different technologies are layered to suit an individual’s anatomy and goals.”

At Hera Clinic, this begins with a conversation with the patient to align his or her expectations, followed by a plan that treats the face as a whole, rather than just a collection of lines.

To address foundational sagging that happens over time, Dr Dong often turns to Ultherapy Prime, which is designed to lift and tighten areas such as the lower face, upper neck and brows by delivering focused ultrasound energy to stimulate collagen production.

He likens the process to the way proteins in meat contract and tighten when exposed to heat – but in a far more controlled and precise manner.

The treatment works at multiple depths. At 4.5mm, it targets the skin’s foundational SMAS (superficial musculoaponeurotic system) layer – the same layer that is  addressed during a surgical facelift. “By stimulating this layer, we can help create a lifting effect without surgery,” he explains.

At 3mm, the treatment reaches the deep dermis, where a high concentration of collagen is found, helping to improve firmness and skin strength. Finally, at the upper dermis at 1.5mm, it works to refine skin texture and soften fine lines.

The enhanced imaging technology of Ultherapy Prime also allows doctors to visualise skin structures up to 8mm deep, improving both precision and safety during treatment.

According to Dr Dong, the latest Prime technology is significantly faster than its predecessor – a full-face session now takes about 45 minutes compared to 60 to 90 minutes before – and treatment is about 30 per cent more comfortable than previous versions. These advancements earned Hera Clinic the Merz Aesthetics Ultherapy Infinity Award 2025 for its expertise in the field.

While some patients may notice a subtle tightening effect immediately after the treatment session, more visible improvements typically develop over two to three months as new collagen forms, resulting in a fresher, more well-rested appearance, says Dr Dong.

“Post-procedure, patients might notice mild redness, which subsides within 30 minutes, and any tenderness typically resolves within a week,” he adds.

Restoring facial volume and skin quality

While Ultherapy provides the lift, Sculptra provides the restoration. Unlike traditional fillers that provide an instant, and sometimes obvious, plumping effect, Sculptra is a biostimulator. It uses poly-L-lactic acid (PLLA) to encourage your body to regrow its lost collagen over time. 

“I often compare it to going to the gym,” says Dr Dong. “You don’t see the results after one workout, but there is gradual improvement in strength and tone.

“Sculptra works particularly well for concerns related to overall volume loss and declining skin quality. It helps restore volume over larger areas such as the temples and mid-face, where the face may start to look slightly hollow due to ageing.”

According to Dr Dong, as collagen production increases, patients may notice smoother-looking skin, with softened smile lines and a reduction in early sagging. Improvements in skin thickness, elasticity and firmness also develop gradually over time. Post-surgery downtime is minimal, with mild swelling or bruising resolving within a few days.

Treating ageing holistically

As ageing affects the skin at multiple levels, treatments are often most effective when used in combination, says Dr Dong. At Hera Clinic, this is reflected in a more holistic, layered approach to treatment planning, supported by a comprehensive suite of services.

“Like building a house, Ultherapy Prime helps create the structural framework by tightening the deeper support layer of the skin,” he explains. “Once that structure is in place, Sculptra can then improve the finer details by stimulating collagen production to enhance skin thickness, elasticity and overall skin quality.”

Because these treatments work with your body’s natural regenerative cycles, the results can be long-lasting, notes Dr Dong. 

Ultherapy Prime is typically performed once a year, while Sculptra results can last up to two years after a full course of treatment usually comprising two or three sessions spaced four to six weeks apart.

A key part of achieving the intended outcomes lies in careful customisation.

“I always start by understanding the patients’ concerns, as well as what they already know about treatments like Sculptra or other biostimulators,” says Dr Dong. “Many patients come in with information from friends or social media, so it’s important to clarify misconceptions and align their expectations early.”

He then walks patients through how each treatment works, particularly how biostimulators differ from traditional fillers.

“Sculptra doesn’t give an immediate filling effect. It works by stimulating your own collagen over time, so the results develop gradually over a few months and often require multiple sessions,” he explains. “Setting that expectation upfront is very important.”

Equally important is how the treatment is planned and performed.

“With Ultherapy, I explain what it can realistically achieve and where its limitations are. For example, it’s not suitable for areas like the upper eyelids, so we may discuss alternatives such as Thermage Eye or Morpheus8 to give patients a complete picture of their options.”

From there, the treatment is tailored based on factors such as skin laxity, facial anatomy and individual goals. Practical considerations, including budget and comfort levels, are also taken into account.

“With Ultherapy, even the number and placement of lines matter. How we distribute the energy across different areas of the face plays a big role in achieving a natural, balanced result,” Dr Dong says.

The same level of precision applies to Sculptra.

“Where and how we place the product affects the final outcome,” he explains. “For example, placing it along the lateral face can create a subtle lifting effect and improve the appearance of jowls. Factors like dilution, injection depth and placement all need to be carefully adjusted based on each patient.”

Ultimately, Dr Dong adds, it is this combination of the right treatments, sequencing and technique that leads to more natural-looking, longer-lasting results.

Find out more about Hera Clinic’s treatments.