Hello, I’m in my mid-40’s with increasing sagging (mainly drooping upper eyelids, jowls and marionette lines). I’ve had three Ultherapy procedures at a highly-regarded clinic over the past five years to lift and tighten my face and neck. The last treatment had no effect whatsoever so I consulted a cosmetic surgeon who specialises in deep plane/SMAS facelifts. He informed me that Ultherapy can weaken facial structures based on the cases he’s seen and operated on. I am understandably concerned. What is your take on this? Are there any other safe, effective treatments you’d recommend for sagging?

Hi, I’m sorry to hear that you had no improvement from your last Ultherapy treatment – surgeons are not keen on it as, in pursuit of the skin, it can (as one put it to me), ‘mash up’ the layers under the skin which makes it more difficult for surgeons to work on – not impossible but it makes their job trickier. They see the same result from treatments like radiofrequency microneedling (Morpheus8 et al) though many surgeons will still use RF microneedling for non-surgical tightening as it is a safe and effective treatment for the right candidate.

Thread lifts can reposition sagging jowls, but if cosmetic surgeons don’t like energy-based tweakments like RF needling and ultrasound, they REALLY don’t like threads. The difficulty is that for all of us, there comes a point where age and gravity are taking everything south faster than non-surgical tweakments can treat. With upper eyelids, as the surgeon you spoke to will have advised, the quickest, simplest and most effective thing is to have an upper blepharoplasty. It is a straightforward op, it gives predictable results, and the recovery is quick.