The short answer
A sagging face can have two different causes. Deflation shows as hollows, with good skin recoil. Descent shows as a fat pad sitting low, with a fold or jowl below it. Many faces have some of each. The thread lift and dermal fillers pages explain each treatment.
Dr Sin Yong examines you upright and in animation, with pinch and recoil tests. That decides what, if anything, is advised. Placing the wrong treatment disappoints in predictable ways.
The cog threads are absorbable and sit in the subcutaneous fat. They are drawn toward a fixed anchor at the temple or in front of the ear. Fillers are chosen by material and placed in a plane that suits the area.
Thread lift vs fillers at a glance
| Thread lift (Bliss Lift) | Dermal fillers | |
|---|---|---|
| Mechanism | Repositions tissue mechanically | Adds volume and support |
| Material | Absorbable PDO and PCL cog threads | HA, CaHA, PCL or PLLA |
| Layer | Subcutaneous fat, above the SMAS | Supraperiosteal plane, deep fat or dermis, by area |
| Target | Descent of a mobile fat pad in elastic skin | Deflation of the cheek, temple, chin or pre-jowl area |
| Reversal | Resorbs on its own timeline, and cannot be removed on demand | Only HA can be dissolved, with hyaluronidase |
Who each may suit
Early descent, elastic skin, no large volume deficit and no established skin excess. Examples are an early jowl, a slid midface or a dropped lateral brow.
A true change in volume in a face whose skin and ligaments still give support. Examples are a deflated cheek or temple, a short chin or a hollow pre-jowl area.
Where each disappoints
Heavy laxity, thin or excess skin, heavy facial fat, or lost volume. Repositioning an empty compartment moves the hollow upward.
Where the problem is descent, because it adds weight to tissue already falling. It cannot be relied on to lift a sagging jowl directly.
Beyond both treatments. You would be referred to a plastic surgery specialist.
If you need both
Filler usually comes first, so threads carry only the tissue that still needs moving. Filler is not placed in the path of a planned thread, and threads are not passed through fresh filler. Earlier filler of unknown type is mapped with ultrasound first. The two are spaced so swelling from one does not distort planning for the other. Threads placed over filler are considered only once examination establishes where the filler sits. Other routes also exist. HIFU uses heat for laxity rather than descent. The VF Lift uses no threads or injected product.
Who should wait
Pregnancy and breastfeeding, and active infection or inflamed skin in the area.
A bleeding tendency or blood-thinning medicine.
A keloid tendency, autoimmune disease or earlier non-resorbable filler.
What neither can do
Neither treatment tightens loose skin, removes skin excess or replaces a surgical facelift. Threads bring no extra volume and deliver no heat. Filler cannot lift a slid fat pad. If your aim is to remove loose skin, neither is the right tool.
Risks and fees
Swelling, bruising and tenderness along the vectors. Dimpling, asymmetry, a visible or palpable thread, infection and, uncommonly, thread extrusion.
Swelling, bruising and lumps. The serious risk is a blocked blood vessel. Hyaluronidase is kept in the room wherever HA is injected. See the warning signs.
No number of sessions is given here, as plans are set individually. The fee depends on thread count and vectors, or on material, quantity and areas. A written quote follows consultation, and no prices are listed.