Question 1

Why can reducing fat cause sagging?

Accepted Answer

When fat is reduced, the volume that the fat was filling decreases, and the skin may appear to sag. This is because the facial volume has decreased, but the skin covering it cannot contract enough to match, creating excess skin.

Skin has some ability to contract on its own, but this is only when elasticity is good. If collagen and elastic fibers are sufficient, the skin tightens along with the volume reduction, resulting in smooth contours. However, skin with poor elasticity cannot keep up with the volume loss and may leave a sagging impression.

In other words, the risk of sagging depends not only on how much fat is reduced but also on how well the remaining skin can tighten. Therefore, it is important to assess skin elasticity before treatment.

Question 2

Do I need to combine it with a lifting treatment to prevent sagging?

Accepted Answer

If you are concerned about elasticity, combining fat reduction with a lifting procedure that tightens the skin may be helpful. In clinical practice, fat loss and reduced elasticity often occur together, so designing a plan that reduces volume and tightens the skin at the same time can help minimize the appearance of sagging.

Lifting methods differ by the depth of skin they target. Ultherapy PRIME® stimulates the SMAS layer with ultrasound, while Thermage® FLX, 10THERMA, and Alltite tighten the dermis with radiofrequency; all induce collagen regeneration to tighten the skin. The appropriate method depends on the degree of sagging and skin thickness.

Purpose	Approach	Related treatment examples
Volume reduction	Local fat reduction	The L injection (contour injection)
Skin tightening (dermis)	Radiofrequency collagen stimulation	Thermage® FLX, 10THERMA, Alltite
Skin tightening (SMAS)	Ultrasound SMAS stimulation	Ultherapy PRIME®

Whether to combine treatments and the order depend on individual skin elasticity, so it is advisable to discuss this during the treatment planning stage.

Question 3

Should I avoid injections if my skin elasticity is low?

Accepted Answer

If elasticity is very low, proceeding with fat reduction alone should be approached with caution, but it is not absolutely contraindicated. By adjusting the dosage according to your elasticity and combining it with lifting, you can expect contour improvement while reducing the risk of sagging.

The problem arises when a large amount of fat is rapidly reduced in skin with low elasticity. If volume is lost all at once, the skin cannot keep up, and sagging may become noticeable. In such cases, treatment may be divided into multiple sessions with gradual reduction, or tightening procedures may be considered first.

Ultimately, low elasticity does not mean treatment is impossible; it means the approach must be different. Since individual variation is significant, it is safer to decide after a diagnosis.

Question 4

Can older people experience adverse effects?

Accepted Answer

As you age, skin elasticity and collagen decrease, so a procedure that only reduces fat may carry a higher risk of causing a sagging appearance. However, this depends more on the skin's elasticity than on age itself. Some younger people have weak elasticity, while some older people maintain good elasticity. Therefore, the actual decision is based on skin assessment rather than age. If elasticity loss is significant, it is better to minimize fat reduction and focus on tightening procedures for a more natural result. Additionally, on a face where volume has already started to diminish, removing more fat could emphasize an aged appearance, and a volume-enhancing approach may be more appropriate in some cases. Such decisions should be made through a personalized consultation with a specialist.

Question 5

How can I receive the procedure safely?

Accepted Answer

The key to a safe procedure is using injections with clearly identified ingredients and designing the dosage based on your individual fat amount and elasticity. A gradual approach with multiple sessions, rather than a large single treatment, helps lower the risk of sagging. Before the procedure, confirm that the injection does not contain ingredients that may cause side effects, such as steroids, and discuss whether a lifting treatment should be combined if needed. Areas prone to hollowing, such as under the eyes or the front of the cheeks, require particular caution. Most importantly, having a comprehensive assessment of your face shape, fat distribution, and elasticity before the procedure is the starting point for safety and natural results. Since individual differences are significant, a consultation with a board-certified dermatologist is recommended.