My whole face is sagging—what should I get first?

Because one of the fundamental causes of facial sagging is laxity of the SMAS (superficial musculoaponeurotic system) beneath the skin. The SMAS is the layer between the skin and muscles that supports facial tissues, and it is a key structure addressed even in surgical lifts. When this layer becomes loose, managing only the surface skin has limited effect on improving sagging.

Ultherapy PRIME® delivers ultrasound energy to the SMAS layer (about 4.5 mm deep) without incisions, creating thermal coagulation points. This stimulates collagen regeneration over several months, inducing a lifting effect. The results typically become noticeable from 2–3 months and are generally known to last about a year. Once the deep layer is organized, it becomes easier for volume and skin texture treatments on top to achieve good results with smaller amounts.

Because each treatment takes a different amount of time to show its full effect, and doing them simultaneously makes it difficult to determine which one produced the result. In particular, ultrasound and RF Lifting involve collagen remodeling that progresses over 2–3 months, so deciding the amount of volume restoration after seeing the lifting outcome helps prevent overcorrection.

Swelling and recovery burden are also reasons. Immediately after a procedure, temporary swelling can make the facial contour appear different from reality, so determining filler amounts in that state reduces accuracy. Receiving multiple treatments at once can combine the stress on the skin, and if a reaction occurs, it becomes harder to identify the cause. Staging the treatments is better for both results and safety.

If your main concern is sagging, we recommend investing first in a deep-layer lifting treatment. Once the structure improves, volume and skin texture concerns often appear to ease as well, and the amount of subsequent treatment needed may itself decrease, which also makes it a reasonable choice in terms of overall cost efficiency.

However, priorities vary by individual. If volume loss (hollowness) is more prominent than sagging, a collagen-stimulating volume treatment like Sculptra may come first. If fine lines and rough texture are the main concerns, a Skin Booster may provide greater satisfaction. More important than the budget size is to identify through diagnosis what the primary cause is on your face and invest in that first.

After an accurate diagnosis of the cause, it is advisable to establish a roadmap on a yearly basis. Assess your current condition based on three criteria—sagging, volume, and skin texture—and then treat the most significant cause first.

Afterward, set a maintenance schedule. For example, repeat lifting at 1-year intervals and Skin Boosters at intervals of a few months, alternating between major treatments and lighter maintenance procedures. The plan will vary depending on age, skin thickness, and lifestyle, so we recommend consulting with a board-certified dermatologist to create a treatment plan tailored to you.