⚠️ Read this first:
There is no single "best" procedure — only the most appropriate one for a given degree of sagging. Non-surgical options are not a substitute for surgery in severe laxity, and surgery is not necessary for everyone who notices early sagging. A face-to-face medical assessment is what decides.
Why does the face sag in the first place?
With age, three things happen at once: the skin loses collagen and elasticity, fat volume drops in some areas and accumulates in others, and the deep supporting layer (SMAS) weakens. An effective procedure is one that treats the right layer for your degree of sagging — which is why the results of these three options differ so much.
Option 1: The thread lift
Absorbable medical threads (PDO or PLLA) are placed under the skin through fine needles. Tiny barbs on the threads grip the tissues and lift them immediately — then stimulate collagen production over the following months. The procedure is done under local anaesthesia in 45-90 minutes, with a return to work after just 2-3 days.
The key point: PDO threads dissolve after 6-8 months, but the collagen they built remains — so the result doesn't vanish suddenly; it fades gradually over 12-24 months. Many patients repeat the procedure every 12-18 months as maintenance. Full details on the thread lift page.
Option 2: Ultherapy
An FDA-cleared technology that uses focused ultrasound (HIFU) to reach the deep supporting layer (SMAS) — the same layer a surgeon tightens — but from the outside, using heat that stimulates collagen. No incision, no anaesthesia, and no downtime at all: you leave the session and go straight back to your day.
The trade-off? Patience. Results start to show after 4-6 weeks, complete over 3-6 months, and typically last 12-18 months, with the option of repeat sessions to maintain them. There is no instant lift as with threads — it is a gradual, natural tightening. Read more on the Ultherapy page.
Option 3: The surgical facelift
The only option that treats the root of the problem in moderate and severe cases. Using the SMAS technique, the surgeon works on the deep layers, removes excess skin and redistributes the tissues, through incisions placed behind the ear and in the hairline so they stay inconspicuous. It is surgery under general anaesthesia taking 2-4 hours, with a recovery of 2-3 weeks.
The result lasts 7-10 years — and a single surgery's cost is roughly equal to 4-5 years of repeated non-surgical procedures. Details on the facelift page.
The honest comparison
Speed of results
Threads: a visible, immediate lift from day one. Ultherapy: gradual over 3-6 months. Facelift: the final result takes shape over 3-6 months as swelling settles.
Longevity
Ultherapy: 12-18 months. Threads: 12-24 months. Surgery: 7-10 years. This difference is the heart of the financial and practical decision.
Downtime
Ultherapy: zero. Threads: 2-3 days. Facelift: 2-3 weeks to return to normal.
The decision map: your degree of sagging decides
Mild sagging (usually 35-45): skin still relatively firm, early fine lines — Ultherapy is an excellent option here, and it also suits those who want to extend the result of a previous facelift.
Moderate sagging (usually 45-55): visible cheek descent and early neck laxity — a thread lift, a combination of threads and Ultherapy, or a mini facelift for those who want longer-lasting results.
Severe sagging (usually 55+): clear cheek descent, jowls along the jawline, and obvious neck laxity — a full surgical facelift. Non-surgical procedures will not give an adequate result here, and it is only honest to say so plainly.
"Patients who tried threads and found them insufficient usually needed surgery from the start. My job in the consultation is to spare you that experience — not to sell you the easiest procedure." — Dr. Ahmad Dawood
⚠️ Don't decide from the internet:
The assessment differs from face to face depending on skin quality, fat volume, bone structure and the degree of SMAS laxity. What suited someone else may not suit you — and age alone is not the criterion; sagging is the real criterion.
Which option suits your face?
A free consultation to assess your degree of sagging and honestly identify the right option — surgical or not