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Blog, Botox, Facelift, Featured, HIFU, Lasers, Skin

Facelift VS Botox For Saggy Lower Face?

A saggy lower face is an issue my patients are very concerned about. Doing a noselift can wait. Treating acne scars, they might delay. But when it comes to a saggy lower face, everyone’s DECISIVE. Why are patients more afraid of this than crow’s feet or forehead wrinkles?

Because you start to look like a man. A heavy lower face forms a squarish jaw which looks very masculine. It is a feature often associated with big, burly, macho man – something women and metrosexual men try to avoid!

Think of your friends. I’m sure everyone has that 1 friend who was very pretty when they were young. Now, they suddenly look a little manly. Now go observe the change in her jawline over the years. I’m quite sure this increased “manliness” is caused by a broadening jaw.

strong manly jaw: arnold schwarzenegger
Look at that square jaw –> arrow

What are the causes for Saggy Lower Face?

Contrary to popular belief, a masculine jaw/square jaw is not always caused by overgrown jaw muscles. A bulky lower face can also be the result of cheek sagging from aging.

sagging chins due to ageing illustration

There is a significant difference in the two cases. The first case of lower face heaviness is because of jaw muscle (masseter) hypertrophy (enlargement). The second case is a result of fat sagging and NOT a large muscle!

How does Botox help in Jaw Slimming?

Botox face slimming is easy to understand and shows impressive results. Asians are blessed with strong jaw muscles genetically, giving many women a squarish jaw and a manly look. By relaxing these muscles with Botox, the muscles shrink and the squarish jaw looks much slimmer with a more smooth contour.

woman with bulky jaw muscles

This lady had bulky jaw muscles (masseters) which was treated with a single session of Dysport (another brand of Botulinum Toxin A). PM me for more photos.

Where do Botox NOT work?

 saggy face: patient used botox on areas where botox doesn't work

This lady thought she needed lower face slimming from Botox injections, and indeed had been faithfully going to different clinics seeking the best Botox promotion every 6 months! When she came for consultation, I was shocked at just how much money she had wasted on botox. I told her to STOP.

She loved the result of the first Botox jaw she did and was convinced that she had to do it regularly forever to keep her face slim. WRONG. (Read my article about how Botox actually lasts forever)

effect of regular doses of botox on muscles: saggy cheeks

Look at this white arrow. Her jaw muscle area was in fact already sunken in! The regular doses of Botox had caused complete muscle wasting in that area and was semi-permanently lost.

woman with sagging cheeks

Her actual problem was with cheek fat sagging. This area (white arrow) had been dragged down by gravity from what used to be youthful upper cheeks, resulting in heavy jowls now. Botox would not fix that problem since it only targets muscles, not fat, nor the sagging.

Also read my guide to Botox Costs

How should I fix my Saggy Cheeks?

For patients looking to fix saggy cheeks, I highly recommend speaking to your favorite doctor about using the Ultraformer.

This device uses High Intensity Focused Ultrasound (HIFU) to tighten the layers of aging and achieves the lifting of saggy tissues by regenerating collagen fibres in the skin, fat and muscle layers. At higher intensity, it also achieves fat melting in unwanted areas (e.g. jowls of the face, double chin or even body fat).

Another big reason why I recommend this is because the results for fat melting and collagen stimulating are LONG LASTING from a single session. Nearly all individuals do NOT need a repeat session until 1 year later.

In other words, when a big lower face is because of sagging and fat, and NOT due to big jaw muscles, Ultraformer is the OBVIOUS choice.

patient who had a double chin and saggy lower face fat

Another patient who had a double chin and lower face fat

Ultraformer VS Ultherapy?

Many people always ask me, why the Ultraformer and not Ultherapy? Both are market leading devices. The Ulthera is from USA, while the Ultraformer is the most branded HIFU from Korea.

However, it is worth noting that the Ultherapy is still a first generation device, whereas the Ultraformer is already a third generation device. This means it is faster and more advanced.

I personally make my decisions based on research and actual studies. I feel that is my obligation as a doctor. This clinical study (1) found that compared to Ultherapy, the Ultraformer was:

  1. 25% more efficient
  2. 40% faster
  3. 50% LESS painful
  4. While also producing the same effect as the Ultherapy!

So if you want something cheaper, more efficient, faster and LESS painful, ask your doctor about the Ultraformer. He might have it in his clinic as well.

Also read: Thermage Facelift (Singapore) may not be the best option in 2020 – A Doctor’s Opinion


Now, many other aesthetic practices offer mini-HIFU treatments to be done weekly/monthly. Basically, breaking down an intensive HIFU session into many small procedures to make the treatments look more low priced and affordable.

This simply does not work, and those who have tried it would know. Read my article on Laser and Skin treatments sharing more about how laser intensity matters during your treatments.

The same goes for HIFU treatments. Treatment intensity matters, which is why those who have underwent Ultherapy procedures would say it is extremely painful. If the same machine suddenly causes no pain, then obviously the intensity isn’t the same and results would be different! Makes sense, right!?

In other words, never subscribe to a set of Mini-HIFUs to achieve the treatment result of a proper HIFU!

1. Harker-Martinez Simon, High-Intensity Focused Ultrasound; Simultaneous Treatment with Market-leading Devices

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