Facial Sagging: Causes, Prevention and Available Treatments

Facial sagging is one of the earliest signs of skin ageing and one of the most common complaints in aesthetic medicine appointments. It shows up as a loss of firmness and elasticity in the skin, progressively affecting the contour of the face, the eyelids, the cheeks and the neck. Although it is a natural process, understanding its causes and acting preventively makes a significant difference to the quality and appearance of the skin over the years.

What Causes Facial Sagging?

The firmness of the skin depends essentially on two proteins produced by fibroblasts: collagen and elastin. Collagen provides structure and strength, while elastin allows the skin to return to shape after being stretched. From the age of 25, collagen production begins to fall by about 1% a year. By 40, this loss is already noticeable; by 50, it can be quite pronounced.

But chronological ageing is not the only factor. There are several external agents that speed up the breakdown of collagen and contribute to early sagging:

• Unprotected sun exposure — UV radiation is the main external factor in skin ageing. It directly breaks down collagen and elastin fibres and stimulates the production of enzymes (metalloproteinases) that destroy the dermal matrix.
• Smoking — Nicotine causes vasoconstriction, reducing the supply of oxygen and nutrients to the skin. Smokers show, on average, a loss of firmness 40% greater than non-smokers of the same age.
• Weight fluctuations — Cycles of weight gain and loss repeatedly stretch and relax the dermal fibres, reducing their ability to retract.
• Chronic dehydration — Dehydrated skin loses turgor and looks thinner and more slack, even in the absence of any real collagen loss.
• A diet low in antioxidants — Oxidative stress speeds up cellular breakdown. Diets high in simple sugars promote a process called glycation, which damages collagen fibres.
• Sleep deprivation — During deep sleep, the body releases growth hormone, essential for cellular regeneration and collagen synthesis.
• Repetitive facial expressions — Grimacing, frowning and other repeated muscle movements create expression lines and, over the long term, contribute to the loss of elasticity.

How to Assess Facial Sagging

Not all loss of firmness is the same. In clinical assessment, three degrees of sagging are distinguished:

• Grade I (mild) — Skin with a subtle decrease in tone, more noticeable to the touch than to the eye. Expression lines begin to set. It responds well to prevention and to less invasive treatments.
• Grade II (moderate) — Visible loss of definition in the facial oval, more marked nasolabial folds, a slight drop of the eyebrows. It requires active treatment for partial reversal.
• Grade III (severe) — Evident ptosis of the facial structures, pronounced marionette lines, significant descent of the tissues. Minimally invasive treatments have limited results; a surgical assessment may be needed.

The degree and the treatment options should always be determined by a specialist, through an in-person assessment.

Prevention: Habits That Make a Difference

Prevention is more effective — and far less costly — than correction. The following habits, adopted consistently, significantly delay the onset of facial sagging:

1. Daily Sun Protection

Using a sunscreen with SPF 30 or higher, every day of the year (including cloudy days and indoor spaces with exposure to natural light), is the preventive measure with the strongest scientific evidence. UV radiation is responsible for up to 80% of visible skin ageing. Choose broad-spectrum formulations (UVA + UVB) and reapply every two hours during direct exposure.

2. Skin Hydration

Applying a moisturiser suited to your skin type, morning and night, keeps the skin barrier intact and improves the appearance of firmness. Look for formulations with hyaluronic acid, niacinamide, peptides or retinol — ingredients with evidence for supporting the dermal structure.

3. A Diet Rich in Antioxidants

Vitamin C (citrus fruits, peppers, kiwi), vitamin E (nuts, olive oil), zinc (pulses, seeds) and omega-3 (oily fish, linseed) are essential nutrients for the production and maintenance of collagen. Reducing the intake of refined sugars and ultra-processed foods lowers oxidative stress and the glycation of dermal proteins.

4. Internal Hydration

Drinking between 1.5 and 2 litres of water a day maintains cellular turgor and improves the overall appearance of the skin. Dehydration, even mild, accentuates expression lines and the appearance of sagging.

5. Regular Physical Exercise

Physical activity improves blood circulation, stimulates collagen production and helps maintain a stable weight. Resistance exercise has a particularly positive effect on overall tone.

6. Quality Sleep

Sleeping between 7 and 9 hours a night, preferably on your back, promotes cellular regeneration and collagen synthesis. Chronic sleep deprivation raises cortisol levels, which break down the dermal fibres.

7. Quitting Smoking

Giving up smoking is one of the decisions with the greatest impact on skin health. The benefits are visible within the first few months after quitting, with improvements in colour, hydration and skin tone.

Clinical Treatments Available

When prevention is not enough, or when sagging has already set in, there is a range of minimally invasive treatments with proven results. At Porto Smile, these treatments are carried out exclusively by qualified doctors:

Botulinum Toxin (Botox)

Botulinum toxin relaxes the muscles responsible for expression lines, softening existing lines and preventing them from deepening. It is particularly effective in the forehead area, the glabella (between the eyebrows) and crow’s feet. The result lasts between 4 and 6 months and the procedure is quick, with immediate recovery.

Hyaluronic Acid Fillers

Hyaluronic acid is a substance naturally present in the skin, responsible for hydration and volume. With age, its concentration decreases. Fillers restore the lost volume in areas such as the cheeks, the nasolabial folds and the lip contour, restoring facial harmony in a natural way. The results last between 9 and 18 months.

Collagen Biostimulators

Unlike fillers, biostimulators stimulate the body itself to produce new collagen. The effect is gradual, but the results are progressive and long-lasting, and can be maintained for between 18 months and 2 years. They are particularly suitable for moderate sagging and for those seeking natural results.

Radiofrequency

Radiofrequency uses electromagnetic energy to heat the deep layers of the dermis, causing the immediate contraction of existing collagen fibres and stimulating the formation of new fibres. It is a non-invasive treatment, with no downtime, with progressive results over the 2 to 3 months following each session.

Microneedling with Radiofrequency

The combination of microneedles with radiofrequency energy makes it possible to act on the deeper layers of the skin with precision. It is effective in treating moderate sagging, uneven texture and scarring, with better results than conventional microneedling.

When to See a Specialist

An early assessment is always more advantageous than waiting for severe sagging to set in. An aesthetic medicine appointment is recommended when:

• You notice a loss of definition in the facial oval, even at rest;
• Your eyebrows seem to have dropped compared to previous years;
• The nasolabial folds are more marked and the “tired” look persists even after rest;
• You want to start a preventive plan before the signs are visible.

At Porto Smile, the aesthetic assessment appointment is personalised: we analyse your facial structure, discuss your concerns and propose a treatment plan tailored to your needs and expectations — always with natural results as the priority.

Book your appointment and look after your skin with people who know how.