Lines, sagging and ageing skin
Four layers age at once. Each treatment works on one of them, which is why one thing never does it all.
Lines that show at rest, cheeks that have flattened, a jawline that has softened, skin that looks thinner, crepey or mottled: these are the visible signs of skin ageing (photoageing and intrinsic ageing), and they come from changes in four layers at once. The skin loses collagen and elastin. The fat pads under it shrink and slide. The ligaments that hold everything up loosen. The bone underneath quietly recedes.
That is why no single treatment fixes an ageing face. Sunscreen and a retinoid treat the skin surface. A prescription treatment for expression lines treats the muscle pull. Fillers replace lost volume. Skin boosters treat skin quality. HIFU tightens mild to moderate laxity. Surgery does what none of them can. This page sets out which problem each is for, including the limits.
What causes it
Two processes run together. Intrinsic ageing is genetic and hormonal: the skin thins, turnover slows, and after menopause collagen loss speeds up. Extrinsic ageing is mostly sun, with smoking and pollution behind it, and gives the coarse lines, mottled pigment, visible vessels and leathery texture of sun-damaged skin. Sun damage is the part you can prevent and partly reverse.
Lines come in two kinds. Expression lines are made by muscle pulling on the skin (frown, forehead, crow's feet) and start as lines only on movement. Etched lines are there at rest, from years of folding plus sun damage. Folds like the nose-to-mouth lines are mostly descent and deflation of the cheek, not the skin itself. Sagging along the jaw and under the chin comes from loose ligaments, shrunken fat and a jaw that has lost height.
What actually treats it
Skin surface: fine lines, texture, mottling. Daily sunscreen plus a retinoid is the first-line answer and has the strongest evidence. A Cochrane review (2005) found that a prescription-strength retinoid cream improved mild to moderate sun damage over 24 weeks, with more irritation at higher strengths. That cream is prescription only and is discussed at a consultation; non-prescription retinol is the gentler route. In clinic, a course of superficial peels or microneedling improves texture and etched lines over several sessions. IPL treats the brown and red of sun damage in lighter skin.
Expression lines. A prescription treatment for expression lines exists, takes effect over days and wears off over months. We cannot name or price it online. It is discussed at a face-to-face consultation. It softens etched lines only partly; those need the skin treatments above as well.
Volume: flat cheeks, hollow temples, folds, a weak chin. Dermal fillers replace what has deflated and support what has slipped. The right order is deep support first, then the fold, and conservative volumes. Fillers lift a little by restoring structure; they do not tighten loose skin.
Skin quality: crepey, dull, dehydrated skin. Skin boosters and polynucleotides improve hydration, elasticity and glow over a course, usually three sessions. They do not add volume or lift. PRP or PRF from your own blood is another route for skin quality.
Laxity: soft jawline, early jowls, loose neck. HIFU is focused ultrasound delivered through the skin, and the tightening builds over three to six months. It suits mild to moderate laxity with reasonable skin quality. Marked laxity and heavy jowls need surgery, and we refer to Mr Benedict Reed for that opinion rather than sell you a course that will disappoint.
If your skin is darker (types IV to VI), pigment change after peels and light is the main risk, so we lean on microneedling, boosters and skincare, with IPL avoided and peels test patched.
When to see your GP
Sun-damaged skin is also skin at higher risk of skin cancer. See your GP for a rough, scaly spot that does not heal, a pearly bump with fine vessels, a sore that bleeds or crusts and comes back, or any mole or brown patch that is changing, growing or unlike the others. We look at the whole face before any light or resurfacing treatment and refer anything that stands out. Sudden weight loss or a face that has changed quickly also deserves a medical look before cosmetic work.
The honest limit
Nothing non-surgical reverses ageing. Every treatment here improves one layer by a margin, and the margin is smaller the more advanced the ageing. Fillers do not lift loose skin, boosters do not add volume, HIFU does not fix heavy jowls, and no cream undoes a decade of sun. We will tell you when the honest answer is surgery, and we will tell you when the honest answer is nothing. Results vary and cannot be guaranteed.
Skincare at home
Sunscreen every morning, SPF 30 or higher with UVA protection, is the single thing with the most effect over years. A vitamin C serum under it. A retinol at night, started two or three nights a week and built up; expect some dryness in the first weeks. Do not use retinol or any retinoid if you are pregnant, planning a pregnancy or breastfeeding. A good moisturiser for the crepey stage, and the neck and chest treated the same as the face.
From the Obagi range we stock: Obagi Sun Shield Mineral SPF50 85g; Obagi Professional-C 20% Serum 30ml; Obagi Retinol 1.0 28g or the gentler Obagi Retinol + PHA Refining Night Cream 50ml; Obagi ELASTIderm Facial Serum 30ml and Obagi ELASTIderm Eye Cream 15g; Obagi ELASTIderm Neck and Decollete Concentrate 60ml; Obagi Hydrate Luxe 48g for drier skin.
Common questions
What is the first thing to do about ageing skin?
Sunscreen daily and a retinoid at night. Everything else builds on that. The prescription-strength retinoid has the strongest evidence for sun damage and is discussed at a consultation; retinol is the non-prescription version.
Do fillers lift a sagging face?
A little, by restoring the support that has deflated. They do not tighten loose skin, and too much filler to chase a lift gives a heavy face. Loose skin is a HIFU question for mild cases and a surgical one for marked cases.
Is there a treatment for frown lines and forehead lines?
Yes. A prescription treatment for expression lines is discussed at a face-to-face consultation. We cannot name or price it online, and we do not treat anyone under 18 with injectables.
Does HIFU replace a facelift?
No. HIFU suits mild to moderate laxity and gives a modest, gradual tightening over months. Heavy jowls, a loose neck and marked sagging need surgery, and we refer for that opinion.
What helps crepey skin on the neck and chest?
Sunscreen first, then a retinol if the skin tolerates it, and in clinic skin boosters, polynucleotides or a gentle peel course. The neck heals more slowly than the face, so we go gently there.
Am I too old for these treatments?
Rarely. The question is which layer is the problem and how far it has gone. At an advanced stage non-surgical work improves the skin without reversing the ageing, and we say so at the consultation.
How do I choose between a skin booster and filler?
Booster for quality: hydration, elasticity, crepiness. Filler for shape: flat cheeks, folds, a weak chin. Many people need one, some need both, and the consultation sorts out which.
Can I have these treatments with darker skin?
Yes, with the plan adjusted. Fillers, boosters and HIFU are used across skin types. Peels are test patched and kept superficial, and IPL is avoided on darker skin because of pigment risk; microneedling is our usual resurfacing choice instead.
Related treatments
Book a free consultation. Or message us on WhatsApp: 077 21 400 600.
Nova Beauty Clinic is in East Finchley, three minutes on foot from East Finchley station on the Northern line, with a car park next door. Most of our clients for ageing skin come from Hampstead, Highgate, Muswell Hill and Finchley, with others from Hampstead Garden Suburb, Golders Green, Crouch End, Whetstone and Barnet.
This page is general information, not medical advice. What suits you depends on your own skin, health and history, which we go through at a free consultation before anything is booked.