Facial Sagging in Daegu — Starting With Which Layer the Treatment Works On

The conclusion, first

“Where in Daegu is good at lifting for facial sagging?” is a question that cannot be settled from public data. So we write a different answer instead — we set out how “the sagging improved” is judged in the data. There are three points. First, the primary endpoint of the most robustly designed trial in this field (201 people · untreated control · five centres) was “improvement if two or more of three blinded assessors say, looking at the photographs, that it improved” — not a degree but a yes or no. Second, what was measured in millimetres was not the face but the submental area. The three-dimensional quantitative analysis in that trial measured only the displacement of the submental skin. Third, the thickness of the layers differs greatly from person to person — in material measuring 30 cadavers with a three-dimensional scanner, facial skin was 2.1 ± 0.4 mm and superficial fat 5.2 ± 1.9 mm. The standard deviation is 36% of the mean. So we do not give you “so many shots at so many millimetres” as a fixed value; we first separate out which layer the problem is in.

The order we actually work through in consultation

1. We separate out what it is that has come down

The impression of “sagging” comes from at least one of three things — the skin itself being thin and stretched, the superficial fat having moved downwards, or the deep fat having deflated so that it no longer supports the tissue above it. The third is not filled by heat. Skip this distinction and different goals end up mixed under the single name “lifting.” The layer-by-layer situation we have written about in lifting has to change with skin thickness and the amount of fat.

2. We tell you how much the thickness of that layer differs between people

The second row matters in practice. Even using the same device at the same depth setting, the tissue that sits at that depth differs from person to person. In someone lean and older the fascia lies more superficially than expected, so a standard setting may pass by the layer it was meant for. So the information “we use a transducer of so many millimetres” on its own does not tell you what is being worked on. We also note that cadaveric material is fixed tissue and so may differ from the living.

3. We look at what “it improved” was judged with

For the lower face and submental indication of focused ultrasound there is a trial of 201 people with an untreated control group (five centres, ages 35 to 65, body mass index 19 to 30). The primary endpoint of that trial reads like this — “three blinded assessors compare the day-90 photographs with the pre-treatment photographs, and if two or more judge that it improved, it is counted as improved.” That is, it counts not how much it improved but whether it improved. Among the secondary endpoints, the three-dimensional quantification in millimetres was the displacement of the submental skin. The remaining secondary endpoints were the treating physician’s global assessment, the patient’s own global assessment, and a patient satisfaction questionnaire.

This trial treated the midface, lower face, submental area and upper neck alike, but the quantitative measure was attached only to the submental area. Within the range we checked, there was no primary endpoint measuring sagging of the cheek or midface in millimetres.

4. We also look at what the comparative trial now under way is contesting

A Korean manufacturer has a randomised non-inferiority trial of 273 people comparing its own device with an existing one under way at five centres (started October 2025, due to complete November 2026). And yet the indication in that trial too is the submental area and the neck. That is, the place where the largest comparative material in this field contends is not the cheek but the submental area. We intend to check the result when it appears and write about it again.

5. So this is the order we decide in

(1) We separate out which of skin · superficial fat · deep volume is the main cause → (2) we put on the candidate list only the classes that actually reach that layer → (3) we check that person’s own layer thickness by ultrasound or by palpation → (4) we tell you whether quantitative data exist for that area or not → (5) items that have not been verified we say have not been verified, and we decide together. Price and discounts enter nowhere in this order; costs are explained separately at the consultation.

Five things worth asking at a consultation

These are questions you can ask at any clinic. If the answers are specific and the place says it does not know what it does not know, that helps a judgement.

1. “Which layer is my sagging a problem in?” — whether it is the skin, the superficial fat or deep volume.
2. “Do you check my layer thickness before setting the parameters?” — superficial fat thickness differs more than threefold between people.
3. “Is there quantitative data for this area?” — for the submental area there is; for the cheek it is thin.
4. “What do you judge improvement by?” — whether by photographic judgement or by measurement, and how many people do the judging.
5. “In my case, is there a reason it might not work well?” — an explanation that does not state the limits is not material for a judgement.

What is confirmed / what is inferred / what we could not confirm / material pointing the other way

Where this article was written

• Miso Clinic, Daegu · 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea (near Kyungpook National University Hospital station)
• Director Lee Chi-Hak · Tel. 053-428-2700
• This column was written by the director and reviewed in September 2026.

This article was written not to recommend a particular treatment but to set out the extent of the data needed for a decision. Judgement about an individual condition requires examination, and this article does not substitute for medical care. As companion pieces it helps to read cheek sagging in Daegu — is there a treatment that deals with the cheek alone and what a natural lifting in Daegu actually adjusts.

Frequently asked questions

Who wrote this

References

1. Controlled trial of focused ultrasound — registration number NCT04795622 (sponsor Merz North America, collaborator Ulthera). 201 people · five centres · ages 35 to 65 · body mass index 19 to 30. A single treatment of the midface, lower face, submental area and upper neck with three transducers (1.5 · 3.0 · 4.5 mm); the control group received delayed treatment 90 days after no treatment. Primary endpoint = the proportion of subjects judged improved by two or more of three blinded assessors comparing day-90 photographs with baseline photographs. The three-dimensional quantification among the secondary endpoints is submental skin displacement (mm), and the rest are the investigator’s global assessment · the subject’s global assessment · a satisfaction questionnaire.
2. Thickness of facial skin and superficial fat — Lee KW, Yoon JH, Kim JS, Hu KS, Kim HJ, Clinical Anatomy 2021;34(7):1050–1058, PMID 33583088, DOI 10.1002/ca.23726. 30 fixed cadavers from Korea and Thailand (17 male · 13 female), 11 paths measured with a three-dimensional scanner. Skin 2.1 ± 0.4 mm, superficial fat 5.2 ± 1.9 mm. The skin grew thicker moving down from the temple, and the variation in superficial fat thickness was greatest around the marionette line. As fixed cadaveric material it may differ from the living.
3. Ultrasound material on the layer structure of the lower face — Kwon SH, Ahn GY, Lew BL, Shin JW, Na JI, Huh CH, Dermatologic Surgery 2022;48(5):527–531, PMID 35093961, DOI 10.1097/DSS.0000000000003393. Retrospective review of the ultrasound records of 200 people who had undergone lower-face rejuvenation treatment (mean 41.1 ± 13.7 years, range 19 to 76). In sagging submental areas the skin was thinner, the superficial fat thicker and the fascial boundary deeper, and the superficial fat grew thinner with age. The fascial boundary lay more superficially in older, male and lean people. It is a retrospective study.
4. Large comparative trial under way — registration number NCT07229430 (sponsor Classys). 273 people · five centres · randomised controlled non-inferiority, the comparator being an existing focused ultrasound device. Started October 2025 · primary completion due November 2026. The indication is the submental area and the neck, not the face. The results have not yet appeared.
5. An approach from the standpoint of the retaining ligaments — Cohen S, Artzi O, Mehrabi JN, Heller L, Journal of Cosmetic Dermatology 2020;19(8):1948–1954, PMID 32543088, DOI 10.1111/jocd.13546. A case series of 45 people · no control group, judged only by global assessment at three months. It is a report of a technique standing on the anatomical premise that laxity of the orbital, zygomatic and masseteric ligaments contributes respectively to brow ptosis, the nasolabial fold and jowling. The design is of a low grade of evidence.
6. Distribution of registered clinical trials — ClinicalTrials.gov search by condition, “skin laxity OR facial sagging” 202 trials (as of the point at which we checked). The sites are concentrated on the submental area and neck. These are figures within the range we checked and will differ with the date of the search.
7. Legislation on medical advertising — Article 56(2) of the Korean Medical Service Act. It prohibits advertising by means of accounts of treatment experience, comparison with other medical institutions, superlative expressions and the like. This is why this column carries no expressions such as “good at” or “the best,” no comparison with other medical institutions, and no prices or discounts.