Are you a sinker, sagger or wrinkler?
You may be familiar with signs of ageing- dark spots, dullness, wrinkles, sagging and hollowness. And while ageing affects us all; however extent and rate of change of facial characteristics differ between people. For example you may notice that your laugh lines may be more obvious compared to a peer, who may have more hollow cheeks. That’s because how we age is a complex interplay of genetics, lifestyle, and environmental factors.
Renowned plastic surgeon Dr. Arthur Swift categorised these ageing patterns into 2 distinct groups, but this has evolved to include a third category: Sinkers, Saggers, and Wrinklers. Although this framework is very generalised, and most of my patients fall along the spectrums of these patterns of ageing, this categorisation is easy for patients to understand and select appropriate treatments
Let’s explore the science behind each ageing pattern, their features, and how they inform treatment strategies.
Features of sinkers
Sinkers
“Sinkers” are primarily characterized by volume loss and support in the face. While most people would intuitively blame age related fat loss in the face (and perhaps, Ozempic faces); many other factors also result in the progressive hollow, sunken appearance and loss of youthful contours.
Related blogpost:
Angelina Jolie, Michelle Yeoh and Victoria Beckham are examples of “sinkers”
The science behind “sinkers”
As we age, our faces lose volume, especially in the cheeks, temples and under eye area as fat pads in the face that used to support and youthful contours in our faces start to shrink and reposition. At the same time, loss in bone support due to resorption and reduction of collagen and elastin within the skin also contribute to the hollow appearance.
Key signs of sinkers
• Hollowing in the temples
• Deepening of the tear troughs causing obvious dark eye circles
• Flatter mid-face
• Prominence of the bony contours
Features of Saggers
Saggers
The science behind saggers
For “Saggers”, sagging or descent of the facial tissues are the prominent features. Due to loss of skin elasticity and weakening of the support ligaments that normally hold fat pads and skin in place; the facial tissues migrate downwards. This leads to heaviness in the lower face, prominent laugh lines (nasolabial folds and marionette lines) and protrusions like jowls.
Related blogposts:
How to Treat Sagging Skin Without Surgery
Takuya Kimura, Kim Hae Sook and Maggie Cheung are examples of saggers.
Key signs of saggers
• Brow ptosis
• Deepening of nasolabial folds
• Formation of marionette lines
• Jowls
• Loss of jawline definition
• Loose skin under the chin and neck (turkey neck)
Features of wrinklers
Wrinkles and lines are a major feature of “wrinklers”. Repetitive facial movements combined with poor skin quality leads to wrinkles that become deeper and static over years.
George Clooney, Brad Pitt and Tom Cruise are celebrity examples of wrinklers.
Key signs of wrinklers:
• Crows’ feet (wrinkles at the outer corner of the eyes)
• Forehead wrinkles • Glabellar wrinkles • Smokers wrinkles (lines around the mouth)
• Skin creases • Accordion lines (vertical wrinkles that appear on the lower cheeks)
• Crepe-y skin
The science behind wrinklers
Repeated facial muscle movements (e.g. smiling, frowning, squinting) causes dynamic wrinkles as early as in our 30’s due to constant pull of the muscles on the overlying skin. Ongoing damage to the skin from factors such as ageing, sun exposure, smoking results in thinning of the skin, decrease in collagen and elastin, and reduced hyaluronic acid content. These changes result in wrinkles becoming static at rest.
Related blogposts:
Sleep Wrinkles: How to Prevent Aging While You Sleep
How to Get Rid of Neck Lines and Wrinkles
DIAGNOSING YOUR PREDOMINANT PATTERN OF AGEING
As you might realise, facial ageing for most people is really a combination of sagging, volume loss and wrinkles- and well fall somewhere along the spectrums. The reality is, very few individuals fit into one category alone. However, recognising the patterns and pathology of your signs of ageing allow for an individualised and evidence based approach for treatments. For example, a “sinker” might also have prominent “wrinkles” from years of sun exposure. Recognizing these classifications allows for a truly personalized and evidence-based treatment plan, moving away from a “one-size-fits-all” approach.
How can signs of sagging, sinking and wrinkles be treated?
How are sinkers, saggers and wrinklers treated?
Sharing the general principles for treating each category of ageing. Always consult with your doctor to discuss your concerns and tailor treatments to your individual signs of ageing and expectations. It’s about having safe, effective and natural looking outcomes- overfilled, overdone looking faces are passe.
Sinkers
As hollowness is the predominant pathology, the primary aim of treatment is to restore volume in hollowed regions to improve facial balance and lift tissues. Dermal fillers are useful in replenishing lost volume and restoring contours in affected regions, especially in regions like the cheek, temples and tear trough. These can be combined with biostimulators or bioremodelling treatments (such as Hybrid Cooperative Complex Injectable Moisturiser) that stimulate collagen and elastin to improve skin quality to enhance skin quality.
Related blogposts:
Getting Cheeky: A Guide to Cheek Filler Injections
Temple Fillers for Hollow Temples
Tear Trough Fillers for Dark Eye Circles
Is Profhilo the Injectable Skincare of the Future?
Neck Hybrid Cooperative Complex Injectable Moisturiser to Lift and Tighten the Neck
Saggers
Treatments for saggers aim to lift and support descended tissues with energy based devices and injectables, by building collagen and elastin in saggy tissues to lift and tighten the skin. Examples of energy-Based Devices include ghigh intensity focused ultrasound i.e. HIFU treatments. Injectables for collagen building in the skin include biostimulators like Hybrid Cooperative Complex Injectable Moisturiser; and dermal fillers as part of the liquid facelift that restores facial contours.
Related blogposts:
Getting Cheeky: A Guide to Cheek Filler Injections
Is Hybrid Cooperative Complex Injectable Moisturiser the Injectable Skincare of the Future?
Wrinklers
The cornerstone of treating wrinkles is with neuromodulators or botulinum toxin. Botulinum toxin injections relax overactive muscles, reducing dynamic wrinkles. Botulinum toxin injections can be combined with biostimulators or resurfacing skin treatments (e.g. fractional CO2 lasers) to promote dermal remodeling and reduce the appearance of static wrinkles.
Related blogposts:
What are the effects of long term Botulinum Toxin injections?
More Than Wrinkles: 5 Surprising Uses for Botulinum Toxin
Too Much BTX: Botulinum Toxin Gone Wrong
CONCLUSION
Ageing is a natural and complex process that affects everyone differently. Knowing your predominant ageing pattern—whether you’re a sinker, sagger, wrinkler, or a combination —treatment can be far more focused and effective. As I’ve always emphasised, aesthetic interventions should be safe, personalised, and evidence based.If you’re unsure of how to get started on treating or preventing signs of ageing, speak to your doctors for an analysis and individualised treatment plan.