As people naturally age they fall into one of three distinct categories: “Sinker”, “Sagger”, or “Wrinkler”. Because each of these aging styles exhibits distinct aging traits, each has a different protocol for treatment.

The state of our skin plays the biggest role in determining if we are going to be Sinkers or Saggers as we age. As we age we lose collagen and elastin in our skin. These two proteins play a vital role in our skin elasticity.

We can see the diminished health and decrease of important structural support proteins in one of two ways. Sometimes the skin will get thinner and thinner, although it may not be droopier. This thinner skin may redrape over the shrinking of the underlying bone, fat and muscle and increase the Sinker appearance.

The question is what will happen to your face over time? Are you a sinker, sagger, or wrinkler?

In reality most us have features of all three and don’t fit perfectly into one category. I use these descriptions to help visualize and understand the changes that are occurring


Ask yourself the following two questions: Is your skin losing volume like a slowly deflating balloon, “sinking” in and wrinkling? If so, then you’re most likely a sinker.

Does your skin look like it is sliding away and down from the bone structure underneath? If so then you are probably a sagger, This is caused by your body losing the battle with the connective tissue in your face, leading to bags under the eyes and heavy jowls.


Is your face losing volume like a slowly deflating balloon? If so you’re probably a “Sinker”.

Sinkers are characterized by volume loss around key areas of the face which can cause a sunken hollowed out appearance. The temples, mid-face and the area below the cheekbones are the most common places where this volume loss occurs.

Sinkers: have some specific features, but in general there are more variations than a typical sagger.

Sinkers can have either thick or thin skin. They can start with large full cheeks or very subtle flat features. The common theme is that the face tends to deflate in specific areas. The eyes become more hollow underneath; the orbital rim (boney prominence of the eye socket) appears more visible and severe. The area around the mouth starts to develop vertical lines and appear puckered. Often the temporal region at the side of the head becomes concave (indented).

The nose can also appear more prominent. The nasal tip can droop and a previously straight nasal bridge develops a bump. If you have a grandma with an old photo from highschool look at her nose in the picture and look at it now. It is most likely drastically different.

Sinkers have better elasticity, and the skin redrapes over the lost facial volume. They begin to look sunken and even gaunt, especially the temples under the cheek bone. Their major problem is volume loss. A face lift for a sinker will do them no good and actually can give them unnatural look. They need to replace the lost volume using fillers and volumizers. In my experience there are more Sinkers than Saggers.

“The natural aging process causes us to lose about 10% of the fat in our face at the age of 35 years and an additional 5-10% every 5-10 years thereafter.”

By the age of 55 you can lose almost half the fat in your face, which once gave it a full, youthful appearance. Additionally the skin becomes thinner, and rougher in texture.

Rapid weight loss can often accelerate the visual effects of “Sinking”, including a hollow facial appearance and loose, wrinkly skin this causes on their face.

Sinkers benefit from a treatment plan utilizing fillers and/or fat transfer. A more youthful appearance can be achieved by adding a little bit of plumpness in the right places.


If your skin looks like it’s sliding away from the bone structure beneath, you’re a “Sagger”.

In some people the skin doesn’t look thinner, but it gets droopier. Instead of sinking with the underlying tissues, it can actually look like there’s too much skin. The underlying muscle and tissues also may look like they’re getting droopier as well. The soft tissues (muscle, connective tissue and skin) look like they’re heading south, rather than shrinking and sinking. This is the classic appearance of a Sagger.

“Saggers have loose skin and can appear to have too much skin. Just replacing the volume will not improve their appearance because it takes too much volume to make up the slack.”

Sagger typically have thick skin. They often had issues with acne in their teens or twenties and many still struggle with oil control. They tend to maintain very smooth looking skin with a few deep creases but overall are not “dry or pruney” looking. These patients tend to look much younger than their age well into their 30’s and early 40’s.

However, once a threshold for skin elasticity and subcutaneous fat loss is reached, everything drops….cheeks, jowls, brow all descend and suddenly these patients look drawn/tired. We see a dividing line develop in the center of the cheek. A once oval or heart shaped face becomes square and a taut neckline disappears. This is typical in many female Asian patients who look 30 years old “forever” and then suddenly age seems to catch up overnight.

A facelift can remove the extra skin. After a facelift a Sagger may begin to look like a Sinker, and will then need fillers and volumizers. Filling and volumizing before a facelift is not a good strategy.

When the skin’s connective tissues loses integrity, your face begins to lose the battle against gravity. As we age the skin’s connective tissues, elastin and collagen weaken and break down, so the skin loses its youthful, springy texture.

The most successful anti-aging treatments for ‘saggy’ faces involve a combination of volume restoration, and collagen stimulation with Sculptra and/or Venus Freeze RF treatments.


Last but not least we have the wrinkler. This takes the least amount of explaining as we have all see this person, most often leaving a tanning salon or on vacation at the beach.

These patients tend to have thinner skin to start and are very susceptible to environmental stress (UV radiation, smoking, wind, cold). Static lines (the lines that are always there, with or without movement) develop on the forehead, around the eyes and mouth, but the real damage can be seen when you ask them to close their eyes tightly and smile as big as possible. This brings out tiny lines in all directions due to the skin’s loss of collagen..

A “Wrinkler” will exhibit clearly defined patches of wrinkly skin, often located around the eyes, brow and lips. A lot of the time, wrinkles are from facial expressions made over time. Examples include:

  • Frown lines “11’s” from a scowl, or a furrowed brow in concentration or concern.
  • Crows feet: Radiating from the outer corners of the eyes, caused by squinting into the sun or at a computer screen, or even smiling.
  • Smokers Lines or Lipstick Lines around the edges of the mouth caused by puckering lips to smoke, use a straw or water bottle.

A little bit of Botox or Dysport will relax these muscles and not only reduce the likelihood of new wrinkles forming, but smooth the appearance of any existing wrinkles. There are also anti-aging dermal fillers that can be used to combat these signs of aging.


Whether or not your natural aging style is already apparent, there are a number of measures you can take to keep your complexion looking youthful:

  • SPF is everything! The aging process is accelerated by exposure to sunshine, so stay in the shade, stay out of the mid-day sun, and slap on some sunscreen.
  • Yo-yo dieting means frequently going on and off of diets. This affects the fullness of your face and can cause the skin to sag and make you look older than you really are.
  • Stop wine-ing. Keep your alcohol consumption to moderate levels. Excess alcohol can deprive the skin of the essential nutrients it needs to maintain a full, plump appearance. Drinking alcohol also causes dehydration, which makes the skin look rough, dry and sunken.
  • Another key tip is exfoliate! Regularly exfoliate your skin with either physical exfoliation (dermaplaning) or a chemical one (retinol, glycolic or salicylic acid) to shed dead skin cells and to encourage regeneration of collagen.
  • Being too skinny – Yes, you can be too skinny! Don’t believe the old adage “you can never be too rich or too thin.” (Well, maybe except for the first part!) However, being too thin accelerates the aging process and makes your face look hollow and skeletal
  • Finally, ensure you are eating a nutrient rich diet, that will supply your skin with the vitamins and antioxidants it needs to stay healthy.


Strawberries– High in Vitamin C, they heal damaged skin cells
Pumpkins– Filled with Vitamins C,E, and A, these key factors synergistically encourage collagen production
Olive Oil– Keeps your skin soft, reduces wrinkles and helps skin resist photoaging
Green Tea– Filled with anti inflammatory antioxidants, it neutralizes UV light, fights inflammation and rejuvenates skin cells


Everyone ages. Luckily, there are more options today. Knowing whether you are a sagger or a sinker is critical to knowing your options. It is impossible to make the face of someone in their 50s look like the face they had in their 20s, but it is possible to create a natural looking rejuvenated face.

Another interesting fact is that everyone’s eye sockets get slightly larger over time. This is one way forensic investigators and archeologists can assess age from looking at a skull. As a result of the expanding eye socket we tend to get bagginess, skin laxity and hollowness around the eyes as we age.

You may now be feeling pretty lousy about the grim scenarios I have laid out for you. But fear not, we have the technology and the tools to slow down, prevent and reverse these changes.

Kristin Gunn has specialized in aesthetic treatments since 2005. Her expertise includes facial rejuvenation with Botox and cosmetic fillers, as well as customized skin care routines.

*When it comes to the SPF debate, SPF 30 blocks 97% of rays and SPF 45 blocks 98% of UVA rays. Anything higher is just silly. Make sure you use sunscreen daily, even on cloudy days. This slows the aging of skin by preventing the breakdown of collagen, whether you’re a sinker or sagger.

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