u/ID_hospital

TL;DR: Botox relaxes the muscle movement that causes wrinkles. If a wrinkle only shows when you make a facial expression, Botox can actually help slow down the process of that line becoming etched into the skin. But if the line is already visible when your face is relaxed, Botox can soften it, but it usually cannot erase it completely. The treatment is the same, but the skin it’s working on is not.

In actual consultations, questions about preventative Botox come up pretty often, but they’re usually framed as, “Does preventative Botox actually work?” A more useful question is: what does Botox actually do, and why does the result change depending on the condition of the skin when you start?

What Botox actually does (and does not do)

Botox temporarily blocks the nerve signal that tells a muscle to contract. With that signal interrupted, the muscle doesn't move, and whatever expression was causing the line stops happening.

That's the full mechanism. Botox doesn't fill anything, doesn't thicken skin, doesn't reverse collagen loss. It stops a movement.

What does it mean for a wrinkle to become “etched” into the skin?

Every time you raise your brows, frown, or squint, the skin folds in the same place. At first, the line only appears during the expression. But over time, it can start to remain visible even when the face is relaxed. That is the shift from a dynamic wrinkle to a static wrinkle. Repeated folding mechanically stresses the collagen and elastin fibers, and the skin gradually loses some of its ability to bounce back to its original state.

When Botox is used at the dynamic wrinkle stage when the line only appears with movement, it can reduce how often that same area keeps folding. Twin comparison studies have also shown that the side treated regularly with Botox developed shallower wrinkles over time compared with the untreated side, so it is not as if there is no clinical basis for prevention. That said, it is also fair to mention that long-term data is still limited.

When Botox is used at the static wrinkle stage when the line is visible even at rest, the muscle still relaxes. Because the movement that kept reinforcing the wrinkle is reduced, the line may gradually soften, and with consistent treatment, it can become less noticeable over time. But the structural crease that has already settled into the skin usually will not disappear with Botox alone. It is difficult to reverse it to the same degree as preventing it in the first place, and that is less a failure of Botox and more about the nature of the skin change itself.

Realistic expectations by age group

For someone in their mid-to-late 20s with strong muscle movement and no resting lines: Botox at this stage can genuinely prevent lines from forming, and the maintenance dose required is usually lower because the muscles haven't been in a pattern for as long.

For someone in their 30s or 40s with resting lines already present: Botox remains useful and effective, but the expectation needs to shift. The lines will soften, particularly after consistent treatment over time. But "softened" and "gone" are not the same thing, and anyone expecting the latter from Botox alone in this situation will usually be disappointed.

For deep, established resting lines: Botox is typically combined with filler or skin resurfacing to address the structural component that Botox alone can't reach. The muscle is relaxed so the line stops being reinforced, while the filler restores volume in the crease itself.

So when is the ‘right’ time to start?

The word gets a lot of skepticism, usually from the idea that you're treating something that doesn't exist yet. But that's actually what makes it effective. Once the skin change is there, you're managing it. Before it's there, you're actually preventing it.

The right age to start isn't a fixed number. It depends on how expressive your face is, how quickly your skin is showing movement-related lines, and what your baseline skin quality looks like. A consultation that assesses movement and early line formation is more useful than any general guideline about age.

Has anyone here started Botox early and found it meaningfully changed how their skin is aging? Or started later and found the results weren't what you expected? Would be interested to hear both sides.

TL;DR: Ultherapy can improve the tissue descent that contributes to nasolabial folds, but it doesn't erase them. Understanding what the folds are actually made of explains why, and helps set more realistic expectations before booking.

Nasolabial folds are one of the most common concerns people bring up when researching Ultherapy. And the before and after photo above is a fair representation of what a good result looks like: the fold hasn't disappeared completely, but the area looks less heavy, the cheek sits slightly higher, and the overall face looks less dragged downward.

That's a realistic outcome. But to understand why it looks like that rather than a full erasure, it helps to know what nasolabial folds actually are.

Why nasolabial folds get deeper

The fold itself isn't just loose skin. It's the result of several things happening at the same time:

• The cheek fat pad descends with age, which means the tissue that used to sit higher is now resting on top of the fold line and deepening it
• The skin loses elasticity and collagen support, which means it no longer bounces back the way it did
• Volume loss in the mid-face means there's less fullness holding the cheek up from underneath
• The retaining ligaments that anchor the cheek tissue gradually loosen, which lets the whole structure drop

Ultherapy addresses one of those factors more directly than the others.

What Ultherapy is actually doing

Ultherapy uses focused ultrasound energy delivered at precise depths, targeting the SMAS layer, which is the same deeper muscular and fascial layer that surgeons work on during a facelift. The energy causes a controlled thermal injury at that depth, which triggers a collagen remodeling response over the following months.

Because it targets the structural layer rather than just the skin surface, it can produce some degree of tissue lifting that a surface-only treatment can't. The cheek sits slightly higher, which reduces how much tissue is folding over the nasolabial line.

What it can't do is restore significant volume loss, reattach ligaments that have substantially loosened, or fully correct a fold that has been deepening for many years. For those cases, the structural improvement from Ultherapy is often combined with filler or fat grafting to address the volume component separately.

Why results vary so much between patients

This matters because Ultherapy results are genuinely more variable than most marketing suggests, and anatomy is the main reason.

Someone at an earlier stage of descent with good baseline skin quality will see a more visible lift. Someone with significant volume loss, very loose ligaments, or substantially thinned skin will see less movement because the structural conditions are harder to work with. The energy goes to the same depth, but the tissue's ability to respond to the remodeling signal differs.

This is also why patient selection matters more for Ultherapy than people expect. It tends to work best as a maintenance treatment or an early-intervention option rather than a replacement for surgical correction once laxity is significant.

When to judge the results

Collagen remodeling after Ultherapy takes 3 to 6 months to complete. Most people notice the clearest improvement somewhere between months 2 and 4. Judging the result at 6 weeks is too early, and some people who felt like nothing happened have reassessed at month 4 and found a meaningful difference.

The photo above is a case where Ultherapy was used to address mid-face descent contributing to nasolabial fold deepening. The fold hasn't gone completely, but the tissue position has changed, and that's what the treatment is actually designed to do.

Has anyone here tried Ultherapy specifically for nasolabial folds? Curious whether people found it most useful as a standalone or whether it was part of a broader plan.

TL;DR: A revision facelift is not simply repeating the first surgery. Scar tissue, changed tissue layers, and the limitations left from the first operation can all affect what is possible the second time. In this post, we’ll look at a case that combined revision facelift + forehead lift + double chin liposuction + lip filler, and explain why each procedure was planned and what can actually be seen in the 6-month result.

One thing that comes up quite often with people looking into revision facelifts is the idea that if the first surgery was not satisfying, the second surgery just needs to be done “better” or pulled more strongly.

In reality, it is usually not that simple.

This is also where a lot of confusion can happen when people try to understand revision facelift cases or compare result differences, so it is worth breaking down carefully.

The first surgery changes the conditions of the second surgery.

In a first-time facelift, the tissue layers are relatively predictable. The surgeon can usually expect how the skin, SMAS, and deeper layers will move, because the tissue has not been operated on before.

In a revision surgery, that changes. Scar tissue from the first surgery can make the skin and deeper layers stick to each other. The SMAS, which is the deeper muscular/fascial layer handled in a facelift, may also not move independently the way it did before. Areas that would usually be easier to dissect may require a much more careful approach because of adhesions.

The previous incision lines are also a variable. Since the skin has already been lifted once, the surgeon needs to make a more conservative judgment about blood supply, tension, and which areas can be safely dissected. Areas that were accessible in the first surgery may be difficult to approach in the same way the second time.

Explaining this can sound negative, but it does not mean revision surgery cannot produce a good result. It just means the first surgery changes the conditions of the second surgery itself. Since the starting point is different, the safest surgical direction can also be different.

Why a forehead lift and facelift were planned together

On paper, a forehead lift and a facelift sound like separate procedures, but in real life, the face does not read them separately.

If the lower face is lifted but the brow and forehead still sit low, the person can still look tired. But if the brow is lifted too much while the lower face is kept natural, the result can look mismatched.

In this case, the Endotine forehead lift helped the upper face match the lower-face correction. Not in an exaggerated or surprised-looking way, but enough to make the overall face look less dragged downward.

That balance matters, especially in older patients, because aging usually does not happen in one isolated area.

Double chin liposuction and facelift surgery address different problems.

This is something that often does not get explained in enough detail during facelift consultations, so it is worth going over clearly here.

A facelift can improve tissue descent and jawline support, but it does not automatically remove fullness under the chin.

That is important because the jawline is not judged only from the front. From the side, even a well-performed lift can look less defined if there is still volume sitting under the chin.

In this case, double chin liposuction helped clean up the neck-to-jawline transition.

The facelift addressed descent and the liposuction addressed fullness.

They are different problems, but visually they affect the same area. That is why combining procedures is not always about “doing more.” Sometimes it is about not expecting one procedure to solve a problem coming from several layers.

In a case like this, lip filler is more of a supporting detail.

This part can be easy to misunderstand, so the intention needs to be made clear.

The lip filler here should not be read as "lip augmentation", but more as a small supporting detail within the overall facial rejuvenation plan.

In facial rejuvenation cases, small-volume lip filler can help restore definition around the mouth, especially when the lower face has been lifted and the surrounding tissue looks cleaner. If too much is added, it can look disconnected from the rest of the result. If it is used conservatively, it can help the lower face look a little softer and more complete.

It is a small detail, but in combination cases, small details can change how natural the full result feels.

What you can see at 6 months, and what you can’t

Six months is a useful point to compare before and after photos, but it is not always the final result.

This matters even more in revision cases. When the tissues have already been operated on once, they often take longer to soften the second time. Scar remodeling and tissue settling can keep changing for a few more months after the 6-month mark.

So with that in mind, what stands out in this case is not one dramatic change in one single area. It is more that the whole direction of the face looks different.

Before surgery, the lower face and neck had more of a heavy, downward pull. After surgery, the jawline looks clearer, the neck line looks cleaner, and the upper face looks a little more open too. And honestly, for a revision facelift, that last part matters a lot: the result still looks like the same person.

When revision facelifts are pulled too aggressively, the face can start looking tight, flat, or strange from certain angles. A good revision result is not really about wiping away every sign of aging. It is more about bringing back the support that was missing, without making the face look like it belongs to someone else.

For anyone who has looked into facelift revision, what part has been the hardest to understand: scar tissue, recovery time, surgeon choice, or figuring out what went wrong with the first lift?

Did you know that the order you do these in matters more than which ones you choose? After seeing a lot of consultation breakdowns in this sub and talking to people who felt like their results were underwhelming, most of the disappointment traces back to a few specific missteps, and not the treatments themselves.

The photo below is also an example of the kind of change people may expect after this type of combination treatment. These treatments are not meant to completely change the face. The improvement is usually more about skin texture, pores, tone, and mild firmness, so before-and-after photos should be read as changes in skin condition rather than a dramatic facial transformation.

1. Doing Thermage too often because results felt slow

Thermage works by delivering heat deep enough to trigger a collagen contraction and remodeling response. The problem is that remodeling takes 3 to 6 months to complete, and most people judge it at 6 weeks when almost nothing has happened yet. So they book another session.

What surgeons rarely publish but see clinically: repeated Thermage at short intervals doesn't accelerate results. It can actually cause fat attenuation in the mid-face over time, meaning the cheeks gradually lose volume in a way that reads as premature aging. One session per year is the standard for a reason.

• Photos at 6 weeks are not representative of the final result
• The "I didn't see anything" feeling at weeks 4 to 8 is normal and not a sign of treatment failure
• More energy is not always better; undertreated is recoverable, overtreated is not

2. Expecting Virtue RF to do the same job as Thermage

Both Thermage and Virtue RF use radiofrequency energy, which is where most of the confusion starts. Thermage sends heat through the skin surface to reach deep structural tissue. Virtue RF uses tiny needles to deliver RF energy directly into the middle layer of the skin, which makes it more precise but also more shallow.

The practical difference is that Virtue RF is better at resetting what you see up close, things like pores, uneven texture, and early scarring. Thermage is better at addressing the kind of sagging or looseness you notice in photos. Expecting one to do the other's job is where a lot of people end up disappointed.

• If deeper tightening is the primary goal, Virtue RF alone may not be enough
• It works well for pore refinement, acne scarring, uneven texture, and mild firmness
• Redness and sensitivity typically resolve within 2 to 5 days
• It pairs well with skin botox and Re2o because all three improve skin quality but none of them overlap in what they actually do

3. Treating Re2O as a one-time glow shot

Re2O gets grouped with regular skin boosters but it works differently. Most hydration shots give you a temporary plumping effect that fades as the product breaks down. Re2O contains ingredients that tell your skin cells to start repairing and rebuilding, so the improvement is slower but it's coming from your own skin doing the work rather than from something sitting in it.

The mistake is doing one session, feeling a bit of hydration for two weeks, and concluding it did nothing. The results build over a course of treatments, and judging it at one session is like stopping a course of antibiotics halfway through because you felt a bit better.

• It is not a volume treatment and should not be judged like filler
• Results show up as better texture, tone, and overall skin condition rather than any shape change
• A course of sessions is standard; one session on its own is largely wasted money
• The active ingredient comes from salmon DNA, worth knowing if you have a fish allergy
• It pairs better with energy treatments when recovery time between sessions is properly planned

4. Not understanding what skin botox is actually doing

Skin botox (mesobotox) confuses people because the name implies it works like regular botox, but it doesn't. It's injected into the very superficial dermis, nowhere near the muscle, so it has zero effect on facial movement or expression.

What it actually does at that depth is it calms down the tiny muscles attached to each pore and reduces oil gland activity around them. The result is smaller-appearing pores, reduced surface oiliness, and a skin smoothness that shows most under direct light. Most patients notice it within 7 to 10 days.

• Duration is shorter than regular botox: 3 to 4 months on average, not 4 to 6
• It pairs well with Virtue RF because they target the same surface concerns through different mechanisms
• It is not interchangeable with regular botox in the same appointment; depth and dosing are calculated separately
• Results are subtler on dry or already-refined skin; the payoff is higher for oily or large-pore skin types

If you've done any combination of these, what was the sequencing you were given and did anyone actually explain the reasoning behind it?

When people travel for surgery, the "why" is usually more than cost. This is Bolor's case, a 48-year-old working in New York's fashion industry. She hadn’t made the decision impulsively. Even during the consultation, it was clear that she had done a lot of research before flying in.

Her concern wasn’t “aging” in the dramatic sense. It was more subtle than that. The way she put it was that she looked tired in a way that no longer felt like herself. She decided that if she was doing a total transformation, she wasn't doing it in the States.

Why not New York?

She had consultations locally as well, but most of the feedback she received was focused on individual procedures.
In the end, she chose Korea for three main reasons.

• Expertise in Asian anatomy- She wanted her features preserved, not westernized, a refreshed version of herself, not a different face.
• The natural aesthetic- The goal was "youthful," not "pulled." Anyone in fashion knows the difference immediately.
• Integrated care- In the US, a case like this might mean moving between different clinics for skin, facial structure, and breathing concerns. Here, those areas could be reviewed by the relevant specialists within one hospital system, under one roof, which made the overall plan easier to coordinate.

The full surgical breakdown

This is a good educational case because the procedures work together as a system, not in isolation.

Structural anti-aging (the foundation)

Rather than tightening skin at the surface level, the approach targeted deeper layers and volume:
• Full face SMAS lift: works on the underlying muscle layer for a result that holds longer and reads more natural than a skin-only lift
• Endotine forehead lift: addressed the brow heaviness that was making her look tired and visually heavy around the eyes
• Fat grafting including upper eyelids: restored the volume loss that no amount of lifting alone fixes. This is an underappreciated step in anti-aging work: faces don't just sag, they also deflate, and the two need to be corrected together for the result to look natural

Feature refinement

• Functional + cosmetic rhinoplasty- she had breathing difficulty on one side. The surgery corrected that structurally while also slimming the bridge, correcting a bulbous tip, and addressing a slight asymmetry. Donor cartilage was used. A quick note on that since it comes up often in complex cases:
• Used when existing septal cartilage isn't sufficient for the correction needed
• Integrates more naturally than synthetic implants long-term
• Gives the surgeon more structural material to work with

• Revision double eyelid- her original line had become indistinct from volume loss and sagging. This restored a clean, defined crease without looking operated-on. Importantly, the fat grafting done above the lid and the eyelid revision were planned together, fixing the crease without addressing the hollow above it would've produced an incomplete result

Where Seoul's post-op protocol differs

This is honestly where a lot of the gap between Western and Korean plastic surgery outcomes comes from not just the surgery itself, but what happens after.

Bolor's recovery included swelling reduction laser, regenerative skin treatments, and exosome therapy. She noticed a meaningful difference in skin elasticity and hydration that she hadn't experienced from any prior treatment. Fast recovery after a surgery this extensive doesn't happen by accident, it's the protocol.

The foreign patient infrastructure also removed the friction that can make medical travel feel risky: dedicated translation, coordinated nursing care, and easier follow-up with relevant specialists within the same hospital system.
Recovering in an environment where these things are well organized is very different from recovering in one where they are not. It may sound like an administrative detail, but it is actually a clinical issue too, because stress can have a real impact on recovery. And for someone flying in from New York with a demanding professional schedule, that logistical reliability matters as much as the surgical outcome.

6 months out

The before and after shows what you'd want to see: the brow sits higher and more open, the eyelid crease is clean, the nose is slimmer through the bridge and tip with the asymmetry resolved. The face has lifted but there's no tension or tightness. Not looking “surgical” or "done" is one of the signs of a well-done SMAS lift.

A few things worth keeping in mind when looking at results at this stage:
• Facelift and forehead lift results are largely stable by month 6
• Rhinoplasty continues refining through month 12, the nose will still get cleaner
• What you're seeing now is already a strong result, but not the final picture
She looks like herself. Just a version that matches how she's always carried herself.

The takeaway

For complex, multi-layer facial work, the "where" matters as much as the "what." For Bolor, 14 hours on a plane was a reasonable price for a result that felt like her, but just with the clock turned back.

Has anyone here done lifting and facial feature refinement together?
Especially if your case involved both a functional issue and a cosmetic goal, I’d be really interested to hear about it. What was the hardest part: the planning stage, the recovery, or something else? Would love to hear your experiences.