Expression-related wrinkles
These wrinkles become more visible with expressions and commonly affect the forehead, glabellar area, and outer eye area. We assess muscle activity and the expressions you want to preserve.
botulinum toxin
WRINKLES & SAGGING TREATMENT
Wrinkles and sagging treatment
Repeated facial expression, skeletal support, fat position, and skin firmness all contribute. We assess the causes of wrinkles and sagging and consider appropriate injectable and device-based treatments for each patient.
Contents of this page
CONCERNS
Wrinkle and sagging concern checklist
A request to remove a line may not identify the most appropriate treatment. We first assess the changes that concern you.
Expression lines on the forehead, between the eyebrows, or around the eyes are noticeable
Nasolabial folds or shadows around the mouth have deepened
The cheeks appear lower
The jawline has become less defined.
Hollowing at the temples or cheeks has become more noticeable.
Skin feels less firm or elastic
Even concerns in the same area can have more than one cause.
For example, a nasolabial fold can reflect reduced cheek support, changes in fat position, and skin laxity. We assess the face both during expression and at rest.
THREE TYPES
Three types of wrinkles and sagging
Identifying the main cause clarifies the role and priority of each treatment.
Shadows caused by reduced support or hollowing
This may affect the temples, under-eye area, cheeks, and nasolabial folds. Changes in skeletal support or fat can make shadows appear deeper.
hyaluronic acidSkin and fat looseness
This includes a lower cheek position, heaviness around the mouth, or a less-defined jawline. Skin thickness and facial fat volume are also assessed.
Major candidates: RF, HIFU, and ALLTITEFACIAL AGING MECHANISM
Causes of wrinkles and sagging
Facial changes appear not only on the skin surface, but also on the skeleton, fat, supportive tissue and muscles.
The diagram explains that sagging can reflect both reduced skeletal support and loosening of the skin, subcutaneous tissue, and retaining ligaments. It compares the face with a tent: bone is the pole and base, skin and subcutaneous tissue are the fabric, and retaining ligaments are the supporting ropes. The sequence is: skeletal support decreases; collagen loss loosens the skin, subcutaneous tissue, and retaining ligaments; reduced support then becomes visible as shadows, hollowing, and sagging. The left example shows stable bone and taut ligaments, while the right shows reduced support and looser ligaments. Treatment concepts are to restore deep support with options such as hyaluronic acid, tighten superficial tissue and support structures with RF or HIFU such as DENSITY, HIFU, or ALLTITE, and combine approaches when needed because sagging rarely has only one cause.
Changes in skeletal support
As the facial skeleton changes with age, shadows at the temples, under the eyes, and around the mouth may become more noticeable.
Fat position and volume change
Fat may diminish in some areas and descend in others, contributing to lower cheek position and heaviness along the jawline.
Skin and supportive tissue
Changes in collagen reduce firmness and may appear as fine lines or excess skin.
Muscle movement creates creases
Repeated facial expression can crease the skin and gradually deepen into wrinkles that remain visible at rest.
OUR POLICY
Assess the whole face rather than committing to one treatment
Rather than treating only wrinkles or tightening only sagging tissue, we assess the face from the front, oblique, and profile views and during facial expression.
Preferences such as preserving facial fat, avoiding injections, or minimizing downtime are important. Treatment can be prioritized and staged rather than performing every possible procedure at once.
Please tell us about your location, past treatment history, desired change, budget, and commuting pace.
TREATMENT OPTIONS
Wrinkle and sagging treatment options
Each treatment has a distinct role. Candidacy, session count, and combinations are determined during the examination.
The original package image shows BOTOX VISTA, botulinum toxin type A injection, purified neurotoxin complex, 50 units, and the Allergan manufacturer name. The Japanese package labeling is retained unchanged so the product can be identified exactly.
EXPRESSION WRINKLES
Botulinum toxin injection
Botulinum toxin adjusts facial-muscle activity in areas such as the forehead, glabellar area, and outer eye area to make expression lines less noticeable. Dose is planned according to eyelid position and the expressions the patient wants to retain.
- Wrinkles that become visible with facial expression
- Effects generally appear over several days to two weeks
- There are individual differences in duration
VOLUME & SUPPORT
Hyaluronic acid injection
Restores selected volume or skeletal support to address shadows and contours at the temples, cheeks, nasolabial folds, mouth, and chin.
- Hollowing, volume loss, or shadows are noticeable
- Focus on overall face distribution and balance
- Select the product, tissue layer, and amount for each area
RADIOFREQUENCY
This treatment uses 6.78 MHz radiofrequency (RF) to heat the skin, with the aim of improving firmness and tightening. It may be considered when loose skin or fine lines are the main concerns.
- Skin laxity or fine lines
- Full-face or eye-area tightening
- Temporary redness or warmth may occur
MEDICAL HIFU
ULTRAcel Zi
High-intensity focused ultrasound (HIFU) delivers energy at selected depths, with the aim of tightening loose skin, selected fat, and the jawline.
- Heaviness of the cheeks or under the chin
- Plan treatment depth and area after examination
- Use caution when preserving facial fat is a priority
LIFTING & TIGHTENING
ALLTITE
ALLTITE broadly heats tissue from the deep dermis to the area around the superficial musculoaponeurotic system (SMAS), with the aim of tightening loose skin and support structures and promoting collagen remodeling.
- You want tightening while preserving facial volume.
- Plan settings with attention to discomfort and downtime
- Consider three sessions at intervals of 1–1.5 months
COMPARISON
Comparison of wrinkle and sagging treatment
Treatment selection depends on the change being addressed, not on ranking one treatment above another.
| Treatment | Mainly organized changes | Features | Treatment interval |
|---|---|---|---|
| Botulinum toxin | Expression lines and muscle movement | Moderates muscle activity | Reassess after approximately 3–4 months |
| Hyaluronic acid | Hollowing, shadows, and skeletal support | Restores selected volume | Varies by product and treatment area |
| Skin laxity, fine lines, and firmness | Heats the skin with RF | Consider once every six months | |
| ULTRAcel Zi | Excess fat or loose skin | Tightens deeper tissue with HIFU | Consider once every six months |
| ALLTITE | Skin laxity and supporting structures | Broad heating from the deep dermis to the area around the SMAS | Consider three sessions at intervals of 1–1.5 months |
*Treatment intervals are approximate. It depends on the skin condition, history of treatment, device settings, etc.
OUR FEATURES
Wrinkle and sagging treatment at our clinic
01
Assessment during expression and at rest
We assess not only the face at rest but also movements such as raising the eyebrows, narrowing the eyes, and smiling to distinguish expression lines from fixed wrinkles.
02
Support, volume, and skin
From the front, oblique, and profile views, we assess skeletal support, cheek and temple volume, and looseness of the skin and fat.
The diagram explains that sagging can reflect both reduced skeletal support and loosening of the skin, subcutaneous tissue, and retaining ligaments. It compares the face with a tent: bone is the pole and base, skin and subcutaneous tissue are the fabric, and retaining ligaments are the supporting ropes. The sequence is: skeletal support decreases; collagen loss loosens the skin, subcutaneous tissue, and retaining ligaments; reduced support then becomes visible as shadows, hollowing, and sagging. The left example shows stable bone and taut ligaments, while the right shows reduced support and looser ligaments. Treatment concepts are to restore deep support with options such as hyaluronic acid, tighten superficial tissue and support structures with RF or HIFU such as DENSITY, HIFU, or ALLTITE, and combine approaches when needed because sagging rarely has only one cause.
03
Share priorities and monitor progress
We agree on the changes to prioritize, budget, and acceptable downtime, then consider the next treatment while monitoring progress.
CASES & COLUMNS
Wrinkle and sagging cases and related articles
These cases illustrate treatment combinations and cause-based planning.
Scroll horizontally to see 10 cases
The original Japanese case graphic is titled “Lift the corners of the mouth with hyaluronic acid.” It presents the photographs in Before then After order and identifies Minato Motomachi Beauty and Plastic Surgery Clinic. The image is retained unchanged; the photographs show an individual case and do not guarantee the same result for another patient.
CASE 01
Support the mouth area and refine the profile
Shadows beside the corners of the mouth and support of the lower face are assessed together.
Read Case Column
The original Japanese case graphic is titled “Combined HIFU and hyaluronic acid treatment.” It presents the photographs in Before then After order and identifies Minato Motomachi Beauty and Plastic Surgery Clinic. The image is retained unchanged; the combination, timing, fees, risks, and response vary by patient.
CASE 02
HIFU followed by hyaluronic acid support
The separate roles of tightening and volume restoration are considered.
Read Case Column
The original Japanese case graphic is titled “Customized hyaluronic acid.” It presents the photographs in Before then After order and identifies Minato Motomachi Beauty and Plastic Surgery Clinic. The image is retained unchanged; injection sites and amounts are individualized and the photographs do not guarantee the same result for another patient.
CASE 03
Balance facial proportions through the forehead, cheeks, and chin
Assess overall facial proportions rather than only individual lines.
Read Case Column
The original Japanese case graphic states that hyaluronic acid was used to create a more balanced, smaller-looking facial contour. It compares Before on the left with After on the right and identifies Minato Motomachi Beauty and Plastic Surgery Clinic. The image is retained unchanged; injection volume and response vary by patient.
CASE 04
Treat muscle activity and volume as separate factors
A case combining botulinum toxin and hyaluronic acid.
Read Case Column
The original Japanese clinical case graphic compares the treatment stages for a plan combining HIFU with botulinum toxin. Read the photographs in the labeled Before-to-After order. The source image is retained unchanged; treatment choice, dose, timing, fees, risks, and response vary by patient and are explained in the linked Japanese case article.
CASE 05
Treat the jawline by assessing fat and muscle separately
Clarify the separate roles of HIFU and masseter botulinum toxin.
Read Case Column
The original Japanese graphic states that the effect of the clinic's hyaluronic acid treatment was maintained at the one-and-a-half-year follow-up. It compares Before with After at 1.5 years and identifies Minato Motomachi Beauty and Plastic Surgery Clinic. The image is retained unchanged; duration and response vary by patient.
CASE 06
Assess durability and additional treatment at one and a half years
Assess remaining hyaluronic acid and the timing of any adjustment.
Read Case Column
The original Japanese case graphic is titled “Natural customized hyaluronic acid.” It presents the photographs in Before then After order and identifies Minato Motomachi Beauty and Plastic Surgery Clinic. The image is retained unchanged; treatment sites, amounts, duration, and response vary by patient.
CASE 07
Balance the mid-cheek groove and central face
Assess the balance of the cheeks and chin as well as individual lines.
Read Case Column
The original Japanese case graphic is titled “Customized hyaluronic acid.” It compares Before with After for cheek and jawline contour and identifies Minato Motomachi Beauty and Plastic Surgery Clinic. The image is retained unchanged; treatment sites, amounts, risks, and response vary by patient.
CASE 08
Balance cheek hollowing and jawline contours
Consider volume loss and contour support together.
Read Case Column
The original Japanese case graphic is titled “Customized hyaluronic acid.” It compares Before with After for a plan addressing the eye area, cheeks, and jawline and identifies Minato Motomachi Beauty and Plastic Surgery Clinic. The image is retained unchanged; injection sites, amounts, risks, and response vary by patient.
CASE 09
Coordinate the eye area, cheeks, and jawline
Localized shadows and whole-face support are assessed together.
Read Case Column
The original Japanese clinical case graphic compares the labeled treatment stages for jawline treatment that includes a botulinum toxin lift. Read the photographs in the displayed Before-to-After order. The source image is retained unchanged; injection area, dose, fees, risks, and response vary by patient and are described in the linked Japanese case article.
CASE 10
Hyaluronic acid combined with a botulinum-toxin lift
Combine volume correction with management of muscle activity.
Read Case Column*Case photographs do not guarantee treatment results. Required amounts, clinical course, and final outcomes vary among patients.
PRICE
Fees
All displayed prices include tax. The treatment area and amount used are determined during the examination.
Botulinum toxin injection
Face expression 1 part¥33,000
2 parts¥55,000
3 parts¥75,000
Facial 4 parts¥88,000
Hyaluronic acid injection
1pc(1cc)¥77,000
Device treatment
DENSITY¥33,000
DENSITY Full face (250 shots)¥99,000
ULTRAcel Zi Full face + neck (Doctor)¥128,000
ALLTITE 300 shots 1 time¥55,000
ALLTITE 3 times course¥139,000
* Self-。。 FeesCurrent Fees Tableand final match.
FLOW
From consultation to treatment
Booking and medical questionnaire
Please fill in your desired area, past treatment history and desired changes.
Examination and consultation
We assess facial expression and the whole face, then explain likely causes, treatment options, expected changes, and risks.
Sharing treatment plans
Review treatment priorities, costs, visit intervals, and downtime.
After consent, baseline photographs are taken and the selected treatment is performed.
Follow-up
Aftercare instructions are provided, with follow-up as needed.
DOWNTIME & RISKS
Downtime and risks
Injectable treatment
Pain, redness, swelling, bruising, asymmetry, contour irregularities, infection, or allergy may occur. With hyaluronic acid, serious complications such as vascular occlusion, skin disorders, visual impairment can occur in rare cases.
RF / HIFU
Redness, warmth, swelling, edema, tenderness, numbness, altered sensation, burns, skin injury, or nerve symptoms may occur. HIFU may reduce fat in the treated area.
After treatment
Instructions differ by treatment. You may be asked to avoid alcohol on the day, strenuous exercise, prolonged bathing, saunas, and strong massage.
Symptoms that require immediate contact
If you have strong pain, white or purple discoloration of the skin, worsening swelling, visual disturbance, marked numbness, difficulty moving, or shortness of breath, please contact our clinic or medical institution immediately.
Unapproved medical devices and off-label use
Devices and treatments listed may include medical devices not approved in Japan or use outside an approved indication. Such devices may be obtained through lawful import procedures under a physician's responsibility, and there may be no approved equipment that has the same performance in Japan. Unapproved devices may not be covered by the Japan's Relief System for Sufferers from Adverse Drug Reactions. The individual approval status, acquisition route, and overseas safety information are explained during the consultation.
FAQ
Frequently asked questions
Can wrinkles and sagging be improved with the same treatment?
Wrinkles are related to facial muscle movement, skin stiffness, sagging may involve skeletal support, fat position, skin looseness, etc. Because the cause is different, you may combine multiple methods.
How are A case combining botulinum toxin and hyaluronic acid. used differently?
botulinum toxin mainly adjusts facial muscle movement, and hyaluronic acid complements reduced volume and skeletal support. Candidacy is assessed during the examination.
What is RF and HIFU?
RF may be considered for skin firmness and tightening. HIFU may be considered when tightening involving fat or deeper layers is intended. Facial fat volume and skin thickness are also assessed.
Is there a downtime?
Downtime depends on the treatment. Injectable treatments may cause swelling or bruising; device-based treatments may cause redness, warmth, edema, or tenderness.
How many treatments do I need?
It depends on the method of treatment and the desired change. Some treatments are assessed after one session, while others are performed several times at defined intervals.
Can you make natural changes?
Perceptions of a natural result vary among patients. We will check the front, oblique, and profile views and facial expression, and discuss which movements to preserve and which changes are desired.
Can I ask for advice if I do not know which treatment is right for me?
Yes. You do not need to choose a treatment name before your visit. We will ask for your concerns, history of treatment, downtime and budget.
COUNSELING
Start by telling us which changes concern you.
Please feel free to contact us if you are not sure what to choose. We assess the causes and explain priorities, including treatments that may not be necessary.