What Each Anti-Ageing Treatment Actually Reaches — and What It Cannot

Which one you should have, I cannot tell you through a screen. What I can do is put these things back where they belong: which layer of the face each one reaches, and how hard that layer is to put right if it goes wrong.

Yi-Ching Lee, MD｜Founder, Yuan Sheng Yan・Licensed in Chinese and Western medicine in Taiwan
Published 1 October 2026　·　Last medically reviewed 18 August 2026

You have probably been recommended several of these already. A clinic will tell you the effect, how long it lasts, and how many sessions make a course.

Two other things come up less often: these treatments do not reach the same layer, and if the result disappoints, the difficulty of putting it right varies enormously.

So let us start there. You do not need to become half a doctor. You only need a table in your head to check a recommendation against.

These treatments do not reach the same layer

A face is not a sheet of skin. From outside in it has at least six layers: epidermis, dermis, fat pads, fascia, muscle, bone. In ageing all six change together — skin thins, dermal collagen falls, fat pads shift and shrink, fascia slackens, muscle tone changes, and bone is quietly resorbed.

Which is why “does this treatment work?” has no available answer. The question is: which layer does it work on?

This table does not tell you which is best. It tells you that if what has slackened is fascia, no amount of laser will move your face off the position it is hanging in — and if your complaint is skin texture, no depth of lifting will refine the skin.

So ask yourself one question first: what you dislike in the mirror — is it the quality of the skin, the position of the face, or the fact that the face has emptied? Those three answers lead to three completely different layers.

Why the layer is the first question

What I meet most often in clinic is someone who has had a good deal done, spent a good deal, and still looks in the mirror feeling something is off. Clinical observation

Asking further usually turns up the same thing: the layer treated and the layer she minds about were not the same layer.

Someone whose cheeks have emptied goes for lifting; the skin is tighter, the hollow is still hollow, and the extra tightness can make it read emptier. Someone whose complaint is rough texture has filler; the face is fuller, the texture has not changed at all. The treatment did not fail. It did its work, on a layer she was not concerned about. She bought the wrong layer.

Epidermis to dermis: lasers, picosecond lasers, microneedling, skin boosters

This layer deals with the quality of the skin itself: colour, texture, fine lines, pores, scars, hydration.

Lasers and picosecond lasers

The principle is selective delivery of energy to a specific target — pigment, vessels, water — so that it is destroyed or stimulated into rebuilding. Clinical consensus This belongs to the Western medical side and I do not perform it, but you should know its boundary: it can make skin look better, and where the face hangs is not its department.

Microneedling

What microneedling is, underneath, is the creation of controlled micro-injuries, traded for a repair response. Clinical consensus It makes skin regrow. It does not make skin thinner — that is the common misunderstanding.

I do perform microneedling myself (the same needle at different depths is doing different things), so I can be specific here. Clinical observation It needs a physician’s assessment first, and is not done during acute inflammation or where there is a wound or infection on the face or scalp. Do not buy a home roller and roll it yourself. Infection is a problem that actually happens, and depth cannot be controlled with those.

Skin boosters

Small amounts of hyaluronic acid and nutrients injected with a fine needle into the superficial dermis, working on hydration and skin quality. Clinical consensus

They use the same family of material as fillers for an entirely different purpose: fillers replace volume, boosters replace water. Small quantity, superficial placement, and mostly reabsorbed.

What to keep in mind is that this is still an injection: too superficial or unevenly distributed and small nodules can be left, and in thin skin the colour can show through. It replaces water. The contour of your face is still not its department.

Tightness: how radiofrequency and focused ultrasound differ

These two get discussed together, and even their names in some markets sound alike — but their depths differ.

Radiofrequency uses electromagnetic energy to heat the dermis and subcutis, contracting collagen and then stimulating new collagen. Focused ultrasound concentrates ultrasound energy to heat discrete points, reaching deeper, as far as the fascial layer.

What they share matters more than what separates them: both trade heat for contraction.

What I see in clinic

Clinical observation People who are thin, people whose faces had little volume to begin with, come out thinner. This is common enough that I now ask the question unprompted: “have you had radiofrequency or ultrasound recently?”

There is another reaction: tightness — not the tightness of looking younger, but a stiff, slightly stuck tightness. It feels different from the face that was there before.

Both of these are documented, with one boundary that matters. In the systematic review of subsurface radiofrequency, the way heat tightens skin is described plainly as coagulating the subcutaneous fat beneath it, and the most frequently recorded sequelae are hardness and palpable nodules. Published evidence That evidence concerns subsurface radiofrequency devices and should not be generalised to every surface platform. The same applies on the ultrasound side: one of its actions is reducing the size of fat cells. That is the principle behind using it for body fat reduction. Established knowledge

So “my face got smaller” is a selling point on a body and a problem on a face that had nothing to spare. The same mechanism, in a different place, means the opposite thing.

Fat that is lost does not grow back. That is the thing to know about this layer. Replacing it means filler or fat transfer — another procedure to make up for the last one. Clinical consensus

Burns

Clinical observation I have seen patients who were burned. Cases are findable online too. Energy that is too superficial or too strong can burn, and the operator’s experience and the generation of the machine both matter. Clinical consensus

As for the folk version that circulates — “too much and the flesh cooks” — Working hypothesis honestly, that is my own phrasing mixed with some internet lore. It helps people picture it, and I do not present it as an established mechanism. What is established is that burns happen, and that heat acts on fat.

And one more thing you will not hear in a clinic: a large share of the research on these devices comes from authors with a commercial interest. In the systematic review of subsurface radiofrequency, 77% of the included studies had authors with a known conflict of interest, and the authors wrote the sentence “marketing precedes the science” themselves. Published evidence I include it because many of the figures you hear in a consultation originate there.

In fairness: that is a pointedly argued review, and it concerns subsurface radiofrequency, which is not quite the same thing as surface devices. I use it because it sets out the mechanism most clearly.

Volume: what fillers actually replace

Filler is the most direct of these. What has hollowed is filled, and you can see it the same day. The problem it addresses is the most clearly defined: not enough volume.

Being direct is also why its problems are the most concrete.

What I see in clinic

Clinical observation Nodules and lumps are common. The most characteristic site is under the eye, where it reads as a ridge lying horizontally beneath the eye. Some people also get the Tyndall effect — a bluish cast showing through from beneath, most visible where the skin is thin.

Over longer periods there is something else: the whole face gradually puffs and flattens. The contours blunt, the features spread apart, the dimensionality fills in — what is often called a pillow face. This is usually not from one occasion. It accumulates from repeated top-ups, a little each time.

Reversibility is decided by the material

Hyaluronic acid can be dissolved with an enzyme, and that is its single greatest advantage. Most other materials cannot. The more a material is marketed as long-lasting, the harder it is for the body to deal with — and the other side of that sentence is that if you dislike it, it is also harder to remove.

The most serious one

The most serious risk with filler is blindness. Established knowledge The mechanism is filler entering a vessel by accident and embolising backwards into the ophthalmic arterial system.

The American Academy of Ophthalmology collated 198 cases of vision loss from intravascular filler injection in 2025. Some figures I want you to have:

• Material: hyaluronic acid in 164 cases (83%), autologous fat in 29 (15%), with small numbers of collagen, poly-L-lactic acid and calcium hydroxyapatite. This is the distribution among reported cases — hyaluronic acid is also by far the most used, so this does not make it the more dangerous material. The point that matters is this: a dissolvable material causes blindness too.
• Site: of 226 injection sites described, nose 90 (40%), forehead 56 (25%), glabella 26 (12%), frontal region a further 17 (7%). Those four come to 84%, all in the midface and upper face. Temple accounted for 21 (9%).
• Treatment attempted included hyaluronidase and intra-arterial thrombolysis, but reported recovery of vision remained limited.
• Final vision, where recorded (196 cases): unchanged in 137 (70%), improved in 56 (28%), worse in 3 (2%). More than seven in ten did not get their sight back.

At the moment of injection, say these immediately

Those numbers read easily as “if it happens, there is nothing to be done”. I would put it the other way round: the reason the recovery rate is low is that the time window is narrow. Sooner means more chance, rather than no chance.

If any of these appear during the injection or within minutes, say so there and then. Do not go home and wait.

• Pain out of proportion to an ordinary injection
• Skin blanching immediately, or a mottled, netlike purple-red pattern
• Blurred vision, a missing part of the visual field, loss of vision in one eye
• Eye pain, a drooping lid, double vision, or headache and nausea with it

Tell the physician who is injecting, immediately. Do not apply heat, do not massage it, do not wait and see whether it settles. If you have already left, go straight back or to the emergency department, ask for an ophthalmology review, and be clear about what was injected and where. That is the reason for the record card further down this page.

There is no agreed standard protocol for managing this, so what is written here is how to recognise it and how to report it immediately, rather than how to treat it.

Support: what a thread is pulling on

The effect of a thread lift comes from two things: the mechanical lift of the thread itself, plus fibrosis from the foreign-body response — the body’s encapsulation of a foreign object produces an additional sense of support.

Threads on the market run from fine and quickly absorbed to thick and barbed, sold on the proposition that thicker holds longer.

Clinical observation I have seen adhesion and fibrosis. Tissue grows along the thread, and over time things stick together — it feels hard, and it moves less.

But holding longer brings two problems of its own: asymmetry, and the oblique creases that appear when the pull is too tight — the cheek is carried upward and a few lines fan outward, where the tension has not been distributed. Clinical observation

Barbed and screw threads demand more of the operator. They hold tissue through their structure, so if the position or tension is not right there is almost no margin for correction: the thread is already inside. It cannot be stopped like a drug, and it cannot be dissolved like hyaluronic acid.

Muscle: what botulinum toxin does

Botulinum toxin works on muscle. It reduces the contraction of specific muscles, so a given line loses one of its chances to be folded in repeatedly. Clinical consensus

So what it is best at are lines still forming — forehead lines, frown lines, crow’s feet, the ones folded in by expression. For static lines long since set, there is a limit to what it can do.

What it looks like when it disappoints

Clinical observation Placement and dose are everything. When they are not right you get a heavy brow pressing on the eye, a mouth corner that drops, a hollow cheek. These look alarming, and fortunately they can be waited out.

Two things that come up less often

First, compensation. Clinical observation When one muscle is switched off, the muscles beside it take over the work. In the short term you cannot see it; over the long term the shape of the face changes. That is not ageing. It is the pattern of use being rewritten. This comes up in clinic more often than complications do, and far fewer people are told about it beforehand.

Second, secondary non-response. A small minority respond at first and then stop responding. Established knowledge It is not an inevitable result of repeated treatment, and the data on how often it happens in aesthetic use remain limited.

The reason is that the body develops neutralising antibodies, and whether antibodies develop is related to the impurities in the formulation. First-generation formulations contain clostridial complexing proteins, which act rather like an adjuvant and push the immune response up. Neutralising antibodies have been seen with those first-generation formulations, and not with second-generation formulations that lack those proteins. Published evidence

If you intend to use it long term, “a little less this time, a little later next time” is the thing that protects its future effectiveness.

How common secondary non-response actually is in aesthetic use remains thinly documented. The literature puts its weight on prevention, because once it has happened, the evidence for managing it is not solid.

Tone: what facial acupuncture does

Facial acupuncture uses very fine needles and works on the tone of muscle, fascia and structure. The way it acts is to give the body a stimulus and let the body do the adjusting. Clinical observation Which is also why it is slow.

I will be honest about the limit: unlike filler, you cannot see it the same day. It usually takes six to eight weeks before a direction is visible. If what you need is a result by next week’s wedding, this is not that tool.

Its value sits elsewhere: what the body grows itself does not become a foreign object to be dealt with later. If you do not like it, you stop. There is nothing to dissolve, nothing to remove, nothing to wait out while it is absorbed.

It gets asked about alongside botulinum toxin, and the two run in opposite directions: botulinum toxin stops a muscle working; facial acupuncture asks a muscle to find the tone it should have. One switches off, the other adjusts.

One boundary has to be drawn first: it adjusts tone, not volume. Bone that has receded and deep fat pads that have dropped are not things it can help with.

And the limits it does have should be stated: bruising is the commonest reaction, haematoma is possible where the skin around the eye is thin, and a few people get temporary heaviness of the eyelid or feel faint. Clinical observation A bleeding tendency, current anticoagulant or antiplatelet medication, local infection or acute inflammation — these need a physician’s assessment before deciding whether to proceed. Clinical consensus

Nor should it be presented as costless. It asks for time, for repeated sessions, and for your willingness to wait. No repeated procedure leaves nothing at all behind; what this one leaves is the body’s own tissue response, rather than something that has to be dissolved or taken out.

What happens when each one disappoints

This is the most important table on the page. Nearly all the material available on these treatments is about how good the effect is and how long it lasts. Very few people tell you what follows if it disappoints. That is the part that decides whether to do it.

Put this table beside the first one and a rule appears:

So depth itself is not the point. A facial acupuncture needle can reach the surface of bone, and the cost of putting it right is still low: it leaves nothing behind and takes nothing away. It leaves a stimulus. Botulinum toxin belongs to the same class: what it changes is whether a muscle works, and in time it wears off.

But let me finish the thought: depth still depends on how well the operator knows the anatomy. Safety there comes from training, not from the needle being fine. Clinical consensus

Conversely, fillers and threads are not necessarily placed deep, and they stay inside. The harder something is for the body to absorb, the fewer options you have later.

So when you decide, put the cost of if it goes wrong into the sum, alongside effect and price.

Five questions to have ready before you walk in

You do not need to understand how the machines work, and you do not need to memorise these terms. Have these five ready:

1. Which layer does this treatment work on? If the answer is unclear, or is only “the results are very good”, that is itself information.
2. What is my face short of right now — slackness, or emptiness? This sets the direction. Slack and empty need different tools.
3. If the result is not good, what is the next step? A good answer gives you concrete options, rather than “it will not disappoint.”
4. If I do not like it, can this be removed? For fillers, ask about the material. For threads, ask about absorption time.
5. Where exactly are you planning to inject? If the answer is nose, forehead or glabella, ask the extra question about risk and preparedness.

And one question for yourself: have I been sleeping and eating properly these last six months? If not, the most expensive treatment available is construction work on a body with no materials.

Keep a record card for your own face

I want to give this its own section, because it comes up again and again in clinic and almost nobody has been prompted about it.

Clinical observation Very few physicians ask patients to remember what they have had. Asked directly, most people cannot say — only “the one that was very popular”, “the one my doctor said suited me”.

Aesthetic medicine from Korea and Japan is widely taken up now, and people often arrive having been recommended a product name translated from another language, having had it done, with no idea what category of thing it was. Was it hyaluronic acid? A collagen-stimulating material? A thread? Unknown.

You can start keeping one yourself. Three columns:

• What was used: beyond the product name, ask which category of material it is. Is it absorbable? Roughly how long?
• Where it was placed: the site matters, particularly nose, forehead and glabella.
• When: the date. This column is the most useful one later, when the question is whether something is still in there.

A photograph of the receipt counts. A screenshot of the conversation counts. Do not rely on the clinic to keep it for you, and do not rely on your own memory.

And one more: do not stack too much into a short period

Seeing what someone else has had, or catching yourself in a mirror on a bad day, makes it easy to book several things at once. Clinical observation There are two problems with that.

First, many treatments take time before the result is visible at all. New collagen takes weeks to months; structural change is slower still. Stacked together, you cannot tell which worked and which did not, so next time you have even less to go on.

Second, the conjecture mentioned earlier: a single exposure to heat acts on fat, and whether repeated exposures accumulate has no direct evidence either way. Working hypothesis I lean conservative, because if they do, the volume that went is not replaceable.

If you do want to go ahead, my suggestion is one layer at a time, finishing the time that layer needs before looking at the next. That is how you learn what your own face responds to.

Order: repair the supply first, so the tools have something to work with

Whichever layer they reach, all of these treatments are doing the same thing underneath: producing a stimulus, then waiting for the body to answer. Laser waits for the epidermis to come back. Microneedling waits for dermal repair. Radiofrequency and ultrasound wait for collagen to build slowly. Even after filler goes in, the response of the surrounding tissue is the body’s.

So they all share one precondition: your body has to be able to answer.

A body that has been short of sleep, short of protein, and carrying stress that never comes down already has a crowded repair schedule. Adding a stimulus to the face at that point may not get scheduled in. Working hypothesis This is my judgement rather than an order proven by trials, and it genuinely shapes how I arrange things in clinic.

Common questions

Do I have to choose between radiofrequency and focused ultrasound? Their depths differ, and combining them is done in practice. But if you are on the thin side and your face has little volume left, I would be more careful about stacking the two. Working hypothesis That a single exposure to heat acts on fat is clear. Whether repeated treatments accumulate, I have not seen direct evidence for. This is my inference, and it is the direction I raise in clinic.

Can I have other things done after filler? Yes, but whoever treats you next needs to know what you had, where, and when. Say it without being asked — many physicians will not ask, and material sitting in the tissue affects both judgement and technique directly. This is the other reason for keeping your own record card.

Can facial acupuncture be combined with aesthetic medicine? Yes. Clinical observation My own approach is to use it as groundwork: get the structural tone sorted first, and other treatments tend to hold more steadily. During the swelling period after a heat-based treatment, acupuncture can also help the circulation clear it faster. How long to leave between them depends on where you are, and that needs assessing in person.

So which one should I actually have? Without having seen your face, I will not answer that. Be wary of anyone who gives you an answer through a screen. What you can do is take this table in and ask — then listen to whether the person can say clearly which layer they are working on. If they can, you are already in a better position.

What if I do nothing? That is an option, and for a good many people it is the right one. Sleeping enough, eating enough, and dealing with the stress affect a face more than you would think. These tools can help you move faster. The foundation is still yours to build.