Are You a Sunker, Sagger or Wrinkler?

Have you ever looked in the mirror and thought, "Something looks different, but I can’t tell what?" That’s the moment when aging becomes visible and it is not just about wrinkles.

At Dream Clinic, I often ask my patients a fun but telling question: “Are you a sunker, a sagger, or a wrinkler?”

This is not a beauty quiz  it’s a helpful way to understand how your face is aging and which treatments might benefit you the most. Based on medical research, facial aging usually follows one or a combination of these three patterns. Let’s break it down.

The 3 Main Types of Facial Aging

1. The Sunker

“Why do I look tired or gaunt?”

Sunkers lose facial volume — the fullness that gives a youthful, healthy look. This can start in your late 20s or 30s and becomes more visible in your 40s and beyond.

You may notice:

• Sunken temples

• Darker, deeper tear troughs

• Cheeks that appear flat or hollow

• Deflated facial contours

  
  

Why does this happen?

• Thinning of bone structure, especially the maxilla and mandible

• Loss of subcutaneous fat (especially in mid-face and temples)

• Collagen and hyaluronic acid decline in the dermis

  
  

Treatments for the Sunker:

• Hyaluronic acid fillers (e.g. Juvéderm, Teosyal) to restore cheek, chin, and under-eye volume

• Biostimulators like Radiesse or Sculptra to promote collagen over time

• Polynucleotides (PNs) to improve skin density and elasticity

2. The Sagger

 “ My face feels heavy and pulled down”

Do you notice jowls forming, a less-defined jawline, or heaviness around the lower face? Then you might be a sagger – someone whose skin and deeper structures have started to descend due to gravity and tissue laxity, particularly in the lower face.

You might see:

• Cheeks that have drifted downward

• Deepening of nasolabial folds

• Marionette lines deepening

• Jowls forming along the jawline

• Saggy neck or undefined jaw contour

Why does this happen?

• Decline in collagen and elastin fibers

• Weakening of retaining ligaments

• Sagging of fat pads and thinning skin

• Loosening of SMAS (Superficial Musculoaponeurotic System)

Treatments for the Sagger:

• Ultrasound skin lifting (e.g. Ultherapy)

• Radiofrequency microneedling (e.g. Sylfirm X) for collagen remodeling

• Fotona 4D® Laser to tighten both externally and intraorally (great for mild jowls)

• Thread lifts (PDO or PLLA) to reposition sagging fat pads 

• Combination filler technique for structural support

3. The Wrinkler 

“I see lines even when I’m not moving”

Fine lines, deep folds, crow’s feet, and forehead wrinkles? Then you are in the wrinkler category. These changes are primarily due to repetitive movement, UV exposure, and thinning of the skin.

Why does this happen?

• Repeated facial muscle movements (dynamic lines)

• Chronic sun exposure causes collagen and elastin breakdown (photoaging)

• Skin dehydration and reduced turnover

• Loss of epidermal thickness and dermal collagen

***UV radiation accounts for up to 80% of visible signs of aging, according to research by the American Academy of Dermatology.

Treatments for the Wrinkler:

• Botulinum toxin (Botox, Dysport) to soften expression lines

• Skin boosters (e.g. Skinvive™ , NCTF) for hydration and glow

• Sylfirm X for utilizes a combination of microneedling and radiofrequency energy to stimulate collagen production and promote skin tightening, reducing wrinkles

• Polynucleotide injections to enhance skin repair and regeneration

• Fractional lasers and chemical peels to improve texture

Can You Be a Combo Type?

Absolutely. Most people age in a combination of all three ways — some more in one area than another. For example, someone may start as a wrinkler in their 30s due to expressive eyes, then become a sunker or sagger in their 40s.

That’s why facial aging should be assessed holistically, not just focusing on one wrinkle or one shadow.

Skincare Still Matters!

While in-clinic treatments are powerful, your home routine is still your first defense. A basic anti-aging routine should include:

• Retinoids to boost cell turnover

• Vitamin C serum for antioxidant protection

• Moisturizer with ceramides or hyaluronic acid

• Sunscreen (daily, even indoors)

Dr Eunice Khor

Final Thoughts: Know Your Aging Type, Treat It Smartly

Whether you are a sunker, sagger, wrinkler or all three, the key is understanding your unique aging pattern. At Dream Clinic, our approach is customized, science-backed, and results-focused. So come and meet me, Dr. Eunice — I’ll guide you every step of the way. Because aesthetic medicine today is not about changing your face, it is about preserving what makes you, you, with the right tools and knowledge.