Hello, I'm Dr. Yoosuk Chung, a plastic surgeon at The Line Plastic Surgery.
My friends don't seem to sag as much as I do
Many patients around the same age wonder why some people still look firm while they feel they've sagged noticeably faster. In consultations, I often hear patients blame themselves: "Is it because I haven't taken care of my skin?" But the truth is, it's rarely just about how well you've cared for your skin.
To get straight to the point: facial sagging isn't a problem with the skin alone — it results from the combined effects of bone, ligaments, fat, and skin. And the pace at which this happens varies significantly from person to person. Much of that difference appears to come from genetic background and environmental factors like sun exposure and smoking, rather than simply how much effort someone puts into skincare.
Why does the face sag in the first place?
Think of the face as a tent. For a tent to stay taut, its support pole (bone), the ropes that anchor it (ligaments), and the padding that fills out the fabric (fat) all need to stay in place. If any one of these weakens, the whole tent begins to sag.
For a long time, the scientific literature has described facial aging as a three main factors:: bone in areas like the eye sockets, cheekbones, and jaw being resorbed and losing supportive strength; fat layers atrophying and descending; and the ligaments that anchor tissue gradually loosening, allowing the whole face to shift downward[1]. Add to this a decline in the skin's own elasticity, and you have the traditional explanation for facial aging.
Four factors behind facial sagging — a conceptual diagram
So why does the pace differ so much from person to person?
Two proteins, collagen and elastin, play a key role in keeping facial skin elastic. As we age, the cells that produce these proteins (fibroblasts) become less active, while the enzymes that break down existing collagen and elastin actually increase — together causing skin elasticity to gradually decline.
The issue is that this rate varies significantly between individuals. A recent study integrating genetic, epigenetic, and lifestyle factors estimated the heritability of skin wrinkling at approximately 50%[2]. In other words, at the same age, a substantial portion of the difference in skin aging speed may already be determined by inherited an inherited genetic background. Another review suggests genetic factors may account for up to 60% of the variation in aging rate[3].
Beyond genetics, environmental factors — sun exposure, smoking, air pollution, alcohol consumption, and body mass index (BMI) — also play a role[2]. One study looking specifically at smoking found that heavy smokers (40 pack-years or more) showed wrinkling at a rate 3.92 times higher than non-smokers[4].
In summary, if you feel like you're sagging faster than others, that's likely not just in your head — it may reflect a real combination of inherited genetic background and acquired factors like sun exposure and smoking. Since genetic factors alone may account for roughly half the variation, skincare and lifestyle changes alone can't fully explain — or override — these differences.
Individual variation and things to keep in mind
The timing and pace of sagging can vary considerably between individuals depending on genetics, hormonal changes, sun exposure, smoking status, and weight fluctuations.
Even at the same age, the areas and patterns of sagging can differ based on skeletal structure and skin thickness.
The studies cited above analyze the mechanisms of facial aging; they are not clinical trials directly testing the effectiveness of any specific procedure.
This remains an active area of research, so it's worth discussing the latest information with a specialist at the time of consultation.
Three key takeaways
1. Facial sagging has long been explained as a combined result of bone resorption, fat atrophy, ligament laxity, and declining skin elasticity.
2. The rate of collagen and elastin decline — which governs skin elasticity — varies by individual, with genetic factors potentially accounting for 50–60% of that variation[2].
3. Acquired factors such as sun exposure and smoking also play a role — heavy smokers showed significantly higher rates of wrinkling than non-smokers[4].
The cause and degree of sagging can vary from person to person. Please consult in person for an accurate assessment.
By Dr. Yoosuk Chung (Board-Certified Plastic Surgeon)
--- Sources
1. Pessa JE, et al. The Science and Theory behind Facial Aging. Plast Reconstr Surg Glob Open. PRS Global Open
2. Facial skin aging: an integrative analysis of genetics, epigenetics, and lifestyle factors. GeroScience. 2025. Springer Nature Link
3. Genetic profiling and precision skin care: a review. Front Genet. 2025. Frontiers
4. Smoking and Premature Aging. Cosmetics & Toiletries. Cosmetics & Toiletries
This article summarizes questions around the causes of facial sagging and individual variation based on research published in academic journals. Please consult a specialist to confirm your individual condition.