Why the Face Can Look Less Firm After 40
Medically reviewed by
4 independent reviewers
Andrew Conrad Barile, PT, DPT
Doctor of Physical Therapy (DPT) | Licensed Physical Therapist (PT) | CEO and Founder, Xtreem Pulse LLC
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Dr. Andrew Conrad Barile is a Doctor of Physical Therapy and the CEO and Founder of Xtreem Pulse LLC, the engineering company behind PureLift. He earned his Doctorate in Physical Therapy from Daemen College and is a licensed physical therapist.
He brings over two decades of clinical and entrepreneurial experience across physical therapy, craniosacral therapy and medical device innovation, built on a working knowledge of human anatomy and muscle physiology.
For PureLift LAB he reviews how current is delivered across all ten levels, from sub-sensory nanocurrent and skin-level microcurrent to motor-level EMS, and how the Infuse pass fits into the same ten-minute routine.
Bertica M. Rubio, M.D.
Board-Certified Physician, Dartmouth Medical School | Medical Director, Antiaging Regenerative Medicine Clinic
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Dr. Bertica M. Rubio is a board-certified physician and Medical Director of the Antiaging Regenerative Medicine Clinic in Redlands, California. She earned her Doctor of Medicine from Dartmouth Medical School and completed her pediatrics residency at UC Irvine Medical Center.
With decades of clinical experience, she specialises in age management medicine, regenerative medicine, wound healing and growth factor therapies, and her practice integrates evidence-based medical science with advanced aesthetic treatment.
For PureLift LAB she reviews articles for medical accuracy across the whole dial, from the gentle nanocurrent and microcurrent settings through to muscle-level EMS and the Infuse pass.
Daniel Grinberg, MD, FACS
Board-Certified Otolaryngologist | Head and Neck Surgeon | Fellow, American College of Surgeons | Mount Sinai
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Daniel Grinberg, MD, FACS is a board-certified otolaryngologist and head and neck surgeon at ENT and Allergy Associates in West Nyack, New York. He earned his medical degree from Columbia University College of Physicians and Surgeons.
He completed his otolaryngology residency at New York University Medical Center, serves as Assistant Clinical Professor at Mount Sinai School of Medicine, and is a Fellow of both the American College of Surgeons and the American Academy of Otolaryngology.
For PureLift LAB he brings a wider clinical lens, connecting at-home facial stimulation from microcurrent to EMS to the anatomy underneath, with the same rigour we apply to every device specification.
Prof. Dr. med. Ivo Buschmann
Chair of Angiology, Medizinische Hochschule Brandenburg | Clinic Director, University Clinic for Angiology
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Prof. Dr. med. Ivo Buschmann is Chair of Angiology at the Medizinische Hochschule Brandenburg Theodor Fontane and Clinic Director of the University Clinic for Angiology at the Brandenburg University Hospital.
He trained at the University of Hamburg, was a Max Planck Society Fellow at the Max Planck Institute for Heart and Lung Research, and held senior consultant posts at the Charite Universitatsmedizin Berlin before his appointment as Chair in 2016.
One of Europe's leading authorities on arteriogenesis, with over 150 peer-reviewed publications and US and EU patents, he reviews for PureLift LAB how the evidence on electrical stimulation is read and where its limits lie.
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Four separate changes arrive around the same decade and they all look like sagging in the mirror.
This article explains what is actually happening, such as:
- The dermis thins
- The fat moves
- The muscle loses tone
- The bone remodels
- Working out which one dominates
and many more!
Working out which one dominates for you is what decides whether a cream, a device or a clinician is the right next step.
Key Points:
Collagen production falls roughly one percent a year from the mid-twenties, and ultraviolet exposure accelerates it far more than time does.
Facial fat sits in discrete compartments rather than an even layer, so loss is uneven and reads as hollow in one place and heavy in another.
Facial muscle loses tone like any muscle, and it is the one change a home device addresses directly.
Bone remodelling changes the frame everything drapes over and nothing non-surgical alters it.
Sunscreen prevents more of this than any product reverses.
The dermis thins
Collagen gives skin its tensile strength and elastin lets it recoil, and production of both falls steadily from the mid-twenties. The fibres that remain fragment rather than being replaced.
The result is skin that stretches and stays stretched, which is laxity. Compare the skin on the inside of your upper arm with the skin on your forearm and you are looking at the difference sun exposure makes to the same tissue at the same age.
Retinoids have the strongest evidence of anything available over a counter for dermal collagen, and sunscreen prevents more damage than any cream reverses.
The fat moves
Facial fat sits in discrete compartments, and they do not all shrink at the same rate. The upper compartments tend to lose volume while the lower ones hold on, and the retaining structures that keep everything in place descend.
The visible outcome is a face that looks hollow high and heavy low: a flattening cheek, a deepening fold from the nose to the mouth, and a jawline that has softened.
Nothing you apply and nothing electrical replaces lost volume; fillers do that job and the decision belongs with a clinician.
The muscle loses tone
Facial muscles behave like other skeletal muscle in the respect that matters: they respond to load, and without it they lose tone.
This is the change a device reaches. EMS crosses the motor threshold and makes the muscle contract; Kavanagh and colleagues measured an 18.6 percent increase in cheek muscle thickness over 12 weeks of motor-level facial stimulation across 108 women (10.1111/jocd.12007), and Chang and colleagues ran a double-blind sham-controlled trial (10.3390/ijerph17113783).
Better tone means better support under everything above it, which is a real and limited claim; it does not put back volume and it does not thicken the dermis.
The bone remodels
The facial skeleton changes shape with age. The eye sockets widen, the midface loses projection, and the jaw angle becomes less defined.
Everything else drapes over that frame, so a change in the frame changes the drape. Nothing non-surgical alters bone, and this is the part of ageing that is simply structural.
It is worth knowing about mainly so that you do not spend money trying to fix it with a cream.
Working out which one dominates
Pinch the skin on the back of your hand and watch how quickly it settles; slow settling points to laxity being a live part of the picture.
Look at your cheek in a mirror while lying down. If the face looks noticeably better horizontal, gravity acting on descended volume and reduced support is a large part of what you are seeing.
Compare a photograph from ten years ago in similar light. Hollowness where there used to be fullness points to volume; softening along the jaw with the cheek unchanged points more toward muscle and support.
What to do about each
For the dermis, retinoids and sun protection, and if you want to go further, a professional heat-based treatment.
For volume, a clinician.
For muscle tone, a device used consistently over months rather than weeks. On PureLift, levels 1 and 2 are nanocurrent and microcurrent, level 3 is where the motor threshold is crossed, and levels 3 to 10 are EMS.
For the bone, acceptance, which is not a product anybody sells.
Three minutes per side is the maximum on any PureLift model, and the ten minute session ends on its own. Photograph monthly in consistent light, because all four of these move too slowly to read day to day.
For the full breakdown of which technology sits where, see how the nine PureLift technologies work.