Bone, fat, ligaments and skin age at different rates. Identifying which one is driving your concern is what determines what will actually work.
One day, the face in the mirror seems to sit slightly lower than it used to: the jawline looks less defined and the skin less supported. The good news is that facial sagging can be improved; the key is understanding that it does not exist in the skin alone.
The face is supported by several layers, and each one changes at its own pace. What works for you depends on which layer is responsible for what you see. That is why so many treatments disappoint: not because they do not work, but because they target a layer that was not the main issue in that particular face.
It is a very common observation: many women who take excellent care of their skin still notice that their face gradually loses definition.
Over time, the facial bones remodel and provide slightly less structural support, particularly around the cheekbones and jaw. The fat compartments that shape the midface lose volume and descend to some degree. The ligaments that anchor the tissues become less supportive. And the skin, producing less collagen and elastin, has less ability to adapt to all of these changes.
The visible result — deeper folds, a less defined jawline — is the sum of these changes, not the failure of a single structure. Understanding this has an important practical consequence: looking after the skin still matters, but if what has changed is the underlying support, treatment needs to address that support.
They work on the layer they can reach: the skin. And their role there is real. Daily sun protection is one of the most effective ways to slow long-term collagen breakdown, while retinoids have been shown to improve skin texture and density with consistent use. If your sagging is mild and mainly related to skin quality, this may be enough to maintain your skin well for years.
What no cream, facial exercise or home-use device can do is reposition descended fat, restore structural support that has been lost through bone remodelling, or correct more established skin laxity.
It is not a matter of finding the right product: the issue lies at a depth these methods cannot reach. If you have invested in several of them and seen only subtle results, you did nothing wrong — you were simply treating one layer, while your case probably involves others as well.
The same stories appear repeatedly online: radiofrequency sessions that improve the skin but leave the facial contour unchanged, threads that did not deliver the expected result, or expensive devices with changes that are difficult to see.
Most of the time, the technique itself is not the problem. Each treatment acts on a specific layer, and if the indication does not match the layer that has changed in that face, the result will fall short.
Put simply:
That is why the useful question is not “What is the best treatment for facial sagging?”, but “Which layer is causing mine?”. That is the question any medical assessment of facial sagging should answer before recommending treatment.
“Some patients come to the clinic asking for the treatment that worked for a friend or that they saw on social media. And the most common mistake I see is exactly that: choosing the technique before making the diagnosis.
Two faces with the same apparent degree of sagging may need completely different treatment plans, because in one case the main cause is the skin and in the other it is structural support.
When I assess a face, the first thing I want to understand is not what is visible, but what is causing it. Sometimes that means the area that bothers the patient most is not the first one that should be treated — and explaining why is one of the most important parts of the consultation.”
Aesthetic doctor, educator in aesthetic medicine and director of Clínica Provença.
Treatments guided by medical judgment, with personalised planning and a conservative approach.
Licensed physician No. 55671 · Barcelona Medical Association
There comes a point when excess skin and tissue descent go beyond what aesthetic medicine can correct.
In those cases, the treatment that can truly address the problem is surgical — a facelift. Aesthetic medicine can complement surgery before and after, or improve specific concerns if surgery is not part of your plans; what it should not do is present itself as a substitute once it no longer is one.
Treatment is not always necessary. If what you notice is only a mild softening of the facial contour and it does not bother you when you look in the mirror, sun protection, a good retinoid and stable lifestyle habits may be all you need for a long time. Facial sagging tends to progress gradually, and there is no need to book a consultation “just in case”.
An assessment makes sense when what you see in the mirror is genuinely starting to bother you, when you have tried several things without getting the result you expected, or when you want to know — before spending money on anything — which layer is driving your case and what realistic options you have, including the option of waiting. Leaving a consultation with that understanding already changes the way you make decisions, whether you go ahead with treatment or not.
If you have read this far, you already have the answer that search results rarely give you: facial sagging is not something you simply “eliminate” with a product. It needs to be understood layer by layer and treated — or left alone — with sound medical judgement. The next step, if you want to take it, is to identify what is happening in your own face.
Free initial consultation. Medical guidance, with no obligation.
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Dr. Manuela Gheorghiu is the Medical Director of Clínica Provença in Barcelona, where she defines the clinic’s clinical standards and treatment protocols, and practices as an aesthetic doctor.
Professor of the Master in Aesthetic Medicine and Comprehensive Rejuvenation of the Catholic University of Valencia and the European Medical College.
Graduated in Medicine and Surgery with highest honours from the Carol Davila University of Medicine and Pharmacy in Bucharest, with her medical degree officially recognised in Spain.
She completed her specialised training in Aesthetic Medicine in Spain, earning a Master’s Degree in Aesthetic Medicine from the University of Córdoba.
She maintains ongoing scientific training, with a strong focus on clinical safety and precision in both treatment indication and execution.
Member of the College of Physicians of Barcelona (COMB), with the number of collegiate 55671, and holder of the Diploma of Accreditation of Training in Aesthetic and Cosmetic Medicine (DIACAP), issued by the COMB.
Member of the Spanish Society of Aesthetic Medicine (SEME) with the number 2729.
Member of the Association of Aesthetic Doctors of Catalonia (SMEC) with the number 65.
Member of the Spanish Society of Fat Transplant Applications (SETGRA).
Professor of the Master in Aesthetic Medicine and Comprehensive Rejuvenation of the Catholic University of Valencia and the European Medical College.
Advanced training and ongoing participation in specialised national and international programmes in Aesthetic Medicine.
Her main areas of expertise include:
Inject Art Lab Course, Advanced Clinical Training in Regenerative Aesthetic Medicine, IT Pharma (2026).
Full-Face and Anatomy workshop, Croma Anatomy, Medical University of Vienna, Center for Anatomy and Cell Biology (2026).
Ultrasound in Aesthetic Medicine: Present and Future, Barcelona Medical Association (2026).
41st National Congress of Aesthetic Medicine and 7th SERECAP Congress (Spanish Society of Hair Restoration), 2026.
Practical fundamentals of aesthetic ultrasound, Dermica Laboratories (2026).
Dermamelan Expert Meeting: leading medical approach to depigmentation, Mesoestetic (2025)
Latest trends in Thread Tightening: Anatomy, advanced technique and results, Croma (2025).
Buttock approach: “New Round Raised Technique”, Dermica Laboratoires (2025).
Galderma Gain Spark Training: “Shaping Progress in Aesthetics’ Real-World Knowledge, Highlighting the latest trends and treatment innovation” (2025).
Well Aging training module: mastering the art of “less is more” and stimulating collagen production for better skin quality, Galderma (2025).
Hands on Sculptra, collagen biostimulator, Galderma (2025).
Seminar on ‘Addressing Facial Sagging in Aesthetic Medicine,’ Barcelona Medical Association (2025).
“Natural Beauty” training: enhance natural beauty with facial harmonization techniques and dynamic wrinkle treatment, Galderma Academy (2025).
Professional seminar ‘Medical-aesthetic treatment with hyaluronic acid in the mid-face and under-eye area’, Barcelona Medical Association (2025).
24th World Congress of Aesthetic Medicine (2025).
40th Congress of the Spanish Society of Aesthetic Medicine (2025).
Nuceiva neuromodulator training, anatomy and clinical results, Evolus Inc. (2024).
Hands on: Launch of Galderma’s NEW neuromodulator Relfydess (2024).
Practical Theoretical Workshop – Special: Collagen Biostimulator, Galderma (2024).
Skymedic Regenerative Day: Exosomes, advanced photobiodynamic therapy and carboxytherapy (2024).
Teoxane’s course in Aesthetic Medicine, advanced level: facial anatomy, middle third and redensification, upper third, rheology, eyebrows, lips and gummy smile and lower third (2024).
Training course on ‘Neuromodulators in aesthetic medicine’, Barcelona Medical Association (2024).
Lifting and Redensification facial treatment training, Galderma (2024).
“Galderma on stage” workshop: anatomy, Skinboosters treatments, collagen biostimulators, dynamic wrinkles, middle third and under-eye circles, lips, rhinomodeling, chin and complications (2024).
Formation of Sculptra corporal, Galderma (2024).
Course “Brighten your patients’ skin”, Galderma (2024).
Session “Discover the best profile of your patients”, Galderma (2024).
Galderma clinical session: Restylane Vital+Sculptra (2024).
Galderma training workshop: Harmony and balance of proportions (2024).
Teoxane Training Workshop: Facial Masculinization (2024).
IBSA training workshop: approach to transgender patients (2024).
Sinclair training workshop: Lanluma day (2024).
Sinclair Hands On: Body Lanluma (2024).
Training by the Barcelona Medical Association: Lasers and light sources in medicine (2024).
Training Spanish Society of Aesthetic Medicine: Anesthesia and Resuscitation in Aesthetic Medicine (2024).
Expert Diploma in Leadership in Aesthetic Medicine – CEU University (2023).
Webinar Skinbooster treatments and skin quality, Galderma (2023).
Allergan Hands On Training: Workshop on Facial Ultrasound as a diagnostic tool in the daily practice of Aesthetic Medicine (2023).
Allergan Training – Master Class: HarmonyCa and Juvederm (2023).
Allergan Behind Beauty 360º Training (2023).
Teoxane training: Lip training workshop (lip techniques, 2023).
Teoxane training: Clinical session (diagnosis of clinical cases, 2023).
Teoxane Academy Regional Congress – MLT 3.1 Technique (2023).
Fillmed training (Protocols: Bionutrishape, Bionutrilift, Bionutrilips, Full-face, 2023).
Fillmed training (Dermatocosmetica, 2023).
Sinclair Hands On (Ellansé and Maili).
Neauvia formation: hyaluronic acid + pen plasma (2023).
Training Galderma Botulinum toxin liquid: Alluzience (2023).
Galderma Formation: Sculptra + Lyft (2023).
Galderma training: dissection of cadavers (ACME Mallorca, 2023).
IBSA Hands On Training (Profhilo, Skinko, 2023).
IBSA Training: Approach to complicated lips (2023).
IFMIL Training- Basic Life Support Course + DEA (Consell Català de Ressuscitació, 2023).
IFMIL Training-Theoretical and practical workshop on minor outpatient surgery (cutaneous, subcutaneous, continuous and discontinuous sutures, wound management and dermatological lesions, 2023).
Training by the Barcelona Medical Association: Adverse effects with materials (2023).
Thermage Hands On Training (2023).
Candela laser training: Nordlys IPL (PR 530 and VL 550) (2023).
Lumenis laser training: IPL and ERBIO YAG (2023).
Lumenis Laser Formation: CO2 (AcuPulse, 2023).
HANDY Laser Training – Plasma Pen (2023).
Master Class: Rejuvenation of face / neck / neckline / hands – by CO2 laser (2023).
Master Class: Non-surgical eyelid retraction & Endolifting (2023).
Aesthetic Surgery Training: Endolifting (2023).
Aesthetic Surgery Training: Nanofat (2023).
Facial and Body Aesthetic Surgery Training: Lipolaser with Liposuction (2023).
Allergan Hands on training: Hyaluronic acid middle/lower/upper third (MD Codes- Mauricio di Maio, 2022).
Allergan Hands on Training: HarmonyCa (2022).
Allergan Hands on Training: Botulinum Toxin (2022).
Teoxane formation: Hyaluronic acid (middle/lower/upper third, 2022).
Teoxane training in collaboration with Cardenal Herrera University: Expert in leadership in Aesthetic Medicine – Training in marketing, sales, facial treatments (2022).
Galderma formation: hyaluronic acid (middle/lower/upper third, 2022).
Galderma training: Sculptra collagen stimulator, Skinbooster (2022).
Merz Formation: Radiesse (2022).
Chroma Formation: Hands on Juvenus Medium-Strong/Skinbooster Rich pure (2022).
Dermica Laboratoires Training: Penis thickening with hyaluronic acid (2022).
Medyglobal Tornado/ Harpoon/ Screwcog (2022).
Medyglobal Training: Body hyaluronic acid and Buttock Treatment DeneB H. (2022).
Medyglobal/Merz Training: Buttock Reshaping with Radiesse and PDO Threads (2022).
Sinclair Training: Buttock Augmentation and Reshaping with Lanluma (2022).
Regenlab (Blisscare) training: PRP/Cellular Matrix (2022).
Regenlab (Blisscare) training: PRP/Cellular Matrix (2022).
Training Spanish Society of Aesthetic Medicine: Filler implants in aesthetic medicine with classroom practice (2022).
Training Spanish Society of Aesthetic Medicine: Collagen Stimulators (2022).
Training Spanish Society of Aesthetic Medicine: Facial flaccidity (2022).
Training Spanish Society of Aesthetic Medicine: Dermatoscopy, teledermatology and topographic dermatology in Primary Care (2022).
Training Spanish Society of Aesthetic Medicine: Business Management in Aesthetic Medicine (2022).
Training Spanish Society of Aesthetic Medicine: Business Management in Aesthetic Medicine (2022).
Training Official College of Physicians of Barcelona: New developments in facial treatments—gummy smile/lower third/dark circles (2022).
Training Official College of Physicians of Barcelona: New developments in the prevention and diagnosis of chronic venous disease (2022).
Training Catalan Society of Aesthetic Doctors: Facial fillers: Lights and shadows (2022).
Fellowship at Clinica Now in Portugal with Dr. Abraham Valência (2022).
Pronokar Formation (2022).
Lipedema training (2022).
National Congress of SEME and SERECAP, Malaga (2022).
Accreditation for the use of Botulinum Toxin in Aesthetic Medicine (2021).
Allergan Botulinum Toxin Training (2021).
PRP Hy-Tissue/ QREM CYTOKINE Training (2021).
Specialization Diploma in Musculoskeletal Ultrasound – UFV Madrid (2021).
Specialization Master in Aesthetic Medicine – University of Cordoba, Spain (2020-2021).
Workshop on facial fillers with hyaluronic acid, results of radiofrequency and microneedling techniques (2020).
Refresher course on the injection of fillers in the body (2019).
Course Basic Life Support +DEA – Consell Català de Ressuscitació (2019).
Master Course Facial Rejuvenation (2018).
Bachelor of Medicine and Surgery, Carol Davila University, Bucharest (2011-2017).
Dr. Manuela Gheorghiu is the Medical Director of Clínica Provença in Barcelona, where she defines the clinic’s clinical standards and treatment protocols, and practices as an aesthetic doctor.
Professor of the Master in Aesthetic Medicine and Comprehensive Rejuvenation of the Catholic University of Valencia and the European Medical College.
Graduated in Medicine and Surgery with highest honours from the Carol Davila University of Medicine and Pharmacy in Bucharest, with her medical degree officially recognised in Spain.
She completed her specialised training in Aesthetic Medicine in Spain, earning a Master’s Degree in Aesthetic Medicine from the University of Córdoba.
She maintains ongoing scientific training, with a strong focus on clinical safety and precision in both treatment indication and execution.
Member of the College of Physicians of Barcelona (COMB), with the number of collegiate 55671, and holder of the Diploma of Accreditation of Training in Aesthetic and Cosmetic Medicine (DIACAP), issued by the COMB.
Member of the Spanish Society of Aesthetic Medicine (SEME) with the number 2729.
Member of the Association of Aesthetic Doctors of Catalonia (SMEC) with the number 65.
Member of the Spanish Society of Fat Transplant Applications (SETGRA).
Professor of the Master in Aesthetic Medicine and Comprehensive Rejuvenation of the Catholic University of Valencia and the European Medical College.
Advanced training and ongoing participation in specialised national and international programmes in Aesthetic Medicine.
Her main areas of expertise include:
Inject Art Lab Course, Advanced Clinical Training in Regenerative Aesthetic Medicine, IT Pharma (2026).
Full-Face and Anatomy workshop, Croma Anatomy, Medical University of Vienna, Center for Anatomy and Cell Biology (2026).
Ultrasound in Aesthetic Medicine: Present and Future, Barcelona Medical Association (2026).
41st National Congress of Aesthetic Medicine and 7th SERECAP Congress (Spanish Society of Hair Restoration), 2026.
Practical fundamentals of aesthetic ultrasound, Dermica Laboratories (2026).
Dermamelan Expert Meeting: leading medical approach to depigmentation, Mesoestetic (2025)
Latest trends in Thread Tightening: Anatomy, advanced technique and results, Croma (2025).
Buttock approach: “New Round Raised Technique”, Dermica Laboratoires (2025).
Galderma Gain Spark Training: “Shaping Progress in Aesthetics’ Real-World Knowledge, Highlighting the latest trends and treatment innovation” (2025).
Well Aging training module: mastering the art of “less is more” and stimulating collagen production for better skin quality, Galderma (2025).
Hands on Sculptra, collagen biostimulator, Galderma (2025).
Seminar on ‘Addressing Facial Sagging in Aesthetic Medicine,’ Barcelona Medical Association (2025).
“Natural Beauty” training: enhance natural beauty with facial harmonization techniques and dynamic wrinkle treatment, Galderma Academy (2025).
Professional seminar ‘Medical-aesthetic treatment with hyaluronic acid in the mid-face and under-eye area’, Barcelona Medical Association (2025).
24th World Congress of Aesthetic Medicine (2025).
40th Congress of the Spanish Society of Aesthetic Medicine (2025).
Nuceiva neuromodulator training, anatomy and clinical results, Evolus Inc. (2024).
Hands on: Launch of Galderma’s NEW neuromodulator Relfydess (2024).
Practical Theoretical Workshop – Special: Collagen Biostimulator, Galderma (2024).
Skymedic Regenerative Day: Exosomes, advanced photobiodynamic therapy and carboxytherapy (2024).
Teoxane’s course in Aesthetic Medicine, advanced level: facial anatomy, middle third and redensification, upper third, rheology, eyebrows, lips and gummy smile and lower third (2024).
Training course on ‘Neuromodulators in aesthetic medicine’, Barcelona Medical Association (2024).
Lifting and Redensification facial treatment training, Galderma (2024).
“Galderma on stage” workshop: anatomy, Skinboosters treatments, collagen biostimulators, dynamic wrinkles, middle third and under-eye circles, lips, rhinomodeling, chin and complications (2024).
Formation of Sculptra corporal, Galderma (2024).
Course “Brighten your patients’ skin”, Galderma (2024).
Session “Discover the best profile of your patients”, Galderma (2024).
Galderma clinical session: Restylane Vital+Sculptra (2024).
Galderma training workshop: Harmony and balance of proportions (2024).
Teoxane Training Workshop: Facial Masculinization (2024).
IBSA training workshop: approach to transgender patients (2024).
Sinclair training workshop: Lanluma day (2024).
Sinclair Hands On: Body Lanluma (2024).
Training by the Barcelona Medical Association: Lasers and light sources in medicine (2024).
Training Spanish Society of Aesthetic Medicine: Anesthesia and Resuscitation in Aesthetic Medicine (2024).
Expert Diploma in Leadership in Aesthetic Medicine – CEU University (2023).
Webinar Skinbooster treatments and skin quality, Galderma (2023).
Allergan Hands On Training: Workshop on Facial Ultrasound as a diagnostic tool in the daily practice of Aesthetic Medicine (2023).
Allergan Training – Master Class: HarmonyCa and Juvederm (2023).
Allergan Behind Beauty 360º Training (2023).
Teoxane training: Lip training workshop (lip techniques, 2023).
Teoxane training: Clinical session (diagnosis of clinical cases, 2023).
Teoxane Academy Regional Congress – MLT 3.1 Technique (2023).
Fillmed training (Protocols: Bionutrishape, Bionutrilift, Bionutrilips, Full-face, 2023).
Fillmed training (Dermatocosmetica, 2023).
Sinclair Hands On (Ellansé and Maili).
Neauvia formation: hyaluronic acid + pen plasma (2023).
Training Galderma Botulinum toxin liquid: Alluzience (2023).
Galderma Formation: Sculptra + Lyft (2023).
Galderma training: dissection of cadavers (ACME Mallorca, 2023).
IBSA Hands On Training (Profhilo, Skinko, 2023).
IBSA Training: Approach to complicated lips (2023).
IFMIL Training- Basic Life Support Course + DEA (Consell Català de Ressuscitació, 2023).
IFMIL Training-Theoretical and practical workshop on minor outpatient surgery (cutaneous, subcutaneous, continuous and discontinuous sutures, wound management and dermatological lesions, 2023).
Training by the Barcelona Medical Association: Adverse effects with materials (2023).
Thermage Hands On Training (2023).
Candela laser training: Nordlys IPL (PR 530 and VL 550) (2023).
Lumenis laser training: IPL and ERBIO YAG (2023).
Lumenis Laser Formation: CO2 (AcuPulse, 2023).
HANDY Laser Training – Plasma Pen (2023).
Master Class: Rejuvenation of face / neck / neckline / hands – by CO2 laser (2023).
Master Class: Non-surgical eyelid retraction & Endolifting (2023).
Aesthetic Surgery Training: Endolifting (2023).
Aesthetic Surgery Training: Nanofat (2023).
Facial and Body Aesthetic Surgery Training: Lipolaser with Liposuction (2023).
Allergan Hands on training: Hyaluronic acid middle/lower/upper third (MD Codes- Mauricio di Maio, 2022).
Allergan Hands on Training: HarmonyCa (2022).
Allergan Hands on Training: Botulinum Toxin (2022).
Teoxane formation: Hyaluronic acid (middle/lower/upper third, 2022).
Teoxane training in collaboration with Cardenal Herrera University: Expert in leadership in Aesthetic Medicine – Training in marketing, sales, facial treatments (2022).
Galderma formation: hyaluronic acid (middle/lower/upper third, 2022).
Galderma training: Sculptra collagen stimulator, Skinbooster (2022).
Merz Formation: Radiesse (2022).
Chroma Formation: Hands on Juvenus Medium-Strong/Skinbooster Rich pure (2022).
Dermica Laboratoires Training: Penis thickening with hyaluronic acid (2022).
Medyglobal Tornado/ Harpoon/ Screwcog (2022).
Medyglobal Training: Body hyaluronic acid and Buttock Treatment DeneB H. (2022).
Medyglobal/Merz Training: Buttock Reshaping with Radiesse and PDO Threads (2022).
Sinclair Training: Buttock Augmentation and Reshaping with Lanluma (2022).
Regenlab (Blisscare) training: PRP/Cellular Matrix (2022).
Regenlab (Blisscare) training: PRP/Cellular Matrix (2022).
Training Spanish Society of Aesthetic Medicine: Filler implants in aesthetic medicine with classroom practice (2022).
Training Spanish Society of Aesthetic Medicine: Collagen Stimulators (2022).
Training Spanish Society of Aesthetic Medicine: Facial flaccidity (2022).
Training Spanish Society of Aesthetic Medicine: Dermatoscopy, teledermatology and topographic dermatology in Primary Care (2022).
Training Spanish Society of Aesthetic Medicine: Business Management in Aesthetic Medicine (2022).
Training Spanish Society of Aesthetic Medicine: Business Management in Aesthetic Medicine (2022).
Training Official College of Physicians of Barcelona: New developments in facial treatments—gummy smile/lower third/dark circles (2022).
Training Official College of Physicians of Barcelona: New developments in the prevention and diagnosis of chronic venous disease (2022).
Training Catalan Society of Aesthetic Doctors: Facial fillers: Lights and shadows (2022).
Fellowship at Clinica Now in Portugal with Dr. Abraham Valência (2022).
Pronokar Formation (2022).
Lipedema training (2022).
National Congress of SEME and SERECAP, Malaga (2022).
Accreditation for the use of Botulinum Toxin in Aesthetic Medicine (2021).
Allergan Botulinum Toxin Training (2021).
PRP Hy-Tissue/ QREM CYTOKINE Training (2021).
Specialization Diploma in Musculoskeletal Ultrasound – UFV Madrid (2021).
Specialization Master in Aesthetic Medicine – University of Cordoba, Spain (2020-2021).
Workshop on facial fillers with hyaluronic acid, results of radiofrequency and microneedling techniques (2020).
Refresher course on the injection of fillers in the body (2019).
Course Basic Life Support +DEA – Consell Català de Ressuscitació (2019).
Master Course Facial Rejuvenation (2018).
Bachelor of Medicine and Surgery, Carol Davila University, Bucharest (2011-2017).
To learn how to exercise your rights regarding your personal information, learn about our privacy practices and how we are committed to protecting and respecting your privacy, please see our Privacy Policy.
