Not Ready For a Facelift? No Problem: Welcome to The Era of “In-Between” Treatments.

6 min readTHE RISE OF BUZZY noninvasive in-office treatments is no coincidence. These days, people want to look sculpted, lifted, and more refreshed without having to make the somewhat uneasy decision to go under the knife. And as more and more patients seek meaningful results without committing to surgery, there’s a growing interest in treatments that bridge the gap between injectables and a facelift, aptly dubbed the “in-between” treatments.These interventions will still give you meaningful lifting, volumizing, sculpting, and tightening results without as much downtime (sometimes, none at all) or diminishing returns on your investment. Think of them as the individualized, targeted treatments you can utilize before considering a face or neck lift. The trick is having a solid understanding of what specific technologies can—and cannot—accomplish. If you’re not pairing the right treatment with the right concern, you’re shelling out good money to “correct something it fundamentally cannot address,” explains Connie Yang, MD, a board-certified dermatologist in New York City.Filler, for instance, is effective for restoring strategic areas of volume loss on the face, but it can’t truly lift tissue or remove excess skin. “If you add more filler in an attempt to recreate a sharper jawline or lift the lower face, you’re just going to end up making the face look heavier and puffier, rather than more lifted and sculpted,” says Dr. Yang.Meet the experts: Connie Yang, MD, is a board-certified dermatologist in New York City. Jennifer Levine, MD, is a double board-certified facial plastic surgeon in New York City.In a similar vein to filler, energy-based skin devices such as radio frequency (think: Morpheus 8 or Xerf) or ultrasound devices such as Ultherapy that target the deeper, structural layers of the face can only do so much up to a certain point. “These treatments can give meaningful improvement in the right patient, but there’s a limit to how much contraction you can achieve non-surgically,” says Dr. Yang. If someone has significant jowling, excess skin, or deeper tissue descent, repeated treatment with these types of devices will end up giving someone only progressively smaller improvements over time.To give you the LD on all of your options, we spoke with experts about what each treatment can realistically accomplish, what patients can expect over time results-wise, and when you should skip straight to surgery.The in-office advancements bridging the gap.As a rule of thumb, most (not all) aesthetic professionals will generally advise you to exhaust all options before spending a pretty penny on a facelift. In the end, it’s an individual decision. Either way, in-office treatments can help to keep your skin radiant and build collagen to help you to get an even better result for when it is time for a facelift. Think about throwing a crumpled up sheet over your mattress in the morning: If you don’t iron it first, the wrinkles will still be there when you go to make the bed.There's no one-size-fits-all approach because not all facial aging is the same. For patients that are truly getting closer to being surgical candidates, “focusing on improving skin quality and some degree of skin tightening can be your best bet, while at the same time managing expectations of the limitations of devices and their expected outcomes,” says Dr. Yang.Double board-certified facial plastic surgeon Jennifer Levine, MD, who uses a combination of injectable treatments and non-surgical devices in addition to surgery in her practice, recommends treatment protocols depending on which components of aging are most responsible for the patient’s concerns.The following treatment categories are considered the in-betweeners that you may want to consider before going under the knife.Microfocused Ultrasound with VisualizationBrand Names: Ultherapy PRIME, Sofwave“This is an important option for select patients with earlier skin laxity who want gradual tightening and a degree of lifting,” says Dr. Levine. Ultrasound imaging allows providers to actually visualize tissue layers and guide energy placement.It’s FDA-cleared for use to lift the brows and help with lax tissue beneath the chin and neck—the places where aging skin can be most obvious. “I consider it an in-between treatment because it can address laxity through targeted tissue remodeling while the patient’s expectations remain appropriate for a nonsurgical result,” says Dr. Yang, but “[they do] not replicate the degree of lifting you can achieve surgically.”Radiofrequency Rreatments lik RF MicroneedlingBrand Names: Morpheus8, XerfThese work best when texture, dermal remodeling, and modest tightening are the goals. Dr. Levine says that for these treatments, energy settings and treatment depth play a huge role and must be chosen carefully based on anatomy. RF microneedling is provider-dependent, especially because at the wrong setting, facial fat loss, unintended scarring, and nerve injury can occur.Fractional Laser ResurfacingBrand Names: Fraxel FTX“I consider this particularly valuable when fine lines, uneven pigmentation, and textural changes contribute substantially to an aged appearance,” explains Dr. Levine. Improving the skin’s surface can make a meaningful aesthetic difference, especially for someone who is beginning to develop skin laxity. She points out that “improvement in skin quality is a different endpoint from repositioning descended facial tissue.”Micro-Coring RechnologyBrand Names: EllacorEllacor is the best example of a true in-between option, says Dr. Yang, “because it actually removes microscopic cores of skin without surgery, allowing the skin to contract as it heals.” Instead of just heating the skin to stimulate collagen, it uses tiny hollow needles to physically remove microscopic columns of excess skin, scarlessly. As the skin heals, it contracts and remodels, which can help to improve wrinkles and laxity.Patient selection for this treatment is especially important because there is some downtime involved and a risk of pigment change. That said, it’s useful for those with mild to moderate laxity and early jowling, who don’t quite have enough excess skin or tissue to warrant a facelift yet.InjectablesBrand Names: Sculptra, Radiesse, Juvederm, RestylaneWhen true volume deficiency contributes to someone’s overall concern, Dr. Levine says that conservative volume restoration with the use of hyaluronic acid fillers or biostimulatory injectables that boost skin’s own collagen production can help to improve contours and balance the face.When surgery’s your best bet.Let’s just get this out of the way right off the bat—age alone isn’t the biggest determining factor in whether or not someone would benefit from a facelift. Genetics, lifestyle choices, and how someone cares for their body and skin have a huge impact. “I have patients in their 40s with very little laxity who are excellent candidates for non-invasive treatments and younger patients whose anatomy or degree of tissue descent make certain treatments less effective,” explains Yang.And while there’s no single telltale sign to know when it’s time for a facelift, one of the main factors is whether the patient has “skin laxity alone or true tissue descent that requires surgical repositioning,” says Dr. Yang. With skin laxity, the skin can appear creepy or loose with decreased elasticity and can be pinched more easily. “Tissue descent is a deeper structural change; if you manually reposition the deeper tissue upward and it significantly restores the contours of the cheek or jawline, that tells me that the concern isn’t just loose skin and that a facelift would be the solution,” explains Dr. Yang.Even if someone is a candidate for a non-invasive treatment, if they're ultimately looking for a dramatic lift or significant change in their facial contours, then surgery may be the answer. Dr. Yang says that she is more inclined to recommend surgery after a patient has gone through multiple rounds of injectables or tightening treatments and they continue to chase the same concern with diminishing improvement or returns. “At that point, continuing to add filler or repeatedly treating with devices can become costly without addressing the underlying structural issue,” she says.Facing reality.Before diving face first into a surgery, Dr. Yang encourages her own patients to really explore all of their options and think deeply about their long-term goals. If you know that a facelift is in your future, it may shape what is recommended to you by a provider. “I don’t want you spending years of over-treating or investing in procedures that may only give you marginal improvement.” Instead, she says, the focus should be on maintaining skin quality and aging well until you’re ready. Conversely, if you’re unsure whether surgery will ever be an option for you, finding the right provider to work with can help you to maximize non-surgical options available in order to get the most meaningful results possible.Overall, the goal should be to maximize what you have and age well, while recognizing when you’ve reached the limitations of non-surgical treatments. “If surgery may eventually be the right choice, you want to arrive there with healthy, well-maintained skin,” she says. Amen to that.Taryn Brooke is a New York City–based freelance writer, beauty expert, content creator, and filmmaker specializing in beauty, aesthetics, and culture. Her work has appeared in New York, Allure, Glamour, InStyle, Cosmopolitan, New Beauty, and Marie Claire, where she regularly covers skincare, plastic surgery, cosmetic treatments, and makeup trends.Alongside her editorial career, Taryn writes, directs, and produces narrative short films that have screened at film festivals nationwide, including Academy Award–qualifying festivals. Her work across both media and film is driven by a sharp eye for storytelling, visual culture, and the evolving relationship between beauty and identity.Brian Underwood is beauty director at Women’s Health, where he oversees content strategy for the brand across all platforms, including digital, print, and social. Underwood previously served as beauty and wellness director at Oprah Daily and O, The Oprah Magazine. During his tenure leading beauty content for the Oprah brand at Hearst, stories Underwood commissioned were awarded the Skin Cancer Foundation Media Award and a Fragrance Award for Editorial Excellence (his second). He was the launch Beauty Director of Dr. Oz THE GOOD LIFE, and has held additional editorial positions at Fitness, Organic Style, Good Housekeeping, Life & Style Weekly, and Woman’s Day and has written for Self, Shape, Seventeen, Redbook, Cosmopolitan, and many more. Underwood previously served on the Skin Cancer Foundation’s gala committee and as partnerships director of the Trans Beauty Clinic, a New York-based charitable organization that provided beauty services and workshops to the city’s trans community.