For crepey skin that has thinned but not dropped, Sofwave™ is the treatment Dr Nish reaches for first at Medisha. It is ultrasound, delivered about 1.5 mm down where collagen is built, in one session with no downtime. In the pivotal study 88% of patients had improved at 12 weeks, and the skin goes on firming to 6 months. It holds FDA clearance to lift the brow and lax under-chin and neck skin. Where the skin is so thin it creases at rest, Profhilo or Sunekos Performa thickens it afterwards. Where a jowl or fold has slipped, only a PDO thread lift moves it back.

Crepey skin comes from losing the two fibres that keep skin flat: collagen, which gives firmness, and elastin, which gives recoil. Both decline from the mid-30s, and faster with sun exposure, smoking, the menopause or losing weight. Thinner skin creases on itself and recovers more slowly, so you see fine tissue-paper lines on the neck, chest, eyelids and inner arms. It is a change in the skin itself. A face that has dropped is a different change, in the deeper supporting tissue, and needs lifting rather than firming.

Pinch the skin and let go: the answer is usually in what happens next. If it crinkles and then settles, the texture has thinned but nothing has moved, and Sofwave™ alone is usually enough. If it looks papery and creased before you pinch it, the skin needs thickening too, with Profhilo or Sunekos Performa once it has been tightened. If a jowl, hood or under-chin fold stays put when the skin is lifted, tissue has slipped, and a PDO thread lift repositions it in a staged plan. Dr Nish does this test with you in the mirror.

Sofwave™ at Medisha Clinic, Mayfair, is priced by area. The brow is £700 and the jowls and jawline £1,000. The full face is £1,400, face with neck £1,800, and face, neck and brow £2,200. A PDO thread lift, where tissue has slipped, is £750 per area. Profhilo is £350 a session (2 sessions £700) and Sunekos Performa £350 a session (4 sessions £1,100). A staged plan of a PDO lower-face lift followed by Sofwave™ face and neck is sequenced by Dr Nish and quoted after consultation. Review appointments are included. Consultation with Dr Nish costs £50, redeemable in full against treatment. Medisha is at 58 South Molton Street, W1K 5SL, a 3-minute walk from Bond Street.

Yes, within the limits of what ultrasound can do: it firms skin that has thinned, and it does not move tissue that has dropped. The FDA cleared Sofwave™ in 2021 to lift the eyebrow and lax under-chin and neck tissue, on the strength of a five-site clinical study. In the pivotal study published in Dermatologic Surgery, 88% of patients had improved at 12 weeks after one treatment. You notice little at 6 weeks, a firmer pinch at 12 weeks, and the full change at 6 months. One session of 30 to 60 minutes, and one a year to maintain it.

No, and the reason comes down to depth. Moisturiser works in the outermost tenth of a millimetre, drawing in water that plumps the crinkle for a few hours. Crepey texture is a loss of collagen and elastin about 1.5 mm down, and nothing rubbed on the surface reaches that layer. Collagen drinks are digested like any other protein. Facials polish the surface. Retinoids and daily SPF are worth keeping because they slow further loss. What rebuilds collagen at depth is Sofwave™; what thickens thinned skin is an injected booster; what moves a dropped fold is threads.

Sofwave™ feels like pulses of deep warmth under numbing cream, and the cooling tip keeps the surface comfortable. You can go to a meeting afterwards; there is nothing to see. Profhilo and Sunekos are a few small injections, with bumps at the points for a day. PDO threads are placed under local anaesthetic; expect 48 hours of swelling and tenderness, possibly a bruise, and a fortnight of taking care. Written aftercare and Dr Nish’s own number come home with you.

Yes, Sofwave™ is used on every skin tone, including the deepest. It is ultrasound, so it has no interest in pigment; the energy is absorbed as heat at depth, not by melanin at the surface. That is why it suits the deeper tones where light and laser devices carry a risk of dark or pale patches. SofCool™ cooling protects the surface throughout. Profhilo, Sunekos and PDO threads are likewise used on all skin tones. Dr Nish treats a wide range of skin at Medisha and will discuss your own at the assessment.

Most people first notice crepey texture between the late 30s and mid-40s, on the neck or around the eyes, and that is a sensible time to act. Firming the skin while it is only thinned is easier than lifting it once it has slipped. There is no upper age limit. What matters is the state of the skin, not the date of birth. The one exception is excess: at any age, skin that hangs in folds may need a surgeon, and Dr Nish will say so.

Think in checkpoints rather than an expiry date. After Sofwave™, your skin is firmer at 12 weeks and firmer still at 6 months, and that collagen is yours to keep. A yearly session keeps ahead of the ageing that continues underneath. A PDO thread lift holds for 12 to 18 months, with the threads dissolving over 6 to 9 months and leaving collagen behind. Profhilo and Sunekos Performa fade over 6–9 months and are repeated. Dr Nish reviews Sofwave™ at 12 weeks, and threads or boosters at 4 weeks, then plans the next step with you.

Then you hear it at the assessment, before any money changes hands. Sofwave™ firms skin and threads reposition tissue, but neither removes a single centimetre of it. If the skin hangs in folds when you let go rather than crinkling and settling, an operation may achieve what firming and lifting cannot. Dr Nish says so plainly and refers you to a surgeon. Medisha’s rule is simple: no session is sold that will not show in the mirror.

Because crepey skin is assessed and treated here by one doctor, Dr Nish Shah MD, who performs every option himself. Sofwave™, as an official partner clinic. Profhilo and Sunekos Performa, as the Official UK Trainer for Sunekos. PDO threads, with thousands of thread lifts behind him. He teaches thread lifting to other doctors as Senior International Clinical Trainer at Derma Medical, and is Brand Ambassador and Key Opinion Leader for PDO threads. He has performed over 30,000 non-surgical treatments and is one of the most experienced aesthetic doctors in the UK and London. If a surgeon would serve you better, he says so. Medisha is rated 5.0 on Google from 128 reviews, in Mayfair and Marylebone.