How to improve your facial contour?

Well rested. Back from holiday. With a good cream on the shelf and concealer under your eye. And in the mirror someone tired and a little sad is still looking back at you.

The patients who sit down in my office often cannot name what exactly has changed. The same nose, the same eyes. And yet the face looks different.

Usually it comes down to one thing: the facial contour. It starts to change as early as after your thirty-fifth birthday — slowly enough that the first signs are easy to miss.

The letter V that slowly turns into a W

The skin loses firmness earlier than most of us expect — already after thirty. The first sign is usually delicate nasolabial folds.

After forty the picture is clearer: the folds deepen, the cheeks lose volume, the corners of the eyes and of the mouth begin to droop.

The pace of these changes depends on many things at once — lifestyle, diet, genes, hormonal fluctuations, skincare, the environment. But the direction is the same in everyone. The skin becomes flaccid, and the shape of the face, which used to resemble the letter V, gradually turns into a W.

The good news: this is not an irreversible process.

Two different causes, two different solutions

This distinction decides the choice of treatment, and almost nobody talks about it.

A drooping contour may result from skin laxity — that is, from the collagen fibres having weakened and stopped holding tension. In that case it makes sense to stimulate the skin to remodel itself: energy, heat, a controlled regenerative stimulus.

But it may also result from volume loss — the cheek has hollowed, the support has disappeared and the tissues have slid downwards. Here no amount of tightening will be enough. What has been lost has to be given back.

Most often both mechanisms are at work at once, in different proportions. That is why the first step is not the choice of a device, but a consultation at which we establish what we are actually dealing with.

Your forties: no scalpel and no invasiveness

A visible improvement of the contour in women in their forties does not require invasive methods. Very good results come from treatments that simply stimulate the skin to regenerate — and as a preventive measure they can be done from the age of 35.

Microneedle radiofrequency — a needle and a radio wave at the same time

A special head simultaneously punctures the skin with very fine needles and emits a radio wave, which heats the tissue around their surface. These controlled overheatings trigger renewal and the production of new collagen fibres.

The treatment takes about 30 minutes and is performed under local anaesthesia. Right afterwards the skin may be reddened — it usually returns to normal within a few hours.

Collagen does not appear overnight, so the effects are best seen after 4–6 weeks. I recommend a series of 3–4 treatments every 2–4 weeks. The improvement in the density and tension of the skin builds up gradually over the following weeks; individual studies show the effect being maintained at six and at twelve months, but there is little data from longer follow-up.

Infrared thermolifting — contraction here and now, rebuilding over months

The head emits infrared radiation of a specially selected wavelength. The heated collagen fibres contract immediately — the skin is better tightened and the contour more defined right after the treatment.

That, however, is only half the story. Controlled heating also triggers the remodelling of the skin's scaffolding and the formation of new collagen fibres — so-called neocollagenesis. It lasts from 1 to 6 months and it is exactly what is responsible for natural results lasting years.

For the improvement to be visible and lasting, the treatment is best performed in a series of 3–6 repetitions.

After fifty I have two pieces of news

The good one: it is never too late.

The slightly worse one: at this stage the treatments are sometimes a little more invasive — they require breaking the continuity of the epidermis.

There is nothing to be afraid of, though. Modern treatments for the facial contour have nothing in common with a surgical lift performed under general anaesthesia. None of them requires weeks of recovery and none leaves scars. That does not mean they are treatments without risk — with any procedure that breaks the skin, swelling and bruises happen, and less often complications that require contacting a doctor. That is why we start with qualification, not with choosing a treatment. And the results can be impressive.

Hyaluronic acid volumetry using the thread technique

We start with anaesthesia — usually in the form of a cream applied to the skin, although for patients more sensitive to pain I also administer dental anaesthesia.

I introduce the hyaluronic acid product with a microcannula — a needle with a rounded tip, which markedly reduces unpleasant sensations. I administer it in the form of linear threads.

Hyaluronic acid binds water molecules and fills the areas that have lost firmness and volume. This is exactly the treatment that answers the second of the causes described at the beginning — it does not tighten the skin, it gives back the lost support.

The effects last even more than a year, although a lot depends on your lifestyle.

Fillers are injected close to blood vessels, which is why there is one complication I discuss with every patient before the treatment: blockage of a vessel. It is rare, but it calls for a response within hours, not days. If after you leave the treatment room you get severe, increasing pain, paling of the skin, a bluish net-like pattern or any disturbance of vision — call us immediately. Hyaluronic acid has an antidote: hyaluronidase, an enzyme that dissolves it and unblocks the vessel. Calcium hydroxyapatite has no such antidote, which is why with it the injection technique and a quick reaction to the symptoms above matter even more.

PDO threads — the longest-lasting effect

Like every medical procedure, the treatment is preceded by a thorough consultation.

The procedure itself is simple: with very fine needles I introduce into the skin threads made of polydioxanone. The thread gradually dissolves in the tissue, stimulating collagen production, the fibroblasts and the formation of new blood vessels. The skin becomes more taut, firmer, better oxygenated and nourished.

There are several types of thread and they differ in what they do:

• biorevitalising — extremely thin, they work on the quality of the skin,
• lifting — tipped with barbs, which make it possible to pull the skin up and genuinely improve the contour.

For the first two weeks after the threads are placed it is worth avoiding intense exercise, facial massage, the sauna and sleeping on your side — this reduces the risk of a thread shifting and of dimples in the skin. A thread you can feel, a small dimple or a temporary feeling of stiffness do happen and usually resolve on their own; if they do not pass, however, come back to the clinic.

The thread itself dissolves within a few months, and what remains is the collagen formed around it. The lifting effect is most pronounced in the first weeks and gradually fades — in most patients the treatment is repeated after a year, sometimes sooner.

Calcium hydroxyapatite

A filler with a thick, gel-like consistency, whose base is calcium.

Injected into the places that need filling, it does two things at once: it replenishes volume and stimulates the development of natural collagen fibres. Skin tension improves, and with it the contour.

I administer the product with a microneedle or a microcannula. A few minutes earlier I apply an anaesthetic cream, and the product itself contains an additional anaesthetic ingredient in the syringe — so the treatment is painless.

The effect is visible immediately and lasts for another 18 months.

What we do in our clinics — in brief

Not every treatment is for everyone. We give up on lifting the contour, or postpone it, during pregnancy and breastfeeding, with active inflammation or a skin infection at the treatment site, with an uncontrolled autoimmune disease, with clotting disorders and during anticoagulant treatment, and also during a course of isotretinoin. With radiofrequency there is one more contraindication: implanted electronic devices, a pacemaker for example. All of this we establish at the consultation — which is why we ask about medications and illnesses before we talk about the result.

• Microneedle radiofrequency — Microneedles plus a radio wave, controlled overheating of the tissue · Skin laxity · After 4–6 weeks; a series of 3–4 treatments every 2–4 weeks; the effect is documented mainly up to 3–6 months, with individual papers reaching a year.
• Infrared thermolifting — Infrared contracts collagen and triggers neocollagenesis · Skin laxity · Tightening right after the treatment, new collagen over 1–6 months; series of 3–6.
• Hyaluronic acid volumetry (thread technique) — Hyaluronic acid administered with a microcannula in the form of linear threads · Volume loss · Immediately, lasts even more than a year.
• PDO threads — Dissolvable polydioxanone threads; the lifting version with barbs pulls the skin up · Laxity and drooping of the tissues · Firming right away; the lifting effect is clearest in the first weeks and usually lasts up to a year.
• Calcium hydroxyapatite — A thick calcium-based filler that at the same time stimulates collagen · Volume loss plus tightening · Immediately, lasts about 18 months.

How to choose for yourself

There is no single best treatment for the facial contour. There is, however, a simple logic of choice.

If the skin has lost tension but the face has not "lost weight" — we work with energy: microneedle radiofrequency or infrared thermolifting, always in a series.

If the cheeks have hollowed and the support has disappeared — we start with volume: hyaluronic acid or calcium hydroxyapatite.

If the tissues have clearly slid down — we reach for lifting threads, which pull them up mechanically.

And most often? We combine. That is why the treatment plan is created at a consultation, and not on the basis of an article on the internet — not even this one.

Finally: the effect needs something to sustain it

Aesthetic medicine copes with a drooping contour really well. But for the results to last as long as possible, you need a healthy lifestyle, proper nutrition, the right amount of sleep, of relaxation and of physical activity that strengthens the muscles.

Add two more habits to the list, the ones that make the biggest difference to the facial contour: a cream with SPF 30 or higher used every day, including in winter, and giving up cigarettes. UV radiation breaks down collagen and elastin faster than we are able to rebuild them with treatments — it is the main factor deciding how long the result will last.

The skin cannot stand stimulants. What it loves are fruit and vegetables rich in folic acid. And for full regeneration it needs 8 hours of sleep — the repair processes do not follow the clock but start once you fall asleep and run most intensively during the first hours of deep sleep.

Provided that you really do give yourself those eight hours.

Apparently we read most often before going to sleep. What time is it where you are?

In the office we improve the contour on two fronts: facial volumetry rebuilds the support where volume has been lost, and tissue stimulators densify the skin itself.

This article was prepared by Aneta Bembenek, MD.