D&PS – D&PS December 2025 Column Dr. Chang-hwan Cho of Dong-An Joongsim Clinic contributed a column to the December 2025 issue of D&PS Magazine, titled “Aesthetic Medicine Trends 2017–2025: Device-Based Approaches to Cellulite.” In this article, Dr. Cho redefines cellulite not as a simple fat-related problem but as a multifactorial structural condition involving the subcutaneous fascia, adipose layers, microvascular system, and lymphatic circulation. He explains that when lymphatic flow declines, interstitial fluid and metabolic waste accumulate between tissues, creating localized edema and worsening the metabolic environment of adipocytes. This process accelerates the formation and progression of cellulite. The subcutaneous fascia, a key structure separating the superficial(SAT) and deep adipose layers(DAT), undergoes fibrosis and stiffening over time due to aging and mechanical stress. As these septal structures lose elasticity, superficial fat begins to herniate upward, resulting in the characteristic uneven and dimpled surface. Dr. Cho notes that women are particularly prone to cellulite due to the vertical orientation of their fibrous septa, making structural intervention especially important. In outlining the therapeutic strategy, he identifies three essential components : 1. Reducing fascial inflammation, 2. Releasing fibrotic, stiffened septa, 3. Enhancing blood flow and lymphatic circulation. He stresses that approaches focusing solely on fat reduction often fail to prevent recurrence. Effective improvement requires simultaneously restoring fascia function, lymphatic drainage, and microcirculatory balance, integrating all three into a single treatment framework. Discussing device-based therapies, Dr. Cho highlights that the most consistent and reproducible outcomes arise from combination treatments. Radiofrequency (RF) delivers controlled thermal energy to “activate" microcirculation, acoustic shockwave therapy helps realign and remodel fascial structures, and vacuum or roller-assisted devices promote lymphatic drainage by mechanically guiding fluid movement. According to Dr. Cho, this sequential approach—“turning on” microcirculation with heat and “flushing out” lymph congestion through mechanical massage—represents the core principle of modern cellulite management. He concludes that contemporary cellulite treatment must evolve beyond traditional fat-destruction paradigms and advance toward a comprehensive structural therapy that addresses fascia, lymphatics, and microvascular health as a unified system.

Interview with Dr. Chang-hwan Cho of Dong-An Joongsim Clinic: “The ASLS Publication Project Will Become Our Identity and a Record of Aesthetic Medicine History.” Korean aesthetic medicine is recognized worldwide for its high level of expertise, yet there has long been a lack of well-organized literature that systematically compiles its extensive clinical experience and techniques. To fill this gap, ASLS launched its first academic publication in 2018, marking the official beginning of a project to document the history of Korean aesthetic medicine. The inaugural book received a far greater response than expected, reaffirming the necessity of such publications and leading to the expansion of standardization efforts across various fields, including skin boosters, lasers, and lifting procedures. In particular, the skin booster category—known for its diverse product range and wide clinical applications—had been a source of confusion among practitioners. The ASLS series effectively clarified and systematized this field, providing practical benefits to medical professionals both in Korea and abroad. The publication process was far from easy. It required the participation of numerous experts, extensive data collection and verification, and long periods of meticulous editing. However, seeing the books actively used in clinical settings brought a tremendous sense of accomplishment. This publication project goes beyond producing textbooks—it serves as a meaningful effort to define the identity of Korean aesthetic medicine, communicate its clinical depth to the world, and leave a legacy of knowledge for future generations. Moving forward, ASLS plans to further solidify the standards of Korean aesthetic medicine and continue sharing clinical expertise globally through ongoing publications and translation initiatives.

D&PS – D&PS November 2025 Column Dr. Chang-hwan Cho of Dong-An Joongsim Clinic contributed a column to the November 2025 issue of D&PS Magazine, titled “2017–2025 Aesthetic Medicine Trends: Understanding Body Contouring and Fat Metabolism.” -Column Summary- The term “localized obesity” is, strictly speaking, not medically accurate, as obesity refers to a systemic disease involving whole-body energy imbalance and metabolic dysfunction. Therefore, fat accumulation in specific areas is more appropriately defined as “localized fat accumulation” or “cellulite.” Cellulite is a complex condition in which chronic accumulation of subcutaneous fat is accompanied by fibrosis of connective tissue, edema, and microcirculatory impairment. This progression follows a cycle: adipocyte hypertrophy → microcirculation disturbance → collagen fiber degeneration and fibrosis → skin dimpling → chronic inflammation and edema. Because traditional weight loss, diet, and exercise alone are limited in improving localized fat or cellulite, non-surgical body contouring treatments have evolved to meet aesthetic demands. Dr. Cho distinguishes clearly: “Obesity is a medical disease, but body contouring is an elective treatment focused on aesthetic satisfaction.” He emphasizes the importance of a systematic treatment approach grounded in the physiological functions of fat cells and the sex- and region-specific characteristics of fat distribution. Regarding fat metabolism regulation, he explains that hormones such as norepinephrine, epinephrine, ACTH, glucagon, and thyroid hormones play critical roles. A key pathway involves activation of β-adrenergic receptors, leading to: cyclic AMP → protein kinase activation → HSL (Hormone-Sensitive Lipase). Through this mechanism, triglycerides break down into glycerol and free fatty acids (FFA), which are then utilized for energy production. Dr. Cho also highlights sex-based differences in fat distribution: • Men exhibit higher lipolytic efficiency in the abdominal region, whereas • Women tend to accumulate fat more easily in the hips and thighs due to the high anti-lipolytic sensitivity of α₂-adrenergic receptors. He concludes that the density and affinity of fat receptors are fundamental determinants of individual body-shape characteristics. Dr. Cho defines the goal of body-contouring treatments not merely as “fat reduction,” but as: “reactivating tissue metabolism, restoring adipocyte function, and re-establishing harmonious body contours.” He underscores the importance of an integrated treatment strategy that reflects the pathophysiology of obesity, cellulite, and localized fat accumulation.

D&PS – D&PS October 2025 Column Dr. Chang-hwan Cho of Dong-An Joongsim Clinic contributed a column to the October 2025 issue of D&PS Magazine, titled “2017–2025 Aesthetic Medicine Trends: The Correlation Between the Facial Lymphatic System and Aesthetic Procedures.” -Column Summary- The facial lymphatic system is a complex physiological network where immune, vascular, neural, and metabolic functions intersect. More than 300 lymph nodes of the cervicofacial region maintain the balance of fluid movement, inflammation control, and metabolic clearance. Because of this, lymphatic flow plays a decisive role in melasma, erythema, facial edema, skin laxity, and post-procedural recovery. Facial lymphatic drainage follows a structured anatomical route: the upper face drains into the preauricular nodes, the midface into the submandibular nodes, and the lower face into the submental nodes, before ultimately reaching the cervical lymph nodes and the thoracic duct. When this drainage pathway becomes stagnant, chronic edema, microcirculatory disturbance, uneven hyperpigmentation, and prolonged inflammation can arise. The infraorbital and malar regions are particularly prone to lymphatic stasis after surgery, trauma, or aesthetic procedures. In conditions such as melasma and rosacea, impaired lymphatic function can increase inflammatory mediators—including IL-18, IL-33, GM-CSF, and PGE₂—leading to symptom exacerbation. Under normal conditions, melanin is phagocytosed by macrophages and cleared through lymphatic channels; however, reduced lymphatic function results in pigment retention and recurrent darkening. Different aesthetic procedures influence the lymphatic system in distinct ways. Hyaluronic acid fillers may physically obstruct lymphatic flow in areas such as the tear trough and malar region, causing persistent malar edema. PDO thread lifting can enhance microcirculation and support tissue architecture, promoting improved lymphatic movement. Biostimulators such as PLLA and CaHA facilitate angiogenesis and lymphangiogenesis, contributing to better perfusion, while autologous fat grafting may increase lymphatic burden through risks of fat necrosis. Energy-based devices also show notable differences. Low-frequency (1–2 MHz) moving-type RF devices generate uneven thermal distribution, limiting their effect on lymphatic pumping. In contrast, 40.68 MHz unipolar RF provides rapid and stable thermal elevation, optimizing lymphatic activation, capillary dilation, and overall tissue perfusion. When combined with mechanical techniques such as rotation, vacuum, or roller massage, thermal activation followed by directed mechanical propulsion toward the cervical region produces the most reproducible and effective drainage outcomes. Dr. Cho emphasized that the facial lymphatic system is “an integrated immune–vascular–neural–metabolic structure essential for the success of aesthetic treatments.” He underscored the importance of lymph-centered treatment planning in addressing melasma, erythema, malar edema, and persistent post-procedural swelling, highlighting the need for anatomically grounded, physiologically informed aesthetic care.

D&PS – D&PS September 2025 Column Dr. Chang-hwan Cho of Dong-An Joongsim Clinic contributed a column to the September 2025 issue of D&PS Magazine, titled “2017–2025 Aesthetic Medicine Trends: Anatomical Diagnosis of Facial Aging III. -Column Summary- When facial aging begins, the lower face is the area where patients most commonly notice the earliest changes. The jawline becomes blunted, the corners of the mouth and marionette lines deepen, and the overall facial structure appears heavier and more fatigued. These changes result from a combination of factors including alterations in the skin layers, descent of fat pads, loosening of ligaments, muscle tonicity imbalance, and a decrease in extracellular matrix (ECM) density. Classic manifestations of lower-face aging include the descent of jowl fat and buccal fat, accentuation of the jawline and nasolabial folds, and positional changes of the oral commissure and modiolus. In particular, weakening of the mandibular ligament and retinacular cutis accelerates the downward shift of skin and fat, reducing structural support. Therefore, simple volume augmentation alone is insufficient. A structural approach is required—one that considers simultaneous changes in ligaments, muscles, fat compartments, and ECM. To achieve this, the combination of various energy-based devices (HIFU, RF, microneedling, lasers) along with regenerative treatments such as non–cross-linked HA, PN, and PDRN is emphasized. Dr. Cho defines the key to lower-face rejuvenation not as “lifting,” but rather as “repositioning” and “restructuring.” He stresses that only a customized treatment plan—based on understanding the complex interplay of muscle tension, ligament laxity, fat redistribution, and ECM changes—can restore naturally youthful and long-lasting facial contours.

D&PS – D&PS August 2025 Column Dr. Chang-hwan Cho of Dong-An Joongsim Clinic contributed a column to the August 2025 issue of D&PS Magazine, titled “2017–2025 Aesthetic Medicine Trends: Anatomical Diagnosis of Facial Aging II.” -Column Summary- Facial aging begins in the late 20s and accelerates after the mid-30s. The dermis becomes thinner, fat is redistributed, and muscles and ligaments loosen, reducing structural support and intensifying sagging and wrinkles. The periorbital area, where the skin is thin and structurally fragile, is particularly prone to wrinkles, hollowing, fat protrusion, and tear trough formation. Fat descent and muscle weakening contribute to a tired, aged appearance, while midface volume loss leads to the development of deep grooves. Perioral wrinkles arise from two primary causes: deepening nasolabial folds due to volume loss, and fixed wrinkles caused by changes in the muscles and ligaments. Marionette lines are associated with fat descent, ligament weakening, and positional changes in the modiolus. Jowl sagging results from a combination of fat pad descent, ligament laxity, reduced soft tissue elasticity, and skeletal changes, closely related to midface ligament weakening. Since aging is a complex process involving concurrent changes to the skin, fat, muscles, ligaments, and bone, treatment should go beyond simple volume augmentation to focus on restoring and maintaining anatomical structures. Dr. Cho emphasized the importance of customized treatment based on an anatomical understanding of fat, ligaments, and muscles, as well as the concept of “Facial Fat Fitness.” Modern aesthetic medicine is shifting away from mere filling, toward achieving anatomical harmony and restoring youthful expressions and natural facial dynamics.

D&PS – D&PS July 2025 Column Dr. Chang-hwan Cho of Dong-An Joongsim Clinic contributed a column to the July 2025 issue of D&PS magazine titled “2017–2025 Aesthetic Medicine Trends: Anatomical Analysis of Facial Aging.” -Column Content- Facial aging begins gradually in the late 20s and becomes more pronounced after the mid-30s. The dermis thins, fat is redistributed, and muscles and ligaments relax, weakening the structural support of the face. The SMAS layer and retaining ligaments loosen, causing fat to migrate downward, which leads to increased sagging and wrinkle formation. The periorbital area is especially prone to aging because of its thin and delicate skin, making it susceptible to wrinkles, hollowing, and fat protrusion. Typical changes include eyelid wrinkles, lower eyelid fat bulging (commonly described as “under-eye bags”), and the formation of the tear trough. As fat descends and muscles weaken around the eyes, the overall expression appears tired and aged. Loosening of ligamentous support in this area also contributes to fat redistribution, altering midface volume and creating deep grooves. Perioral wrinkles develop through two main mechanisms. First, reduction in paranasal volume deepens the nasolabial fold. Second, structural changes around the orbicularis oris muscle create fixed, deeply etched lines. The superficial fat overlying the nasolabial fold becomes thinner, and fixed creases form, with close involvement of muscles such as the levator labii superioris and the zygomaticus major and minor. The marionette lines (sagging lines at the corners of the mouth) result from downward fat migration and ligament weakening beneath the mouth. Changes in the position of the modiolus (the fibromuscular node at the mouth corner) also accentuate these lines. East Asian populations, including Koreans, often have a more inferiorly positioned modiolus, making lower-face sagging and marionette line formation more prominent. The commissural line (the crease at the mouth corner) also deepens due to weakening of subcutaneous fat and supporting ligaments. Jowl formation occurs as fat compartments migrate downward and the mandibular septum loosens. The platysma muscle and other soft tissues weaken, causing skin to sag and fat to accumulate lower on the face. Weakening of the mandibular ligament is a key factor, and midface retaining ligament laxity is closely linked to jowl development. Additionally, bony changes with age alter the lower facial skeleton, accelerating sagging in the lower face. Ultimately, facial aging is a complex process involving simultaneous changes in the skin, fat, muscle, ligaments, and bone. Treatment must go beyond simply adding volume to focus on restoring and maintaining anatomical support. Managing not only fat volume but also fat quality an approach sometimes called “Facial Fat Fitness” is essential. A deep anatomical understanding of ligaments, fat pads, and muscles is critical to devising individualized treatment plans. Modern aesthetic medicine is evolving from simply “filling” the face to a precise science of restoring anatomical harmony and youthful movement.

D&PS – D&PS June 2025 Column Dr. Chang-hwan Cho of Dong-An Joongsim Clinic contributed a column to the June 2025 issue of D&PS magazine titled “2017–2025 Aesthetic Medicine Trends: Facial Aesthetics – Structure, Perception, and Treatment.” -Column Content- Recently, aesthetic medicine has evolved beyond simple cosmetic enhancement to focus on anatomical structures, brain perception mechanisms, and the scientific understanding of aging. Humans are instinctively drawn to faces that approximate the golden ratio (1:1:0.8), but our sense of beauty has changed across eras and cultures. For example, in the Joseon Dynasty, a round and full face was considered beautiful, while today, a more three-dimensional and balanced facial structure is preferred. The position and angles of the eyes, nose, and mouth, along with the distribution of facial volume, play decisive roles in what the brain judges as attractive. Aging begins in the late 20s, leading to thinning of the dermis, redistribution of fat, and relaxation of muscles and ligaments. Notably, lower-face (jowl) sagging and the formation of marionette lines result from structural changes such as weakening of the mandibular ligament and downward migration of fat. A healthy, youthful face features a balanced distribution of fat cells, but as aging progresses, the number of fat cells decreases while their size increases, giving the face a heavier, more fatigued appearance. As a result, there is growing interest in the concept of “Facial Fat Fitness,” which considers not only the volume of fat but also its quality. Ultimately, beauty is shaped by a blend of structural proportions, expressive capacity, skin elasticity, and patterns of neural preference. Modern aesthetic medicine is no longer simply about filling or sculpting the face, but about restoring anatomical harmony and youthful dynamics through precise, science-based approaches.