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.