Introduction: Facial aging is a multifactorial process involving skin laxity, volume loss, and progressive collagen degradation. Calcium hydroxyapatite (CaHA) is a well-established biostimulatory filler capable of providing both structural support and long-term collagen stimulation.

Objectives: To evaluate the clinical outcomes, patient satisfaction, and safety of a novel, ligament-targeted technique using region-specific CaHA dilutions for minimally invasive facial rejuvenation.

Methods: This prospective, single-center study included 20 patients presenting with facial laxity. Treatments were performed using three tailored CaHA dilution protocols, strategically applied to the zygomatic, temporal, and mandibular regions, with a focus on ligamentous support structures. Outcomes were assessed using the FACE-Q questionnaire, Global Aesthetic Improvement Scale (GAIS), and standardized 2D and 3D imaging.

Results: At 90 days, 94% of patients reported aesthetic improvement, with a significant increase in mean FACE-Q Skin score from 43.2 ± 14.7 to 74.9 ± 14.7. Results were sustained at 360 days, with continued improvement reported by 94% of participants and a maintained FACE-Q Skin score of 77.2 ± 16.4. Investigator assessments corroborated these findings, while 3D imaging demonstrated persistent enhancement in facial contours. All adverse events were mild and self-limited.

Conclusions: This technique demonstrates that a ligament-focused approach combined with customized CaHA dilutions can achieve a natural lifting effect with long-lasting results and a favorable safety profile. It represents a reproducible and minimally invasive strategy for facial rejuvenation.

Bárbara Saavedra is a Full Member of the Brazilian Society of Dermatology and a Member of the Brazilian Society of Dermatological Surgery. She is a speaker for Merz Aesthetic, training and updating dermatologists and plastic surgeons from Brazil and around the world. Her main mission is to seek beauty combined with health and naturalness. She works in the areas of aesthetic, clinical, and surgical dermatology.