In short
- A 2023 study found that facial ligaments do not loosen with age; they become stiffer.1
- Injecting to "tighten ligaments" therefore has a weaker rationale, and human evidence is very limited.2
- What still makes sense is restoring deep support, using the ligament lines as landmarks.3
- Each product works in a different layer, so the choice should match the layer that has actually changed.
What facial ligaments are
Picture a curtain hung on hooks. Facial ligaments are the hooks that pin skin and soft tissue to bone. The fabric hanging between the hooks is your fat and skin. With age, the fabric sags into folds and jowls.
What the new research says
It was long believed that the hooks (the ligaments) stretched and loosened. An experimental study published in Aesthetic Surgery Journal in 2023, with Prof. Sebastian Cotofana, found the ligaments did not loosen but became stiffer, with thicker collagen bundles.1 What really sags is the fabric between the hooks. Read the details in Do facial ligaments really loosen with age?
Worth knowing: the study was done in rats and focused mainly on the cheekbone ligament. Some ligaments, such as those around the eyes, may change differently.
Does injecting to "tighten ligaments" still work?
If the hooks are already firm, injecting into them to make them firmer does not fix the sagging fabric.
- Human evidence for injecting to thicken a ligament is currently a single case report based on ultrasound.2
- No study has yet clearly measured a long-term lifting effect from injecting the ligament itself.
What still makes sense: restoring support
As bone and deep fat gradually recede with age, the fabric between the hooks loses its support. Rebuilding support in the deep layer, near where the ligaments attach to bone, helps carry the tissue above. This principle does not depend on ligaments being loose, so it still fits the new data.34
Put simply: don't pull the hooks; give the fabric something to rest on.
What each product does
| Product | To "tighten ligaments" | Better-suited role |
|---|---|---|
| HA filler | No rationale | Restoring deep support where volume has receded |
| PN (skin booster) | No evidence | Improving skin quality in the upper layer |
| Collagen stimulators (e.g. PCL in CMC gel) | No evidence | Deep support plus collagen stimulation in the surrounding area |
Compare collagen stimulators and HA filler in Sculptra, Ellansé and HA filler, and read about facial layers in the 5-layer facial anatomy article.
Questions to ask your doctor before treatment
- Which layer is causing my sagging? Bone, deep fat or skin?
- Which layer will you inject, and why? If the answer is "to lift the ligament", ask what evidence supports it.
- Are there major blood vessels near this area? How will you protect against complications?5
At Vinfinity, the doctor assesses the face layer by layer before planning every treatment, following The Filler Architect approach.
References
- Zhang et al. Age-Related Changes of the Zygomatic Ligament: An Experimental Animal Study. Aesthetic Surgery Journal. 2023. doi:10.1093/asj/sjad235; Cotofana S. Do Facial Ligaments Age? cotofanaanatomy.com
- Yi KH, Jitaree B, Yoon SE, et al. Facial Ligament Thickening Using Poly-D,L-Lactic Acid Injection. Journal of Cosmetic Dermatology. 2025;24(7):e70300. PMC12202259
- Injectable Filler Technique for Face Lifting Based on Dissection of True Facial Ligaments. PubMed 33300562
- Practical application of the facial fat compartments and the line of ligaments concept in achieving the lifting effect in the lower face region. PMC10082303
- Hong GW, Kim SB, Chua D, et al. Quantifying the Strength of the Facial Ligaments and Its Clinical Implications. Aesthetic Plastic Surgery. 2025;49(22):6227–6233. doi:10.1007/s00266-025-05060-y
This article is for general information and is not personal medical advice. Results vary from person to person. Please see a doctor for a facial assessment before choosing a treatment.