Why I favour a multimodal approach
to facial ageing

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One of the biggest changes in modern aesthetic medicine is that we no longer need to rely on a single treatment to try to address every aspect of facial ageing.

Ageing occurs at multiple levels simultaneously. We see changes in the skin itself — in its texture, pigmentation, hydration and collagen content. We see changes in the fat compartments of the face, which descend and redistribute over time. We see a gradual loss of the bony structural support that provides the scaffold the overlying soft tissue depends upon. We see changes in muscular activity. And we see the cumulative effect of all of these changes on facial appearance.

It therefore follows that one treatment alone cannot meaningfully address all of these changes. This is why I favour a multimodal approach to facial rejuvenation.

Different treatments have different jobs

This point is worth dwelling on, because it is often misunderstood — both by patients and, sometimes, within the industry itself.

Dermal filler can be extremely effective when we need precise structural support or restoration of volume in a specific area. But it cannot improve the quality of the overlying skin, stimulate new collagen, or address the dynamic muscular activity that contributes to lines and expression. It has a clear and specific job, and it does that job well — within its remit.

Equally, treatments designed to stimulate collagen or improve skin quality cannot replicate the structural support that can be achieved with appropriately placed filler. They are targeting different layers, different tissue types, and different mechanisms of ageing.

Depending on the individual assessment, a treatment plan might incorporate some or all of the following:

• Dermal filler to restore specific areas of volume loss and provide structural support — placed precisely and conservatively where it is genuinely needed.
• Biostimulatory treatments such as Sculptra where gradual collagen stimulation and progressive improvement in tissue quality and volume are the objective.
• Profhilo or Profhilo Structura where tissue laxity, skin quality and structural support are the primary concerns — chosen according to the depth and nature of the changes being treated.
• Polynucleotides and skin boosters where improving skin quality, hydration, texture and cellular health is the priority.
• Botulinum toxin to address excessive muscular activity and soften dynamic lines — while carefully maintaining natural expression and facial movement.
• Microneedling, resurfacing treatments and medical-grade skincare to address the skin itself, including texture, pigmentation, collagen production and overall skin health over time.

The important point is that these treatments do not need to compete with one another. They complement each other because they are targeting different components of the same ageing process.

Structure first, then skin quality

Where there is significant structural or volume change, I often begin by considering the deeper foundations of the face before turning to the surface. Addressing the underlying support structures first — and then reassessing — frequently reveals that less treatment is needed at the surface level than initially appeared.

In practice, I assess the facial thirds. Where filler is indicated, I may begin with the lateral mid-face before moving medially — supporting the cheek and restoring foundational structure before deciding whether any direct treatment to the lower face is actually required. Soft tissue follows structure, and restoring support higher in the face often has a beneficial indirect effect on areas further down.

But structural restoration is only one part of the picture. Once the underlying support has been addressed, we can consider the quality of the overlying skin — its hydration, texture, pigmentation, collagen density and elasticity — and introduce treatments specifically designed to improve those concerns.

In other patients, skin quality may be the primary concern from the outset, and filler may not be required at all. There is no fixed sequence that suits everybody. Each person's face ages differently, and each assessment is individual.

Creating a long-term plan rather than a one-off treatment

This is also why I think in terms of treatment plans rather than individual procedures. We do not need to do everything at once — and in most cases, it would not be appropriate to try.

A staged plan allows us to treat the areas that will make the greatest difference first, review the response, and introduce other treatments only where they genuinely add value. It also allows the patient time to see how their skin responds, to build confidence in the process, and to make informed decisions about what they would like to pursue next.

Over time, the emphasis in a treatment plan naturally shifts. The early focus tends to be on correction — addressing the changes that are already present. Later, the focus can move towards maintenance and prevention: supporting ongoing collagen production, maintaining skin quality, and replacing structural support only when it is genuinely required rather than on a fixed schedule.

For me, this is where modern aesthetics is heading. Not towards more filler, and not towards eliminating filler altogether. But towards combining the right treatments, in the right areas, at the right time — using the least intervention necessary to achieve a balanced, natural result.

The goal is not to change the face. It is to understand how the face is ageing and to intervene thoughtfully, in a way that supports the patient's long-term skin health as much as their immediate concerns.