Can You Get a Lifting Treatment If You Have a Lean Face?

Hello, I’m Dr. Heejin Park, Director of Onu Clinic.

In recent years, the expectations of patients seeking lifting treatments have been changing rapidly.

In the past, many patients were willing to wait several months for collagen to gradually rebuild and for the effects of treatment to become noticeable over time.

Today, however, more and more patients come in shortly before an important photo shoot, wedding, or major event and ask for a treatment that can visibly refine the facial contour immediately after the procedure.

As demand for immediate contour improvement has grown, so-called “immediate contouring devices” based on multi-wavelength diode lasers such as 755 nm, 810 nm, and 1064 nm wavelengths have emerged as a new option in the lifting market.

At the same time, however, patient anxiety about lifting procedures has also increased.

There are several questions I hear almost every day in the consultation room.

“Doctor, won’t lifting make my hollow cheeks worse?”

“I already have very little facial fat. Is it really safe for me to have a HIFU treatment like Shurink?”

“I’ve heard that if lifting is done incorrectly, it can make the cheekbones look more prominent and actually make you look older.”

In fact, many patients are so concerned about lateral cheek hollowing or unnecessary volume loss that they avoid even the tightening treatments they may genuinely need.

Some patients come to us after being told at another clinic, “You don’t have enough facial fat, so you should never have HIFU lifting.”

Others have undergone treatment using the same depth and number of shots across the entire face and later experienced visible cheek hollowing, leaving them understandably hesitant about future lifting procedures.

From a physician’s perspective, these problems are not necessarily caused by the device itself.

Rather, they often arise from a one-size-fits-all treatment approach that views facial fat and soft tissue as one continuous mass and delivers the same type of energy to every area of the face.

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1. An Anatomical Approach: The Face Does Not Age as One Single Fat Compartment

We often simplify facial aging by saying that “the face loses fat and starts to sag with age.”

But actual facial aging is far more complex.

Anatomically, human facial subcutaneous fat is divided into multiple independent fat compartments.

Between these compartments are network-like fibrous septa extending from the superficial fascia to the dermis.

Together, these structures form a retaining system that helps support and maintain the overall shape of the face.

CT-based facial studies in Asian women have shown that certain fat compartments may actually become thicker with age.

For example, infraorbital fat and nasolabial fat have been observed to increase in thickness over time.

In contrast, superficial cheek fat in the central cheek area may become thinner and undergo selective atrophy.

In particular, thickening of the lower portion of the fat above the nasolabial fold has been identified as one factor that can deepen the nasolabial fold and make the midface appear heavier and more descended.

The lower face behaves in a similarly complex way.

The lower and deeper portions of the jowl fat compartment may become thicker with age, while fat in other areas around the jawline may show different patterns of atrophy or hypertrophy.

In other words, several opposing changes can occur simultaneously within the same face.

Hollowing and Prominence

The anterior and lateral cheeks may lose volume and become sunken.

As this happens, the cheekbones can appear relatively more prominent.

Bulging and Heaviness

At the same time, nasolabial fat may become thicker, making the midface appear heavier.

Jowl fat may also protrude below the jawline, obscuring the mandibular border and making the jawline appear blunt or interrupted.

For this reason, it is not anatomically appropriate to classify someone simply as “a person with little facial fat” and completely exclude all tightening or fat-reduction treatments.

Conversely, applying fat-reduction energy at the same depth and intensity across the entire face can also lead to significant adverse effects.

Before designing a lifting treatment, the following three questions must be carefully assessed:

Which fat compartments have already atrophied with age and therefore need to be preserved?

Which fat compartments have become relatively thick, descended, or heavy and are contributing to an aged appearance?

And independently of fat volume, which areas and depths require structural contraction and elastic support?

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2. From Hair-Removal Laser to “Immediate Contouring Laser”

Multi-wavelength diode devices using wavelengths such as 755 nm, 810 nm, and 1064 nm were originally developed as hair-removal systems designed to treat different skin tones and varying hair depths.

Early clinical studies therefore focused primarily on hair-removal efficacy and safety.

However, continued research by clinicians began to suggest that multi-wavelength energy could also be useful for skin rejuvenation, tightening, and contour refinement.

Studies have reported that repeated exposure to multi-wavelength diode laser energy may promote histologic changes involving collagen and elastic bundles within the dermis.

Other clinical research has explored its potential role in lipolysis and facial sculpting.

Of course, the various multi-wavelength devices available today differ in output, spot size, energy delivery, and cooling protocols.

Therefore, findings from earlier studies cannot automatically be assumed to represent the exact clinical effects of Portra.

Nevertheless, they provide an important scientific basis for understanding how multi-wavelength diode laser technology may extend beyond hair removal into the fields of skin rejuvenation and facial contouring.

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3. How Portra Quattro Produces Acute Contour Contraction

Patients who undergo Portra Quattro treatment often describe more than just a feeling of tighter skin.

They frequently say things such as:

“My face immediately felt more fitted and compact.”

“The heaviness beside the nasolabial fold and around the jowls felt lighter right away.”

However, new collagen formation and dermal remodeling require biological time—typically several weeks to several months.

For this reason, the immediate changes seen directly after treatment cannot be explained by newly formed collagen alone.

A key mechanism lies in the thermal contraction of existing collagen.

When sufficient thermal energy, or thermal dose, is delivered to the tissue, the triple-helix structure of collagen undergoes thermal denaturation.

This causes the collagen fibers to shorten immediately.

This reaction depends not only on temperature, but also on exposure time, tissue hydration, mechanical stimulation, and other factors.

It is an irreversible structural response at the collagen level.

However, this immediate contraction does not last forever.

The face is not made of collagen alone.

Beneath the skin lies a complex structure composed of fat lobules, fibrous septa, blood vessels, extracellular fluid, and other tissues.

Therefore, the dramatic contour refinement seen immediately after Portra treatment is best understood as the result of several mechanisms acting together—a phenomenon we refer to as acute contour contraction.

These mechanisms may include:

- Acute thermal contraction of existing collagen and fibrous septa
- Morphologic changes in the collagen network surrounding subcutaneous fat
- Temporary compression of fat lobules caused by physical pressure from the treatment handpiece
- Temporary changes in blood flow and redistribution of tissue fluid

Because early changes in tissue fluid and temporary compression gradually recover over time, the slimmer appearance seen immediately after treatment is not expected to remain 100% unchanged in the long term.

For this reason, the immediate contraction effect should be distinguished from long-term collagen remodeling.

A complementary treatment strategy is often needed to support and maintain the contour over time.

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Why Can a Multi-Wavelength Laser Appear to Produce a Stronger Immediate Effect Than Radiofrequency?

Monopolar RF devices such as Thermage and Oligio also deliver heat to the dermis and fibrous septa and can produce immediate tissue contraction.

So why does a multi-wavelength laser such as Portra sometimes create a more noticeable immediate change in facial contour?

1. Reduction in Fat-Compartment Projection

Portra uses a broad treatment area and rapid repetitive energy delivery.

This allows heat to accumulate broadly and efficiently across protruding or descended fat compartments, such as the fat above the nasolabial folds or the jowl area.

This may help reduce the visible projection of these areas and flatten the overall contour.

2. Heat Delivery to Deeper Tissue Levels

According to recent cadaveric research involving Portra, stacked delivery of multi-wavelength energy may allow heat to penetrate beyond the superficial dermis and reach deeper tissue levels, including the fascia.

This suggests the possibility of simultaneous contraction in deeper supporting tissues.

3. Changes in Facial Shadowing

Even a small reduction in fullness above the nasolabial folds or in protruding jowls can noticeably alter facial shadowing.

When these darker contour lines are softened, the face can appear immediately slimmer and more lifted.

In other words, the soft tissue does not necessarily need to move dramatically upward.

Even subtle changes in the boundaries between light and shadow can cause the brain to perceive the face as more defined and lifted.

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4. The Complementary Design of Portra Quattro and Shurink Universe

Facial contour lifting should not rely blindly on a single device.

When two technologies with different mechanisms and treatment depths are combined appropriately, more precise facial sculpting may be possible while minimizing unnecessary volume loss.

① Portra Quattro: A Global Contour Reset

Portra Quattro uses four wavelengths simultaneously:

755 nm, 828 nm, 940 nm, and 1064 nm.

The newly incorporated 940 nm wavelength has relatively high absorption in both water and lipid, helping distribute heat more evenly across deeper and broader tissue layers.

With its broad tip and strong contact-cooling system, Portra is well suited to treating larger areas of heavy soft tissue.

This includes prominent nasolabial fat and jowl fat.

Its role is to create the “big picture” by broadly heating and refining heavier or protruding facial contours and smoothing the overall silhouette.

Limitation

Because the treatment tip covers a relatively large area, Portra is less suited to highly localized sculpting at the millimeter level.

It also produces a strong acute contraction effect, but as a standalone treatment, it may have limitations in maintaining long-term structural support.

② Shurink Universe: A Detailer That Improves Spatial Resolution by Depth and Location

If Portra reduces the overall heaviness and resets the broad facial contour, Shurink Universe can add precision and detail.

HIFU has the unique advantage of creating thermal coagulation points at specific target depths such as 3.0 mm and 4.5 mm while minimizing unnecessary stimulation of surrounding tissue.

MP Mode — Linear Energy Delivery

MP mode delivers energy in a continuous linear pattern.

It can be used to refine small residual fat pockets that remain after Portra treatment.

For example, it may be applied to a narrow localized fat pocket immediately above the nasolabial fold.

Normal Mode — Focal Thermal Coagulation

Normal mode places closely spaced focal thermal coagulation points.

This makes it useful in areas where fat volume should not be reduced, but where structural support and contraction are needed.

In such areas, treatment can be directed toward a lax SMAS layer to create strong structural anchor points.

In addition, delayed collagen remodeling and elastin regeneration following Shurink treatment can serve as an important structural support mechanism.

This may help reinforce and prolong the immediate contraction effect produced by Portra.

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5. Facial Contouring Design: The Three Principles of Preserve, Reduce, and Anchor

Customized bespoke lifting should be based on careful anatomical planning.

Preserve

Key Goal:

Preserve necessary volume and prevent unwanted hollowing.

Areas that are already atrophic or hollow—such as the lateral cheeks, under-eye area, or the region below the anterior cheekbone—should receive little or no unnecessary energy.

The goal is to protect the patient’s natural facial volume.

> Deciding where not to treat is just as important as deciding where to deliver energy.

Reduce

Key Goal:

Reduce heaviness and age-related bulging.

Portra Intensive Mode can be used to accumulate heat within deeper soft tissue containing prominent nasolabial fat and jowl fat.

Dynamic Mode can then be used to broadly contract the fibrous support structures within the dermis and subcutaneous tissue.

This may help reduce the projection and heaviness of specific fat compartments.

Afterward, Shurink Universe MP Mode at depths of 3.0 to 4.5 mm can be used to refine remaining localized fat more precisely by depth.

Anchor

Key Goal:

Improve structural support and long-term lifting stability.

Portra Intensive Mode can be intentionally stacked more strongly at depths corresponding to retaining ligaments.

The goal is to induce contraction of the retaining ligaments and surrounding fibrous support structures, creating functional anchoring points.

After this, Shurink Universe Normal Mode at 3.0 to 4.5 mm can place independent thermal coagulation points in the lateral face and SMAS layer.

This can help reinforce structural support and contribute to longer-term tissue remodeling.

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Lifting Is Not Determined Simply by the Number of Shots or the Name of the Device

Among the many lifting devices available today, there is no single device that is absolutely superior in every situation.

Even a high-output, premium device can cause unwanted cheek hollowing if it is used in a uniform way without considering the patient’s anatomy, skin characteristics, facial asymmetry, and fat distribution.

True bespoke lifting is completed through careful medical design:

What should be preserved?
What should be reduced?
And where should structural support be reinforced?

The answer lies not simply in the device itself, but in how the physician designs the treatment based on the individual anatomy of each face.

For patients who want both an immediately refined facial contour and longer-term improvement in firmness over time, a scientifically planned and anatomically precise bespoke facial contouring strategy may be worth considering.

At Onu Clinic, we will continue to study facial anatomy in depth and place patient safety at the center of every treatment decision.

Thank you.