A Dual-Phase Approach to Facial Rejuvenation Integrating Contouring and Ligamentous (CL Code) Anchoring With a...

Facial aging reflects concurrent skeletal remodeling, fat redistribution, and attenuation of retaining ligaments. Volume-oriented fillers may restore contours but often underaddress structural support.

To describe the CL Code, a dual-phase injectable protocol combining Contouring (C) and Ligamentous anchoring (L), using a polycaprolactone (PCL) collagen stimulator to integrate immediate volumization with delayed neocollagenesis.

The protocol aligned the biphasic kinetics of PCL with facial anatomy. The C-phase targeted seven contouring zones using small aliquots to restore volume, while the L-phase reinforced eight retaining ligament support points at the supraperiosteal or subsuperficial musculoaponeurotic plane using 27-gauge needles. A 49-year-old woman with pan-facial volume loss underwent treatment with a total volume of 2.9 mL (0.3 mL per C site and 0.1 mL per L point). Outcomes at 6 months included Global Aesthetic Improvement Scale (GAIS) ratings and patient-reported FACE-Q scores. FACE-Q was administered pretreatment and at 6 months using the Satisfaction with Facial Appearance module. GAIS was assessed by two independent dermatologists blinded to treatment details using standardized photographs.

In this single patient, standardized photography demonstrated improved jawline definition, reduced jowling, and softening of nasolabial folds. GAIS was rated as "Very Much Improved," and FACE-Q scores increased from 58 to 86 (out of 100), indicating high patient satisfaction.

Aligning the temporal behavior of PCL with anatomically targeted injection planes may couple immediate contour restoration with progressive ligamentous support. The CL Code achieved meaningful esthetic improvement using conservative volumes. Controlled comparative studies with longer follow-up are warranted.