Ligament injection in Daegu — it does not make ligaments ‘stronger’, it places a support beneath them
“Ligament strengthening injection” (인대강화주사 in Korean), “retaining ligament filler”, “ligament lifting filler”. I hear all three names in consultations, and they are all the same treatment. I use this approach often these days, so I want to set out in my own words the actual principle hidden behind the names. This column contains no prices, no reviews and no photos.
The short answer
Ligament injection places very small amounts of filler in the deep layer near and beneath the retaining ligaments — the structures that tie facial skin and fat to bone — to create a ‘support’. The aim is not to fill a hollow but to let the tissue resting on that support sit a little higher, changing the lines of the whole face. Miso Clinic uses about 2 cc of filler for the whole face, about 0.1 cc per point. The name says ‘strengthening’, but there is no human data showing that ligament tissue actually becomes stronger. In one randomised trial the results were similar to a conventional injection technique. Miso Clinic in Daegu (4F Bombom Building, 125 Dongdeok-ro, Jung-gu, +82-53-428-2700) explains this range before anything is injected.
Ligament strengthening injection, retaining ligament filler, ligament lifting: are they the same thing?
Yes, they are names for the same treatment. Each clinic and each training course simply calls it something different. There is no standard technique name yet.
Where does ‘strengthening’ come from? A Taiwanese research team used the phrase “ligament strengthening” in the title of a 2022 paper, and the word seems to have spread from there. But it is closer to a metaphor. I could not find any data in humans showing that the ligament tissue itself becomes thicker or tougher after the injection.
So in consultations I explain it as “placing a support under the ligament” rather than “making the ligament stronger”. That is closer to what actually happens.
What are retaining ligaments, and why inject there?
Facial skin and fat do not simply rest on top. Here and there they are firmly attached to bone or deep fascia — like the pegs that fix a tent to the ground. These are called retaining ligaments.
The ones most often named are at the outer corner of the eye (orbital ligament), over the cheekbone (zygomatic ligament), the inner cheek (maxillary ligament) and in front of the jawline (mandibular ligament). With age, the tissue between these anchor points slides down, like fabric sagging between tent pegs. That is how the cheek beside the nasolabial fold and the jowls along the jawline come to look.
This treatment slips a small support just beside the peg, beneath the point where the tissue starts to sag. The tissue resting on that support sits a little higher. When one point above rises, the line hanging below it looks less stretched too. It supports from above instead of filling below.
Why is it said to differ from ‘filling’ filler?
| Filling filler | Support at ligament points (ligament injection) | |
|---|---|---|
| What it treats as the problem | Volume loss causing a hollow | Tissue that has moved down from its place |
| Where it goes | Where it looks hollow | Above where tissue has descended, near the anchor points |
| How much | As much as the hollow needs | A small amount per point, little for the whole face |
| What changes | Volume at that spot | The direction of the facial lines |
I see this as the difference between “a puffed-up face” and “a face returned to its place”. I have often seen that filling a deep nasolabial fold again and again makes the mouth area look heavy. Supporting from above can often address the same concern with less.
One study put this sense into numbers. In a 12-person split-face study, the side where the area outside the ligament line was injected first used 1.26 cc in total, the other side 1.88 cc — yet the assessment scores were identical on both sides. The same result with roughly two-thirds of the volume.
How much does Miso Clinic inject?
About 2 cc for the whole face, about 0.1 cc per point. The points differ from face to face, so how many places to divide it among is decided after examination.
To put 2 cc in context: among studies reported abroad as ‘full-face rejuvenation’, one used an average of 14 syringes per person. Our aim is different. We are not building a new face, but supporting what has descended to recover the original lines.
A small volume is both a strength and a limit. For faces with major hollowing, or skin loose enough to fold, this amount is not enough. In those cases I discuss other approaches alongside from the start.
How far does the evidence go?
I will be frank. The evidence behind this treatment is still thin.
| Study | Result | What to look for when reading |
|---|---|---|
| Chinese randomised trial 2023 (40 people, nasolabial folds) | Fold score improvement at 24 weeks: ligament technique 0.73 vs conventional 0.89, no difference | Blinded, split-face. Funded by the product company |
| Split-face study 2019 (12 people) | Same score with 1.26 cc vs 1.88 cc in total | Small. Not ‘lifts more’ but ‘uses less’ |
| Retrospective study 2020 (306 people) | Mean change of 0.19 mm in skin landmark distance | Statistically significant but small in size |
| Taiwanese prospective study 2022 (12 people) | Brow-to-orbit distance 1.9 → 3.9 mm (12 weeks) | PLLA injected too, so effects cannot be separated |
The randomised trial did not find that “the ligament technique is better”. It found it “similar to the conventional method”. That does not mean it has no effect, but it is not evidence that it lifts more either. Anatomists are still debating the very premise that ligaments ‘stretch’ with age.
I still use this approach for one reason. If the result is the same, I believe injecting less leaves less behind in the face, puffs it up less, and leaves more room for the next decision. I do not hide in consultations that the evidence is thin. A more detailed review of the same data is in Retaining ligament filler: the evidence behind targeting ligaments.
When I do not recommend ligament injection first
- Faces with marked hollowing of the cheeks or temples — filling volume is needed before a support.
- Skin loose enough to fold — 2 cc is beyond its range. A thread lift or a surgical consultation may be appropriate.
- When you want a big change in one go — this treatment refines lines; it does not change the face.
- Inflammation at the treatment site, or pregnancy or breastfeeding — we do not treat that day.
- When you do not know what filler was injected before — we first check what remains.
A face with mild sagging and not much hollowing that still “looks somehow sunken and tired”: that is who I bring this treatment up for first.
Frequently asked questions about ligament injection in Daegu
Are ligament strengthening injection and retaining ligament filler the same treatment?
Yes. Ligament strengthening injection, retaining ligament filler and ligament lifting filler are all names for placing a small amount of filler in the deep layer near the facial retaining ligaments to create a support. There is no standard technique name yet.
Does ligament injection actually make the ligaments stronger?
I could not find human data showing that. ‘Strengthening’ is closer to a metaphor; in practice the treatment places a support near the ligament so the tissue above sits a little higher.
How much filler does ligament injection use?
Miso Clinic uses about 2 cc for the whole face and about 0.1 cc per point. The number and position of points are decided by looking at the face.
How is ligament injection different from ordinary filler?
Ordinary filler fills a hollow. Ligament injection supports the area near the anchor points above where tissue has descended, aiming to change the direction of the facial lines. So the placement and the amount differ.
Has the effect of ligament injection been confirmed by research?
The evidence is still thin. In one randomised trial (40 people), improvement of nasolabial folds was similar to a conventional injection technique, and a 12-person study reached the same result with less volume. Most data have no control group.
Who is ligament injection suitable for?
I think it suits people with mild sagging and not much hollowing whose face nonetheless looks sunken and tired. For marked hollowing or very loose skin, other approaches come first.
Where can I get a ligament injection consultation in Daegu?
Miso Clinic is at 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, in front of Exit 1 of Kyungpook National University Hospital Station. +82-53-428-2700. Weekdays 11:00–19:00, Saturday 10:00–16:00, closed Sundays and public holidays.
Read next
- Where ligament injection came from — MD Codes and Restylane HIT
- Ligament injection and thread lifts lift in different ways
- Ligament injection: what to watch even in small doses
- Retaining ligament filler — how far does the evidence actually go
- A Natural Lifting in Daegu — What Is Actually Being Adjusted
- Cheek sagging — we start by asking what has descended
Product pages
Related reading: How filler and boosters differ · What hyaluronidase can reverse
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, director of Miso Clinic, Daegu. The treatment standards and injection design set out here are the ones we use in practice.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Randomised trial, ligament technique vs conventional technique — Feng G et al., Aesthetic Plast Surg 2023;47(4):1550–1559, PMID 36810835, DOI 10.1007/s00266-023-03278-2, ChiCTR2100041702. 2 centres in China, 40 people with moderate to severe nasolabial folds, split-face randomised and double-blind. Blinded WSRS improvement at 24 weeks: ligament technique 0.73 ± 0.61 vs conventional 0.89 ± 0.61 (p>0.05); GAIS 1.32 vs 1.41 (p>0.05). The authors concluded “similar efficacy, better improvement of midface deficiency and fewer adverse events”, but I could not confirm those figures in the abstract. Funded by the product company.
- Split-face study injecting outside the ligament line first — Casabona G et al., J Cosmet Dermatol 2019;18(5):1237–1243, PMID 31402563, DOI 10.1111/jocd.13089. 12 people. The side where points outside the ligament line were injected first used less total volume, 1.26 ± 0.64 cc vs 1.88 ± 0.57 cc (p=.02), with no left-right difference in assessment scores (p=1.00).
- Retrospective study of lateral support injection — Casabona G et al., J Cosmet Dermatol 2020;19(2):303, PMID 31840373, DOI 10.1111/jocd.13245. 306 people, mean 0.32 cc. Mean change in the distance between midface skin landmarks 0.19 mm (p<.001). No control group.
- Prospective study of HA + PLLA at ligament points — Chuang AD et al., J Cosmet Dermatol 2022;21(6):2429–2436, PMID 34535947, DOI 10.1111/jocd.14461. 12 Taiwanese women; HA (about 1.0 mL per side) and PLLA injected together at the orbital, zygomatic, maxillary and mandibular retaining ligaments. At 12 weeks the brow-to-orbit distance went 1.9 → 3.9 mm and the tragus-to-mouth-corner length 281 → 275 mm. No control group; the design cannot separate the effects of the two materials. The authors used the word “strengthening” in the title.
- Anatomy of the mandibular ligament — Minelli L, Yang HM, van der Lei B, Mendelson B, Aesthetic Plast Surg 2023;47(1):170, PMID 36050569, DOI 10.1007/s00266-022-02996-3. 49 cadavers. The body of the mandibular ligament lies only in the deep layer beneath the platysma, and jowls are explained by lengthening of the subcutaneous connective tissue. Evidence that the premise of ligaments “stretching” and causing sagging is still debated.
- Limits of ligament-targeted approaches (perspective paper) — Kwon BS, Hong GW, Lim Y, Clin Cosmet Investig Dermatol 2026;19, PMID 42472085, DOI 10.2147/CCID.S616026. The authors, who are themselves developing the technique, write that the results are observational data from few cases and a single operator, that quantitative analysis of ligament tension is lacking, and that ordinary volume support may have contributed to the lifting observed.
- Retrospective full-face MD Codes study — Bertossi D et al. (co-authored by de Maio), J Cosmet Dermatol 2020;19(9):2219–2228, PMID 32623790, DOI 10.1111/jocd.13596. 250 people, mean 14 ± 4 syringes (4–25), with botulinum toxin. FACE-Q appearance-related distress score 54.3 → 36.1 (3 months). Bruising 35.2%, transient swelling 14.0%, persistent swelling around the eyes 3.6%. No control group.
- Korean Medical Service Act — Article 56(2) prohibits treatment-experience testimonials, comparisons with other clinics and superlatives in medical advertising. This is why the column carries no reviews, before-and-after photos or prices.
- Miso Clinic treatment criteria — Support injections at ligament points use small divided doses: about 2 cc in total for the whole face and about 0.1 cc per point (confirmed by the director); thread lifts use dissolvable threads only, planned conservatively for people aged 50 and over; for hollow cheeks, dissolvable hyaluronic acid filler comes first. Source of the sentences written as “I” or “we”.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.