Ligament injection: what to watch even in small doses — the site, not the volume, sets the risk
“It’s only a small amount, so it’s fine, right?” That is the question I hear most in ligament injection consultations. It is true that the amount is small — about 2 cc for the whole face with us. But the risk of this treatment does not come from the amount. It comes from where it goes. That is what this column is about.
The short answer
Ligament injection uses small amounts of about 0.1 cc per point, but the places where retaining ligaments sit are deep layers close to bone and overlap the paths of named blood vessels. So saying ‘it is safe because it is a small amount’ is not correct. A vascular event is decided not by the total volume but by whether a single injection enters a vessel, and the depth of the facial artery at the jawline varied from 2.5–15 mm between people. So I think of dissolvable hyaluronic acid as the default material, and explain what goes where before injecting. The order we follow at Miso Clinic in Daegu (4F Bombom Building, 125 Dongdeok-ro, Jung-gu, +82-53-428-2700) is set out below too.
Why be careful when the amount is small?
The most feared event with filler is a blocked blood vessel. If filler enters an artery, the skin that vessel supplies can be damaged, and rarely a vessel supplying the eye is blocked and vision is lost.
This is not a question of total volume. Even 0.1 cc becomes an event if it goes into a vessel. In fact, ligament support is often done by placing small boluses with a needle in the deep layer close to bone — a technique at the very centre of the discussion about intravascular injection.
So I do not say “it is safe because it is a small amount”. I go only as far as “because it is a small amount, it puffs up less and is easier to reverse”.
Which blood vessels lie near the ligament points?
The places where retaining ligaments are named are usually deep and close to the paths of blood vessels. Near the mandibular ligament in front of the jawline, the facial artery crosses the jawbone and travels upward.
Its depth varies considerably from person to person. In a study that examined 84 people with Doppler ultrasound, the depth of the facial artery crossing the lower border of the jawbone ranged from 2.5 mm to 15 mm. The authors concluded that “there is no absolutely safe depth or area”.
In a collection of 365 reports of visual loss after filler, the nose (40.6%) · forehead (27.7%) · glabella (19.0%) were most common. The cheekbones and jawline where ligament supports go are not at the top of that list. That does not mean they are proven safe areas. And of the cases with a reported visual outcome, only 6.0% recovered fully.
Why does it matter whether the material can be dissolved?
Hyaluronic acid filler can be dissolved with a drug called hyaluronidase. That means there is a way back both when a vascular problem is suspected and when you are not happy with the result.
Some materials promoted for ligament support are not hyaluronic acid. Calcium-based fillers and polymer materials of the same family as dissolvable thread materials are not dissolved by this drug. For deep places close to vessels, such as ligament supports, I think of dissolvable hyaluronic acid as the default.
Dissolving is not free of cost either. It also acts on the tissue that was already there, and rarely causes allergic reactions. Details are in What hyaluronidase can reverse.
What order does Miso Clinic follow?
- First we separate whether tissue has descended or hollowed. We start by checking whether the face suits a support.
- We choose the anchor points that need support and divide about 0.1 cc per point within about 2 cc for the whole face.
- Before treatment we tell you which product goes where and whether it is a material that can be dissolved.
- We inject slowly, one point at a time, watching for changes in skin colour and pain as we go.
- We record the product name and where it was placed, so it can be known later what remains.
The choice between needle and cannula differs by site. The pros and cons of each tool are set out in Needle or cannula?.
Common reactions after treatment, and signs to contact us right away
Common ones are swelling, small bruises, and the injected spots feeling stiff or palpable for a few days. Most settle within 1–2 weeks. The result is best judged after the swelling has gone down.
The following are signs to contact us immediately, without counting days.
- When the skin around an injected spot turns white, or takes on a net-like purplish pattern
- When pain gets worse as time passes
- When your vision becomes blurred or changes — this is an emergency
- When warmth · redness · tenderness grow together a few days later
When we do not do ligament injection, or postpone it
- When there is inflammation · acne · a wound at the treatment site
- During pregnancy · breastfeeding
- When it is not known what is already in the same place — we check first
- If you have had a vascular problem after filler before — we redesign very cautiously
- When a big event is only a few days away — allow time for swelling · bruising to settle
The principle and evidence are in Ligament injection in Daegu is really about placing a support, and the difference from thread lifts is in Ligament injection and thread lifts.
Frequently asked questions about ligament injection side effects · safety
Is ligament injection safe because the amount is small?
The amount is small, but that does not make it safe. A vascular event is decided not by the total volume but by whether a single injection enters a vessel, and the ligament points are deep and close to vessels.
What are the common side effects of ligament injection?
Swelling, small bruises, and the injected spots feeling stiff or palpable for a few days are common. Most settle within 1–2 weeks. Skin turning white or a net-like purplish pattern, worsening pain, or changes in vision mean you should contact us right away.
Can ligament injection be dissolved?
If it was done with hyaluronic acid filler, it can be dissolved with hyaluronidase. Calcium-based fillers and polymer materials do not dissolve, so check first what is being injected.
Is ligament injection near the jawline riskier?
The facial artery passes near the jawline, and its depth varied from 2.5–15 mm between people. The researchers concluded there is no absolutely safe depth, so we inject slowly and in small amounts.
When should the result of ligament injection be judged?
Judge it after the swelling has gone down. Most of it settles within 1–2 weeks. It is better not to rush decisions to add more or dissolve before then.
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
- Ligament injection in Daegu — it does not make ligaments ‘stronger’, it places a support beneath them
- Where ligament injection came from — de Maio’s MD Codes and Restylane’s HIT
- Ligament injection and thread lifts — hooking and pulling versus supporting and lifting
- Hyaluronidase — what it can reverse and what it cannot
- “Is Rejuran injected with a needle or a cannula?”
- Adverse events by booster class — what is common, and when it appears
Product pages
Related reading: Retaining ligament filler: the evidence behind targeting ligaments
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
- Depth of the facial artery — Ten B et al., J Cosmet Dermatol 2021;20(7):2247, PMID 33171021. Doppler ultrasound in 84 people, 168 hemifaces; facial artery depth at the lower border of the mandible 2.5–15.0 mm. Authors’ conclusion: there is no absolutely safe depth or area.
- Collected reports of visual loss after filler — Doyon VC et al., Aesthet Surg J 2024;44(10):1091, PMID 38630871, DOI 10.1093/asj/sjae091. 365 new cases from 2018-09 to 2023-03. Nose 40.6% · forehead 27.7% · glabella 19.0%; HA 79.6%. Of the 318 cases with a reported visual outcome, full recovery 6.0%.
- 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.
- 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.
- 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.