FULL-FACE REJUVENATION

Dr Thivos Sokratous at Ouronyx looks beyond the mirror for a holistic approach

DR THIVOS SOKRATOUS

Dr Thivos Sokratous is an Imperial College London graduate, with a pronounced passion for aesthetic medicine. Next to his specialism in facial aesthetics, he has a strong background in anatomy and physiology with experience in surgery and psychiatry. Known for combining his tailored approach towards full face rejuvenation with intricate skin-health work; Dr Sokratous enjoys incorporating his systematic skin analysis with his bespoke facial harmonisation treatments.

This article explores the journey of Jace Smith, a 42-year-old first-time patient, through a comprehensive full-face rejuvenation treatment. She came to Ouronyx with concerns about looking aged, tired, and sagging, and underwent a tailored, multi-layered approach involving neuromodulators and dermal fillers. This case demonstrates how a holistic perspective and advanced techniques can restore balance, natural beauty, and confidence.

INTRODUCTION

True facial rejuvenation goes far beyond softening a wrinkle or plumping a cheek – it’s about restoring balance and harmony to a face that has changed across multiple dimensions with time. Ageing impacts every face layer; the bone resorbs, muscles overcompensate, fat pads shift, and the skin loses elasticity. Addressing these changes in isolation often leads to disjointed results, whereas a cohesive approach can create a transformation that feels authentic and natural.

Smith, a first-time patient, came to me seeking a solution to her concerns of looking tired and aged. Her journey reflects a common challenge: how do we achieve transformational results while preserving the patient’s identity? By combining neuromodulation and a total of 16ml of hyaluronic acid fillers strategically placed across multiple planes, I could address her concerns with precision and artistry. This case highlights not only the possibilities of advanced techniques but also the importance of respecting the face as a cohesive unit.

METHODOLOGY - PATIENT ASSESSMENT

Smith presented with:

• Mid-face volume loss: Contributing to heaviness in the nasolabial area and jowling

• Muscle overactivity: Most notably in the mentalis (chin), depressor anguli oris (DAO), and platysma, which exaggerated the downward pull on the lower face

• Structural challenges: Retrognathism (receding chin) and a naturally projecting upper lip border, creating a tendency for the lips to pout outward when treated improperly

• Skin quality concerns: Fine lines and early laxity.

Her treatment was divided into two stages: full-face neuromodulator treatment to harmonise muscle activity and prepare the face, followed by strategic filler placement to restore structural support and volume.

Stage 1: Neuromodulator treatment

Two weeks before filler placement, Smith received a comprehensive neuromodulator treatment. The goal was to address muscle overactivity and lay the foundation for balanced and precise filler placement.

Key areas treated:

• Upper face: Relaxation of the glabella, forehead, and crow’s feet to soften lines while maintaining natural expressiveness

• Mid-face: The orbicularis oculi muscle was treated laterally, superiorly, and medially to reduce skin bunching, smooth the transition to the cheekbone, and brighten the overall eye area

• Lower face: Mentalis: Relaxing the overactive chin muscle to smooth creases and soften puckering. DAO and platysma-jaw insertion: Lifting the corners of the mouth and alleviating the downward pull on the lower face, indirectly improving the appearance of early jowling. Base of nose: Preventing downward nasal tip movement on animation for a more balanced profile.

This step used a total of 10 units of neuromodulator, harmonising muscle dynamics and creating a neutral, cohesive baseline for the filler phase.

Stage 2: Strategic filler placement

Two weeks later, Smith underwent dermal filler treatment using 16ml of hyaluronic acid filler of varying densities. The placement was precise, addressing the unique challenges presented by her anatomy.

Key areas treated:

1. Lateral cheeks and temples: Filler was placed to restore volume and provide structural support to the lateral face, alleviating mid-face heaviness and lifting the nasolabial region indirectly.

2. Preauricular area: Filling this region helped counteract sagging and reinforced lateral ligaments for a more youthful contour.

3. Jawline and chin: This was a key focus, with filler placed in both deep and superficial planes to enhance jawline definition and provide chin projection. This balanced the lower face, reduced marionette lines, and blended seamlessly with the lips.

4. Lips and perioral area: Enhancing Smith’s lips required careful attention. Using a soft filler, I rotated the lips outward to restore balance and minimise her upper lip’s natural tendency to pout. Additional filler was placed outside the lip border to refine projection, creating a harmonious, natural appearance.

5. Tear troughs and nasolabial folds: Minimal filler was placed to soften shadows and reduce hollows, ensuring the mid-face remained balanced and free from central heaviness.

RESULTS

Smith’s transformation was subtle yet powerful, highlighting the importance of a multi-layered approach. Key outcomes included:

• Alleviated mid-face heaviness: Strategic lateral support improved the nasolabial region and provided lift without contributing to central heaviness

• Balanced lower face: Chin projection and jawline enhancement restored harmony to Smith’s proportions, smoothing transitions and reducing marionette lines

• Refined lip appearance: The lips were subtly enhanced, with filler placed to reduce the upper lip’s natural tendency to pout outward and create a balanced, soft projection

• Rejuvenated expression: The treatment brightened Smith’s overall appearance, leaving her looking rested, vibrant, and confident.

Smith described the results as “exactly what I wanted — refreshed and balanced without looking like I’ve had work done.”

CHALLENGES AND CONSIDERATIONS

Smith’s case presented unique anatomical challenges that required careful planning and precise execution:

1. Mid-face heaviness: The visible separation of fat pads in the mid-face meant filler in this area would exacerbate the problem. Instead, lateral and upper structural support was prioritised, achieving lift and balance without contributing to central weight.

2. Lip anatomy: Smith’s naturally projecting upper lip border required a strategic approach to avoid overprojection. The use of soft filler to rotate the lips outward and refine the lip border showcases how subtle adjustments can deliver significant improvements.

3. Filler stigma: Using 16ml of filler may seem like a large volume to some, but this case highlights the need to stop demonising filler. The key lies in how filler is used —choosing the right product for the right area, placed in the right plane with the right technique by a skilled and experienced practitioner. When done correctly, filler achieves results that look beautiful today and age gracefully.

Before and after

This case underscores the importance of nuanced anatomical knowledge and a holistic perspective. Treating the face as a cohesive unit is critical to achieving results that feel both natural and transformative.

CONCLUSION

Smith’s journey exemplifies the transformative potential of modern aesthetic medicine when approached with precision, artistry, and a deep respect for facial harmony. By addressing multiple layers of the face — structural, muscular, and volumetric—and tailoring the treatment to her unique anatomy, we achieved results that restored her natural beauty without compromising her identity.

This case also serves as a reminder of the importance of patient education. At Ouronyx, we place importance on demystifying aesthetic treatments and showcasing the artistry and science behind them, we can shift the narrative around injectables from stigma to empowerment. The goal isn’t to fight ageing but to guide it gracefully, enhancing each patient’s confidence and sense of self.

Ultimately, this case demonstrates that true rejuvenation is not about isolated corrections—it’s about seeing the face as a whole and creating harmony that lasts.