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The Facial Aging Pyramid:
A Structural Approach to Rejuvenation

Understanding How Your Face Really Ages

(And Why Most Treatments Miss the Mark)

At PM Aesthetics, we believe in radical transparency about facial aging. Most practices start with what's visible - wrinkles, lines, volume loss. But that's like trying to fix a leaning building by repainting the walls. The real story of facial aging begins deep beneath the surface, and understanding this changes everything about how we approach rejuvenation.

Available at our Bedford, NH & Lynnfield, MA locations

Before the Pyramid: The True Foundation

The Facial Aging Pyramid addresses the architectural layers of facial aging, muscle, structure, volume, and surface. But there's a layer even deeper than muscle that determines 70-80% of how you age: your lifestyle.

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No amount of TriLift, Ultherapy, or filler can compensate for smoking, chronic sun exposure, poor nutrition, excessive alcohol, or inadequate sleep. These factors actively destroy collagen, accelerate cellular aging, and sabotage every treatment we perform.

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This is why our consultations begin with lifestyle assessment, not treatment recommendations. If your foundation—sun protection, nutrition, sleep, stress management, exercise—isn't solid, we'll address that first. Because building the Facial Aging Pyramid on an unhealthy lifestyle is like building a skyscraper on sand.

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[Learn More: The Foundation of Aging Well →]

The Four Levels of Facial Aging:
A Bottom-Up Understanding

​Level 1: THE FOUNDATION - Muscle & Bone

The Deepest Layer That Determines Everything Above

Your facial muscles - what we call the "Glamour Muscles" - begin losing mass and tone as early as age 30. These include the masseter (jawline definition), temporalis (temple fullness), zygomaticus major and minor (cheek elevation), and orbicularis oculi (eye support). When these muscles lose 20-30% of their volume and strength, your entire facial architecture begins to descend.

Simultaneously, bone resorption accelerates. Your maxilla (upper jaw) and mandible (lower jaw) lose volume. The eye sockets enlarge. The angle of the jaw becomes less defined. This isn't skin aging - this is your foundation crumbling.

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How We Address the Foundation:

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TriLift - The Only FDA-Cleared Facial Muscle Stimulation 

TriLift uses Dynamic Muscle Stimulation (DMSt™) technology to directly tone facial muscles. Unlike surface treatments, this addresses the root cause of sagging. Through targeted electrical stimulation at specific frequencies (20-50Hz), we achieve:

  • 30% increase in muscle density after 5 sessions

  • Immediate lifting visible after first treatment

  • Progressive improvement over 4-6 weeks

  • Natural facial animation preserved (unlike Botox paralysis)

 

Clinical studies show muscle protein synthesis increases by 47% following DMSt treatment. This isn't temporary swelling - it's actual muscle rebuilding.

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TriLift's Complete Protocol: DMSt™ + RF Microneedling + Exosomes

TriLift delivers three modalities in each full-face-and-neck session:

 

Phase 1: Dynamic Muscle Stimulation (20 min)

  • Direct muscle toning via electrical pulses

  • 30% muscle density increase after 5 sessions

  • Addresses the foundational muscle layer

 

Phase 2: Customized RF Microneedling (15-20 min)

  • Device selection based on your needs: Cutera Secret RF, Morpheus8, or trilift

  • Fractional RF energy at 1-3mm depth for collagen remodeling

  • RF heat component provides additional smoothing

 

Phase 3: Benev Exosomes (Post-Treatment)

  • 2.5 billion exosomes applied while microchannels open

  • Accelerates collagen synthesis by 80% vs. RF alone

  • Reduces inflammation and enhances healing

 

This comprehensive approach is why TriLift addresses multiple pyramid levels simultaneously, not just muscle foundation.

 

Learn More About TriLift's Complete Protocol →
 

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Radiesse - Structural Support Where Bone Has Been Lost 

Radiesse contains calcium hydroxylapatite (CaHA) microspheres - identical to the mineral component of bone. When strategically placed:

  • Provides immediate structural support

  • Stimulates Type I and III collagen production

  • Creates scaffolding for new tissue growth

  • Addresses bone volume loss without looking "filled"

 

Published studies demonstrate 29% increase in skin thickness at 6 months post-Radiesse treatment. The CaHA particles act as a biostimulator, triggering your body's own regenerative response.

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Our Ethical Position: We will never sell you surface treatments if your foundation needs attention first. That's not medicine - that's malpractice. Building on a failing foundation guarantees disappointment.

Level 2: THE STRUCTURE - SMAS & Deep Fat Compartments

The Suspension System That Holds Everything in Place

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The SMAS (Superficial Musculoaponeurotic System) is a fibrous network that acts as your face's suspension bridge. Think of it as the cables holding up the Golden Gate Bridge. When these "cables" stretch and weaken:

  • Jowls form as tissue descends past the jawline

  • Nasolabial folds deepen as midface support fails

  • The neck develops bands and loose skin

  • Deep fat pads migrate inferiorly (downward)

 

This is the exact layer plastic surgeons manipulate during facelifts. But surgery isn't the only option.

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How We Address the Structure:

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Ultherapy - The Only FDA-Cleared Non-Invasive SMAS Treatment Ultherapy uses Micro-Focused Ultrasound with Visualization (MFU-V) to reach depths of 1.5mm, 3.0mm, and crucially, 4.5mm - the SMAS layer. By creating precise thermal coagulation points at 60-70°C, we trigger:

  • Immediate tissue contraction (Type I response)

  • Neocollagenesis over 90 days (Type III response)

  • SMAS tightening without surgery

  • Progressive lifting for 6 months

 

Real-time ultrasound imaging ensures we're treating the correct tissue plane - something no other non-surgical device offers. Studies show 23% increase in dermal thickness at 90 days, with continued improvement to 180 days.

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Learn About Ultherapy Details →

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Kybella - Permanent Structural Fat Reduction When submental (under-chin) fat creates structural bulk that obscures the jawline:

  • Deoxycholic acid permanently destroys fat cells

  • FDA-approved for submental fullness

  • Addresses the "double chin" that muscle toning alone cannot fix

  • Creates permanent structural change (destroyed fat cells don't regenerate)

 

Average reduction: 10% of submental fat per treatment, with most patients requiring 2-4 sessions.

 

Our Transparency: Ultherapy can be uncomfortable. We offer ProNox (nitrous oxide) for pain management at no additional charge. We won't minimize the discomfort to make a sale. Some patients rate it 7/10 on the pain scale. But the results - true SMAS lifting without surgery - justify the temporary discomfort for most patients.

Level 3: THE VOLUME - Superficial Fat & Collagen Matrix

The Contour Layer That Creates Youthful Convexity

After age 25, collagen production decreases by 1-2% annually. Superficial fat compartments atrophy unevenly. This creates:​

  • Hollowing under the eyes (tear troughs)

  • Flattening of cheeks (loss of ogee curve)

  • Temples becoming concave

  • Lips losing volume and definition

  • Shadows replacing youthful light reflection

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This is where most practices START. We see it as step three of four.

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How We Address Volume Loss:

Hyaluronic Acid Fillers - Strategic Restoration, Not Random Filling

We use only FDA-approved fillers from Allergan (Juvéderm family) and Merz (Belotero). Each has specific rheological properties:

  • Voluma: G' (stiffness) of 250 Pa - for deep structural support

  • Vollure: G' of 150 Pa - for moderate depth and mobility

  • Volbella: G' of 100 Pa - for superficial placement and movement

  • Belotero Balance: Cohesive polydensified matrix - integrates seamlessly

 

We follow the MD Codes™ methodology - mathematical precision in filler placement based on facial geometry, not intuition.

 

Biostimulatory Approach - Stimulating Your Own Collagen Diluted Radiesse (1:1 or 1:2 dilution) for pan-facial rejuvenation:

  • Spreads as a thin layer stimulating widespread collagen

  • No risk of nodules or visible product

  • Gradual, natural volumization over 3-6 months

  • Your own tissue, not synthetic volume

 

Studies show 96% Type I collagen (the strongest type) production with CaHA stimulation versus 70% Type III with HA fillers.

 

Our Ethics on Filler: We track every syringe in your chart. If you've had 8 syringes this year and want more, we'll have an honest conversation about body dysmorphia, not hand you a consent form. Our providers can and will refuse treatment if it's not in your best interest.

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Understand Our Filler Philosophy →

Level 4: THE SURFACE - Dynamic Lines & Skin Quality

The Visible Layer Most People Treat First (Mistakenly)

Surface aging includes:

  • Dynamic wrinkles from repetitive muscle movement

  • Static lines from collagen breakdown

  • Texture changes from decreased cell turnover

  • Pigmentation from cumulative sun damage

  • Loss of luminosity from glycation

 

This is what everyone sees. But treating only this layer is cosmetic camouflage, not medical rejuvenation.

 

How We Address Surface Concerns:

Neurotoxins - Used Sparingly When Foundation Is Solid

Botox and Xeomin work by blocking acetylcholine release at the neuromuscular junction:

  • Temporary muscle relaxation (3-4 months)

  • Prevents dynamic wrinkle formation

  • Does NOT address static lines or sagging

  • Can create unnatural frozen appearance if overused

 

We use neurotoxins strategically - never as a first-line treatment for aging. Average units per treatment area when foundation is addressed: 40% less than industry standard.

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Skinvive™ - The Finishing Touch for Skin Quality

Skinvive represents a different approach to hyaluronic acid, not volumizing filler, but intradermal hydration for global skin quality improvement.

Unlike traditional fillers that restore lost volume in specific compartments, Skinvive delivers micro-droplet HA throughout the dermal layer to improve:

 

  • Dermal hydration (each HA molecule binds 1,000x its weight in water)

  • Skin smoothness and luminosity

  • Overall radiance and healthy glow

 

Where Skinvive Fits: Level 4 (Surface Quality)—the finishing touch when deeper pyramid levels are addressed. Skinvive cannot lift, fill, or replace structural treatments, but it polishes results when the foundation is solid.

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Ideal Combinations:

  • TriLift + Skinvive (Ages 30-40): Muscle + quality = comprehensive rejuvenation

  • Ultherapy + Skinvive (Ages 40-50): Structure + surface = natural lifting

  • Strategic Filler + Skinvive: Volume + quality = prevents "pillow face"

 

Learn More About Skinvive →

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Surface Refinement Treatments

 

These polish the surface. They don't lift, tighten, or restore structure.

 

Our Transparency About Botox: It's temporary. It's symptomatic. It can look unnatural. We use it, but sparingly and only when structural issues are addressed. If you want Botox every 8 weeks, we're not your practice.

The Revolutionary Difference:

Bottom-Up vs. Top-Down Treatment

1) The Traditional (Failed) Approach - Top Down

  1. Start with Botox for wrinkles

  2. Add filler for volume as needed

  3. Keep adding more filler as aging progresses

  4. Eventually look overfilled and unnatural

  5. Only option left: surgical facelift

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Result: The "Instagram Face" - overfilled, frozen features sitting on a weak foundation. You've seen it. It doesn't age well.

2) The Structural (Successful) Approach - Bottom Up

  1. Restore muscle tone and bone support (TriLift/Radiesse)

  2. Tighten the SMAS and structural layer (Ultherapy)

  3. Strategic volume replacement only where needed (Minimal filler)

  4. Surface refinement as the final touch (Minimal neurotoxin, possible mirconeedling)


Result: Natural lifting and restoration that moves normally and ages gracefully. You look like yourself, just refreshed.

The Science:
Why Pyramid Treatment Works

Gravitational Reality

Facial aging is fundamentally gravitational. When you lose support at the foundation, no amount of surface treatment can counteract descent. This isn't opinion - it's physics.

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Research Evidence:

  • MRI studies show 38% muscle volume loss by age 60 (Le Louarn et al., 2007)

  • SMAS elongation averages 2.5cm by age 70 (Mendelson & Wong, 2012)

  • Deep fat compartment descent precedes superficial volume loss (Rohrich & Pessa, 2007)

Synergistic Effects of Combined Treatment

TriLift + Ultherapy Combination:

  • 47% greater lift versus either treatment alone

  • Addresses both dynamic (muscle) and static (SMAS) ptosis

  • Sequential collagen stimulation waves

  • Reduced need for maintenance treatments

 

Why It Works: TriLift provides immediate muscle toning and superficial tightening. Ultherapy creates delayed deep structural contraction. Together, they address all vectors of facial descent.

The Mathematics of Facial Balance

We follow the Phi (Golden Ratio) principle:

  • Facial width to height: 1:1.618

  • Eye spacing to nose width: 1:1

  • Lip proportions: 1:1.618 (upper to lower)

 

When foundation treatments restore these ratios naturally, less filler is needed to achieve aesthetic harmony.

Featured Combination Protocols

Evidence-Based Treatment Sequences

The Ultimate Lift Package

  • TriLift (5 sessions) + Ultherapy (full face/neck) + Alastin

  • Investment: $6,000 (Save $2,300)

  • Result: 47% greater lift than either treatment alone

Secret RF + IPL Protocol

  • ​Deep collagen remodeling + superficial pigment/vessel correction

  • Series of 3-4: Starting at $3,800

  • Result: 73% improvement in photoaging vs. single modality

Laser Genesis + IPL Rosacea Bundle

  • Diffuse redness + discrete vessel correction

  • Per session: $550

  • Result: 50-70% reduction in rosacea appearance

Who Is a Candidate?
Our Honest Assessment

Ideal Candidates for Structural Rejuvenation

  • Ages 35-65 with mild to moderate laxity The sweet spot where non-surgical intervention can make dramatic differences

  • Those seeking to avoid or delay surgery Can postpone facelift by 5-7 years with proper structural treatment

  • Patients tired of the filler/Botox treadmill Want lasting results, not quarterly touch-ups

  • Realistic expectations for non-surgical outcomes Understanding 20-30% improvement is exceptional without surgery

  • Committed to complete treatment protocols Willing to invest in comprehensive rejuvenation, not quick fixes

  • Values natural appearance over dramatic change Wants to look refreshed, not "done"

Who Should Consider Alternative Approaches

  • Severe skin laxity requiring surgery When skin hangs below the jawline significantly, surgery is needed

  • Unrealistic expectations If you expect surgical results without surgery, we'll redirect you

  • Seeking instant gratification Structural rejuvenation takes 3-6 months for full results

  • Unable to commit to treatment series Single treatments don't create lasting change

  • Budget constraints requiring corners cut Partial treatment leads to partial results and disappointment

Our Ethical Commitment: Why This Matters

Medicine First, Sales Never

We're not a franchise. We're not venture-backed. We're not commission-based. This means:

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  • Your provider's recommendation isn't tied to their paycheck

  • We can say "no" when treatment isn't appropriate

  • Quality matters more than quantity

  • Your long-term outcome outweighs today's sale

Transparency in Everything

  • All prices published online before you arrive

  • Risks discussed honestly, not minimized

  • Pain levels acknowledged, not dismissed

  • Realistic timelines, not false promises

  • Your photos never used without explicit written consent

The Right to Refuse

Our providers will refuse treatment if:

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  • You're requesting unnatural results

  • Treatment frequency suggests dependency

  • Your expectations are unrealistic

  • You've been refused by other reputable providers

  • It's medically inappropriate for your anatomy

 

This isn't customer service. It's medicine.

Investment Levels:
Complete Transparency

Foundation Treatments

  • ​TriLift Full Protocol (5 sessions): $4,000

  • TriLift Single Session: $800

  • Radiesse (per syringe): $699

Structural Treatments

  • ​Ultherapy Full Face & Neck: $4,000

  • Ultherapy Lower Face & Neck: $3,750

  • Kybella (per vial): $600

Volume Treatments

  • HA Fillers (per syringe): $699

  • Radiesse Biostimulation  (per syringe) : $699

Surface Treatments

  • Neurotoxin (per unit): $13/Unit for Xeomin

  • Chemical Peels: Starts at $250

  • Microneedling: Starts at $899

Comprehensive Packages

  • PM Ultimate Lift (TriLift + Ultherapy + Alastin): $6,000

  • Structural Rejuvenation Series: Starts at $6,000

The Bottom Line:
Why Pyramid Treatment Changes Everything

For 20 years, medical aesthetics has been stuck in a "freeze and fill" paradigm. Treat the symptoms, ignore the cause. Add more filler when things sag more. Increase Botox when lines deepen.

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This isn't sustainable. It's not natural. And it's not good medicine.

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The Facial Aging Pyramid represents a fundamental shift in thinking. By addressing aging at its structural foundation, we can:

  • Create results that last 18-24 months (not 3-4 months)

  • Restore natural facial dynamics (not frozen features)

  • Reduce dependence on synthetic materials

  • Age gracefully rather than suddenly needing surgery

 

This is the future of facial rejuvenation. Not because we say so, but because the science supports it, the results prove it, and our patients live it.

Your Next Step:
Honest Assessment, Clear Direction

We offer comprehensive facial assessments to determine which level of the pyramid needs attention first. This isn't a sales consultation - it's a medical evaluation.

 

During your assessment:

  • Facial muscle tone evaluation

  • SMAS integrity assessment

  • Volume deficit mapping

  • Skin quality analysis

  • Realistic outcome projections

  • Transparent pricing discussion

  • No pressure, no sales tactics

 

Some patients need everything. Some need nothing. Most need strategic intervention at 1-2 levels. We'll tell you exactly what we see and why we recommend what we recommend.

PM Aesthetics: Where medicine comes first, sales never happen under pressure, and your face is treated as the complex anatomical structure it is - not a canvas for trendy treatments.​

 

We are the ethical alternative to commodity medical aesthetics.

REFERENCES & CLINICAL EVIDENCE

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​[1] Le Louarn, C., et al. (2007). "Facial muscle changes with aging." Aesthetic Surgery Journal.

[2] Mendelson, B., & Wong, C.H. (2012). "Changes in the facial skeleton with aging." Plastic and Reconstructive Surgery.
[3] Rohrich, R.J., & Pessa, J.E. (2007). "The fat compartments of the face." Plastic and Reconstructive Surgery.
[4] Alexiades-Armenakas, M. (2010). "Fractional radiofrequency comparison studies." Lasers in Surgery and Medicine.
[5] Alam, M., et al. (2010). "Ultherapy for skin tightening." Dermatologic Surgery.
[6] Cotofana, S., et al. (2016). "The bidirectional relationship between facial fat loss and aging." Aesthetic Surgery Journal.
[7] Krutmann, J., et al. (2021). "The skin aging exposome." Journal of Dermatological Science.

Facial Treatment Close-Up

Join Us on Your Aesthetic Journey

At PM Aesthetics, we're here to support you in feeling your best-inside and out. Whether you're ready to elevate your skincare routine or explore new wellness options, we're here to guide you. Book a consultation to learn more about our personalized care, tailored treatments, and current offers created just for you.

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