Ingeborg van Lotringen knows from experience that not all cosmetic tweakments give great results. But there is one she thinks is pretty spectacular

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With 25 years as a beauty journalist and five as an aesthetic treatments columnist under my belt, you’d be right to assume I’ve tried and reviewed my fair share of non-surgical cosmetic 'tweakments'. And while I haven’t made the leap to cosmetic surgery, some of these ‘minimally invasive’ procedures are a heck of a lot more invasive, and potentially damaging, than others.

From injectables (fillers, skin boosters, neurotoxin such as Botox) to energy-based devices (lasers, ultrasound, radiofrequency, plasma) to a gamut of other skin stimulants (microneedles, acids, cryo, microcurrents, and so on), I’ve had most of them at least once. And while they do stop short of cutting the skin with a scalpel, they can sometimes cause nasty temporary bruising, swelling, peeling and bleeding (which I’ve had my fair share of, being the sort that gets damaged easily) - you can see some of them in my truth about tweakments story.  In the wrong hands, or in the wrong circumstances, treatments like this can also change your face in ways that might not be to your liking.

Injectables without the ‘pillow face’ look

Many (if not all) tweakment results are temporary, with any unintended trout pouts, hamster cheeks or ‘surprised’ shiny foreheads taking from three (for toxin injections) to 18 months (fillers) to revert to ‘normal’. Nonetheless, I’ve learned to err on the side of extreme caution, opting for treatments that rev up skin function or replace lost tissue and moisture rather than anything that can visibly reshape or augment part of my face. I worry that that latter way,  a distorted perception of normality lies, and I don’t want to succumb to it.

Thing is, this approach does sometimes make for results so ‘undetectable’ that you can see only a minimal difference. Injectable skin boosters such as hydration-infusing Profhilo and collagen-promoting polynucleotides are examples of this, as is having filler in my temples to counteract the progressive hollowing and gaunt-ness that comes with age. What I try to do is keep skin in a healthy, youthful state of self-repair and prevent those tired-looking signs of ageing from advancing.

But while this is all great, there is only so much extreme subtlety I want to plump for when tweakment prices start at hundreds of pounds and often run into the thousands. The bigger the outlay, the more you want to look in the mirror and see your face-from-five-years ago staring back at you. That’s only natural, right?

What is the best non-surgical treatment for ageing well?

For the perfect balance of subtlety and transformation, where you are guaranteed to see results, I can only vouch for one treatment after all these years. It’s called HArmonyCa (complete with convoluted spelling), and it’s only been on the market for a year or two.

What is HArmonyCa?

It’s a ‘hybrid injectable’ that does two things. A very liquid, hyaluronic acid-based filler with a difference, it doesn't change the shape of your face but gives a bare minimum of volume and added density to the ‘lateral’ parts of the lower face (meaning the lower cheeks and jaw area that can be prone to drooping and creating jowls, especially if you have a relatively thin face). The gel is spiked with an agent that stimulates fibroblast activity to induce collagen and elastin generation.

That means that over time (the products lasts 18 months), a second benefit becomes evident: any deeper laughter lines in the cheeks, also referred to as ‘accordion’ or ‘concertina’ lines, smooth out and become less evident. HArmonyCa is one very rare tweakment that can successfully do this. 

It works on very much the same principle as the buzzy polynucleotides treatment (a type of skin booster) but the active ingredient is calcium hydroxyapatite (CaHA). And because HArmonyCa is a filler that stays in the skin for up to 18 months, as opposed to a skin booster that disappears over three months, the long-term, cumulative benefits are far more dramatic.

What are the results of HArmonyCa? A year on, here's my verdict

You'll see long-term firmer, smoother skin on cheeks and jawline, less thinning and slackening. On top of that, as mentioned, the CaHA works on progressively plumping out ‘sideways WiFi symbol’ laughter lines spreading from the corners of the mouth towards the lower cheeks - something no injectable has previously been able to do.

The instant results, when I had this treatment over a year ago, were satisfying. My normally very pliable skin felt instantly denser and firmer, and I gained nearly imperceptible (yet obvious to me) width to my narrow lower face. There was no trace, however, of chipmunk cheeks or a lantern jaw, which are things I’ve seen happen when people are over-enthusiastically injected with too much regular filler.

But the long-term results have been even better. The menopause-induced process of deepening lines, thinning skin and jowling that had set in around my lower face has been stopped in its tracks, and my cheeks look smooth and firm, imbued with the ‘baby fat’ and youthful collagen I still had two decades ago.

It recently caused an eye surgeon to comment that I might try doing something to “make my eyes match the youthfulness of my lower face”. Which I could have taken as an insult but which made me laugh, as it was a testament to the success of HArmonyCA.

Unfortunately, due to the fact that it's administered via cannula, it cannot be used around the bony part of the upper face as there’s not enough space between the skin layers of the soft tissue for it to be given effectively - more’s the pity.

What is involved in a HArmonyCa treatment? Does HArmonyCa hurt?

The cannula (a blunt-tipped hollow needle) used to administer the HArmonyCa gel to the lower dermal layer (where collagen and elastin are made) is extra-long, using up to three injection points in each cheek. 

It would hurt quite a lot if the anaesthetic Lidocaine wasn’t incorporated in the gel – as it is, the procedure is uncomfortable but bearable. Over about 30 minutes, your face is cleansed and marked for injection points, followed by quite nasty jabs to make insertion points for the cannula. In my case, there were four in total.

The cannula, which is swiped windscreen-wiper style under the skin, didn’t really hurt until it reached the far end of my face near the jaw, where it exerted a horrible pressure. 

The thin tube moves around freely under your skin without doing damage: apparently, explains surgeon and cosmetic physician Dr Apul Parikh (who did my treatment) there’s plenty of space between the skin layers of the soft tissue of the lower face to fiddle about. This is not the case for the bonier upper face, which is why you sadly can’t have the procedure there.  All in all, my treatment was hardly fun but once done, I only felt a slight tenderness in my jaws and could see nothing but some redness at the injection points.

“Thanks to the length of the cannula, we can spread it under the entire cheek and jaw area, depositing the gel right where the calcium hydroxyapatite can get to work: throughout the dermis," says Dr Parikh. "The CaHA will have a noticeable effect in one skin cycle, so after about six weeks."

Who can have HArmonyCa?

HArmonyCa is very much a procedure for ‘mid-lifers’ and above. Those 'concertina' lines and jowls in most cases  don’t set in until your forties when collagen levels drop and skin loses its density and spring.

There is a limit to what it can do is terms of firming, however: if skin is exceptionally slack and loose, which can happen from your 60’s and beyond, surgery is advised instead.

Those with round or fuller faces, or very strong jawlines, should also think twice. The (very) subtle amount of volume the procedure adds will not always be appreciated by those who don’t like the natural width or volume in their face. Ultrasound treatments, which can rev up collagen but also mildly ‘shrink’ fat and tighten tissues, are potentially a better alternative here.

How long does HArmonyCa last?

The volumising and slightly line-plumping results are instant, but they actually improve as the filler induces more collagen and elastin production over a period of about 18 months (for some, it even lasts three years), while the filler simultaneously wears down in the skin. So you’ll keep deepening and multiplying lines at bay for a good year-and-a-half before you might want to get another treatment.

What does HArmonyCA cost?

Dr Parikh charges £1200 for the procedure (which includes a spell under the skin-calming LED light device Celluma). Other London clinics can charge from £1600 and upwards, while outside the capital, the treatment starts at about £850.