The Science of Facial Harmony: Dr. James Co on What It Really Means to Age Well

For years, the language of beauty has been fixated on anti-aging. But as our understanding of the face becomes more nuanced, perhaps the more meaningful conversation is not about fighting age, but about aging well.

At a media roundtable on “Building Confidence Through Facial Harmony,” founder of Cosma Institute, Dr. James Co walked us through the science and psychology of healthy aging and why a personalized, harmonized approach matters far more than following trends. 

“Aging is not a disease we need to cure. It is a biological process,” said Dr. James. Facial aging is not simply a story written on the skin: changes occur across the bone, ligaments, muscles, fat compartments, and skin, with different structures evolving at different rates. Reviews published in Facial Plastic Surgery and Aesthetic Surgery Journal have examined how these interconnected changes, including those beneath the skin, contribute to the appearance of an aging face. 

That is also why there is no universal blueprint for what a particular age should look like. Research has shown that facial fat is divided into distinct anatomical compartments that can change in volume and position over time, influencing facial shape and balance. Meanwhile, genetics, skeletal structure, skin characteristics, sun exposure, lifestyle, and environmental factors can all influence how those changes appear from one person to another. Two people may share the same birthday yet have entirely different facial anatomy and aging patterns.

“Two patients can be the same age and come to me with completely different anatomy, lifestyles, concerns, and goals. Why would we expect their treatment plans to look exactly the same?” he remarked. It is a distinction that becomes increasingly relevant in an era when social media can make specific aesthetic procedures seem universally applicable. 

Seeing a treatment online, however, is not the same as understanding whether it is appropriate for an individual face. “Patients should not have to diagnose themselves from social media. You might recognize a concern, but deciding why it is happening and what should be done about it requires proper assessment,” Dr. James stated.

We also sat down with Dr. James to ask him our top questions on facial harmony, patient-centered care, and the future of aesthetic medicine. Here is what he had to share: 

Dr. James Co: Healthy aging, or its first step, is to accept that you are aging, but we can improve how you age or how you look at your best right now. Hindi kailangan na you’re chasing anti-aging na kailangan you stop the change. Most of the time, I ask the patient their motivations kung bakit gusto nilang pumunta sa clinic. If they say that they want to look 10 years younger, 20 years younger, it should be me telling them that it is a process. They can still look young, but we cannot say na magmumukha silang 20 years younger. What I can give them is mostly to look at their best at their age right now. So, hindi ito technically looking back or bringing back what they have. It’s technically to give them what they can get at their best at this time at this age. So, healthy aging starts with understanding that you are aging, but you want it to look the best way that you can. 

DJC: Usually, they would come whenever they see a trend, and they want to look like something, or they want to get something out of this treatment. The realistic conversation there with your patient is to say that if you do this treatment, ito ‘yung makikita mo or ito ‘yung ma-achieve mo. They have to know what they’re getting. We have to talk about the outcomes that could happen or would happen after this type of treatment, [especially] if they’re chasing something of a trend. It’s still my expertise versus what the trend is or versus what we will want to achieve.

DJC: For clinical practice, looking and actually being your best at that age is having a simple treatment of even just one evidence-based machine. Makukuha na ‘yung treatment na ‘yun. It’s not just if gusto mong magmukhang bata or magmukhang youthful, kailangan marami kang gawin. That doesn’t mean the same. So, we target what needs to change and then what we can do with the skin na kahit sa pinakamababang way to do it. Hindi naman kailangang mas marami kang gawin para mas maganda ka. Most of the time, the simplest way is to say na, ‘Ito lang ‘yun,’ and then you have to do it lang nang continuous para ma-achieve ‘yun. Hindi ito the more treatment that you do, the better the outcomes are.

Regenerative aesthetics is the number one thing right now. It’s becoming aesthetics and regenerative medicine going into one science. Kasi before, the aesthetics is more of parang you’re building something, you’re doing a structure or may binubuo ka, may nilalagay ka na ilong, nilalagay ka na lips. Ngayon kasi, we want to marry it to the regenerative one. We want our skin to look natural. That’s why ‘yung gusto natin ay ‘yung katawan natin mismo ‘yung gagawa nu’ng gusto nating outcome. Technically, we’re stimulating our skin to generate the right amount of collagen and the right amount of elastin to the skin na magmu-mukha kang bata.

DJC: Misconception number one that patients have is kapag pumayat sila, nagbagsak ‘yung skin, or ‘yung mga matataba, ‘yung may chubby cheeks, gusto nila matanggal ‘yung chubby cheeks na ‘yun. Those are usually the problems that arise, and I tell my patients that you don’t need to remove that. Kunwari, meron silang tinuturo na “Sag na ‘to, Doc.” That’s not really a sag. Most of the time, patients think na kaya sila nagmumukhang matanda is most of the sag. But it’s dahil ‘yung skin quality nila is not good.

Kaya naman bumabagsak ang skin kasi usually, the aging goes in—laging naarawan, ‘’yung iba naman nag-so-smoke. There are times I have patients na smokers na ang hirap pagandahin ‘yung balat, not because pumayat sila or ano, but because ‘yung skin nila is not responding to the treatments that we do. [Due to] the extrinsic aging caused by smoke inhalation or smoke presence, pumapangit ‘yung balat nila. So those are the problems that arises for the skin.

That’s why there’s such a thing right now as the Ozempic face, ‘yung mga tirzepatide, Mounjaro face, GLP faces, because it’s mainly because of the lifestyle. Of course, when you’re on GLP, I’ve seen a lot of patients na hindi kumakain or hindi na nag-workout. Since you’re not eating, there are patients who don’t move or don’t do any workouts or don’t do any physical exertion. Doon nagkakaroon ng sobrang pagpayat ng face o paglubog nu’ng mukha nila. Kasi number one, they have low calorie intake. S’yempre, namamayat sila and they’re not maintaining their movement—parang nagiging sedentary, parang patients that are bedridden. Kaya ‘di ba parang bagsak lahat? They don’t want that. So usually, you combat it by being with your doctor na dapat palaging nababantayan ka. You have to know what to do to combat that. Kailangan lang naman nu’n mag-exercise ka. Kailangan naman nu’n mabantayan natin ‘yung dosing mo. Mga ganu’n lang naman. It’s with regard to how you take care of it or how you and your doctor talk about it.

DJC: There are, of course, science-based modalities that could see kung ano ‘yung magandang perfect harmony or symmetry for the face. I apply that, but usually, it’s mostly for help lang sa akin. Hindi ko kailangang i-apply sa lahat. Pero kasi, there is such a thing as counting or parang measurements, let’s say, if you have a nose na gusto mong pataasan or gusto mong i-change or the chin, may specific measurement tayo r’yan kung kailangan dagdagan or kailangan may gawin. Pero not everyone needs to do that. Kasi minsan, okay naman pala. Nakikita mo, parang kulang ‘yung baba nila, gusto mong dagdagan, pero sila mismo okay sila ro’n. So, hindi mo siya kailangang i-change. Pero if you are basing it on science, meron kang backing na ito kasi ‘yung magandang effect if we do that. So, roon ko siya mini-marry.

DJC: Facial harmony—it’s mostly because of how they feel about themselves on a personal level. It’s really personal before being objective. The objectivity of that is, s’yempre, there’s no one beauty trend on one face. So generally, kailangan ng acceptance na maganda siya at one point and then we want it to be objectively beautiful. That’s number one. Number two, it’s mostly for the patient to see that they feel like okay ‘yung standing nila sa face nila, and for them to accept na kung ano meron sila. Du’n natin pinapasok si facial harmony. And then, we build their confidence with regard to what they did see. Kaya that’s why my conversation starts with a consultation na kung ano ‘yung nakikita nila na kailangan i-improve or bakit ba sila nandito. If nakuha natin ‘yung problem na ‘yun, doon nila ma-accept na maganda sila or harmonious ‘yung face nila. That’s where it starts.

DJC: Usually, fatigue or structural loss comes from degeneration of the skin. Ang number one r’yan nakikita is the under-eye. Number two, ‘yung sa cheeks, ‘yung lines or sagging—nag-sta-start doon. Those areas that we treat, especially the under-eye—it doesn’t change the whole structure or the whole features of the patient. Let’s just say, ‘di ba ‘pag your eyes are your asset, hindi ma-che-change kapag inayos mo ‘yung under-eye. Mag-be-better pa, mas ga-ganda pa. There are also areas that we could improve by changing some parts na hindi nagbabago ang features. There are techniques to do that naman.

DJC: For non-verbal cues, it’s how they open up. Actually, it’s what they’re not saying. Kasi minsan, pagka-pumasok si patient for assessment or for consultation, sila muna magsasalita. Sila muna magku-kuwento kung anong kailangan nila or bakit sila nandito. That’s where I assess already. There are patients kasi na parang hindi sila ganu’n mag-open up. There are patients naman na s’yempre maraming nang sasabihin—that’s the easier patient. Pero ‘yung mga ang hirap makuhanan ng information, usually, how I assess them or how I do their assessment is mostly watching their face, watching how they respond, watching how they smile, how they talk. Du’n ko sila ina-assess. If they’re not open, that’s when the experience comes in. The conversation would have to be a medical one or objective one or kung ano ‘yung nakikita ko professionally na kailangan magawa. If you agree on that, then okay. Kung hindi, we can do other things na kung ano ang nasa isip mo. But most of it comes from the individual or the person in front of me.

DJS: There are specific trends na hindi talaga bagay for the patient. If it is not really good for them, I would say no to them. Number one, explain ko muna kung ano ‘yung makikita ng patient if we do that. That’s also where technology comes in; then mapapakita ko sa kanila na ganito ‘yung effect niyan. But then, I would still say na I would give them alternatives first na ma-aaccept nila. Like instead of doing this, why not do this? This would lead to something better than your usual. Kasi siyempre kailangan convincing powers sa pasyente. Pero there are times naman na since ayaw nila or ayaw nila makinig or gusto nila ‘yun, there are times na I still say no na hindi ko siya gagawin kasi I don’t want to be part of the problem, technically, kung magkaka-problema. Of course, I can say no. There is such a thing as a doctor’s right to say no to a treatment lalo na kung hindi siya mukhang okay.

The consultation there is: if I see na hindi bagay sa kanila, I point it out. And most of the time, I don’t get bullied by the patient na kailangan gawin ‘yun. ‘Pag gan’yang may trend sila [ta’s pupunta sila sa’kin], let’s just say, if you want the trending lips pero hindi bagay sa’yo ‘yung gusto mong makita, I can do the lips na bagay sa’yo. Ipakikita ko or sasabihin ko na ito ‘yung nakikita kong bagay sa’yo. If you agree, I would do that. Pero technically, if I don’t agree with what you are looking for or the trend, I would say no. Kung hindi mo nakikita ‘yung vision ko na sinabi ko sa’yo na ito dapat ‘yun, and ayaw mo siyang pagawa, that’s where we can say na hindi natin siya pwede gawin. Pero kung lumapit ka na may trend [kang gustong sundin], tapos I can see na okay naman, I would do it still.

DJC: Usually, it’s them talking first kung ano ‘yung nakikita nila. That’s the first thing that I ask. After that, how I empower them for their consultation is I point things that we want to preserve, the things that work. And then, how would we want to maintain that with regard to the other things that they see. Kunwari, pumunta si patient, I point out like your main feature is the nose, your main feature is the eyes. I want that to marry the whole area. Kung kailangan, maganda ‘yung whole area para ma-model natin ‘yung eyes and nose mo to other parts of the face. If pumunta siya at sinabing wala raw siyang baba, wala raw siyang jaw. I-po-point out muna natin kung ano ‘yung feature na gusto natin na ma-maintain or maging reference natin for the whole face before we talk about what we should improve on or kung ano kailangan natin gawin.

DJC: Okay, so evidence-based, especially here in Cosma, I don’t get all types of products, lalo na ‘yung mga sikat. I follow my own judgment. I follow my own research skills. Kasi there are products na sobrang sikat that everyone wants to do. Pero when you look at it, look at the journals, look at the research, the science is not there. Ang ganda lang nila mag-marketing. It’s my prerogative or it’s my ethical judgment na hindi ko siya ipasok sa clinic. S’yempre, it’s my expertise or my know-how if kukunin ko ba. There are three things I use to assess them. Of course, the government agencies, the FDA approvals. Number two is the proof, ‘yung makikita mo ba ‘yung effect. Number three is the journals or the research: is it saying that it’s safe? Or is it saying na tama ‘yung ginagawa niya or the way to inject it or the way to put it on the skin. So kahit sabihin mong trendy siya, I don’t have that. Meron mga ganu’ng gamot na wala ako rito.

DJC: Over the next decade, the facial harmony conversation would mean it has to look good objectively and subjectively. But it’s mostly for the patient’s own confidence in themselves. It’s mostly what they see sa mukha nila na kailangan i-improve; ‘yun ‘yung mai-improve natin rather than chasing a trend or conventional beauty standards that are hard to achieve.