The fundamental principle of Morphodynamic Cosmetic Surgery is that “function determines form” (Rizzo 2020) and Mechanobiology is a mainstay of it.
We can certainly trace the birth of Mechanobiology back to 1892, when Julius Wolff formulated the Wolff’s Law:
” Tension and compression stimulates bone deposition and increased density at points of stress, while a decrease in stress will cause the bone to weaken over time.”
Wolff J. Das Gesetz der Transformation der Knochen. Berlin: Hirschwald; 1892.
Wolff’s Law, formulated by Julius Wolff in 1892, is a foundational principle in bone mechanobiology, stating that bone structure adapts to the mechanical loads it experiences. According to this law, bone tissue is continuously remodeled in response to functional demands—becoming stronger and denser under increased mechanical stress and weaker or resorbed when mechanical loading decreases.
This adaptive process occurs through coordinated osteoblastic (bone formation) and osteoclastic (bone resorption) activity regulated by mechanotransduction mechanisms involving osteocytes, the primary mechanosensors of bone.
In 1997 Melvin Moss developed the revolutionary Functional Matrix Theory:
” The growth, development and maintenance of all skeletal tissues and organs are secondary, compensatory and obligatory responses to the functional demands of surrounding non-skeketal tissues, organs or functioning spaces”
Moss ML. The FUNCTIONAL MATRIX Hypothesis. The role of Mechanotrasduction. Am I Orthod Dentofacial Orthop. July, 1997.
In recent years, the emerging discipline of Mechanobiology has explored the mechanisms of action of extrinsic mechanical stimuli, explaining in detail how cells, tissues, and organs translate mechanical stimuli into biological processes (https://www.chirurgiacosmeticamorfodinamica.it/2025/10/21/the-role-of-mechanobiology-in-regenerative-aesthetic-medicine-and-morphodynamica-cosmetic-surgery-mdcs/)
In his paper, Harris (2019) Introduces the facial filler as a myomodulation agent — the strategic use of injectable materials to modulate the dynamic contractile behaviour of mimic muscles, and thereby rebalance their antagonistic pairs and “engineered geometry” of support (Harris, 2019).
Clinically this means that beyond volumising soft-tissue deficits, practitioners must actively engage the underlying neuromuscular architecture: for example, by placing a hyaluronic acid bolus beneath a hypoactive elevator muscle (such as the zygomaticus major), the practitioner effectively shortens its working arm and enhances its lever action, while simultaneously increasing the resting length of its overactive depressor (such as the platysma or depressor anguli oris), thereby reducing its hyperkinetic behaviour (Harris, 2019; de Maio, 2018).
This principle aligns closely with the “function determines form” philosophy articulated in the blog of Chirurgia Cosmetica Morfodinamica (Rizzo, 2020) which places neuromuscular balance at the core of aesthetic outcomes: small-volume, high-precision injections are used not only to restore lost volume, but to fine-tune muscle length-tension relationships so as to preserve natural animation and avoid the frozen, mask-like appearance (Rizzo, 2020).
Supportive evidence from clinical series (Coimbra & Stefanello, 2023) confirm that applying this myomodulation strategy results in improved facial symmetry, softer transitions between static and dynamic states, and enhanced patient-reported satisfaction with both aesthetic and functional outcomes (Coimbra & Stefanello, 2023).
Consequently, the primary clinical implication is that injectors should adopt a biomechanical and dynamic-anatomic mindset: rather than simply replacing volume, they must consider the interplay of scaffold, muscle, and movement.
Practically this implies systematic assessment of muscle pairs, dynamic photography or video to capture contraction patterns, and tailored filler placement that supports weak muscles while attenuating overactive ones — thereby achieving not just volume restoration but harmonised motion and expression (Harris, 2019; Rizzo, 2023).
For greater diagnostic and therapeutic awareness, it is advisable to apply an in-depth facial analysis (https://www.chirurgiacosmeticamorfodinamica.it/2025/09/10/morphodynamic-craniofacial-analysis/).
In summary, the integration of myomodulation by filler, botox, threads, in facial treatments mandates a shift from static volumetry to dynamic anatomy and functional aesthetics.
References
Moss ML. The FUNCTIONAL MATRIX Hypothesis. The role of Mechanotrasduction. Am I Orthod Dentofacial Orthop. July, 1997.
Rizzo A. La Chirurgia Cosmetica Morfodinamica: la bellezza olistica, i nuovi paradigmi della Chirurgia Estetica. Amazon. Self publishing, 2020.
Rizzo A. Morphodynamic Cosmetic Surgery: holistic beauty, the new paradigms of Aesthetic Surgery. Amazon. Self publishing, 2020.
Coimbra, D. D., & Stefanello, B. (2023). Myomodulation with facial fillers: a comprehensive technical guide and retrospective case series. Aesthetic Plastic Surgery, 47, 1162–1174. https://doi.org/10.1007/s00266-022-03193-y
de Maio, M. (2018). Myomodulation with injectable fillers: an innovative approach to addressing facial muscle movement. Aesthetic Plastic Surgery, 42(3), 798–814. https://doi.org/10.1007/s00266-018-1116-z
Harris, D. (2019). Myomodulation and facial dynamics: evolving paradigms. Aesthetic Plastic Surgery, 43(6), 1485-1492. https://doi.org/10.1007/s00266-019-01461-7
Rizzo, A. (2023). Function determines form: neuromuscular balance and morphodynamic cosmetic surgery. Chirurgia Cosmetica Morfodinamica – Blog. Retrieved from https://www.chirurgiacosmeticamorfodinamica.it/
