The four steps, and what each contributes
What makes this protocol different is that it treats the face in four distinct planes in a single session — including one that almost no technology reaches:
That first step is why the protocol is called "4D" and not "3D": treating tissue from the mucosal side allows the deep dermis to be heated without crossing the epidermis, and therefore without the pigmentation risk that entails — particularly relevant in darker skin.
- 1. SmoothLiftin — intraoral. The laser is applied inside the mouth, on the mucosa, to heat the dermis of the nasolabial fold and the perioral contour from within. It does not touch the skin surface.
- 2. FRAC3 — fractional, at depth. It acts selectively on deeper imperfections, leaving surrounding healthy tissue intact.
- 3. PIANO — bulk heating. Deep, even, prolonged heating of the tissue — the step responsible for most of the collagen contraction.
- 4. SupErficial — the finish. A very light laser peel working surface texture and luminosity. It is the step that makes you look well on the way out.
The honest conversation: energy or surgery
This page is written by someone who also performs facelifts, and can therefore tell you what a centre that only owns machines will not.
Fotona 4D is excellent for mild to moderate laxity. It improves the jawline, softens the nasolabial fold, tightens the perioral contour and improves texture. In the right person — typically between 35 and 55, with skin that has lost firmness but has not descended — the result is very good and requires no theatre.
And it is not a facelift. If the tissue has already fallen, if there is structural jowling, if there is genuine excess skin in the neck or jawline, no energy device is going to lift it. What is called for then is a facelift, or a blepharoplasty if the problem is the eyelids. Selling a course of sessions to someone who needs surgery is charging them to postpone their problem — and over the years that delay is paid for with a worse result.
The answer to "energy or surgery?" does not come from a catalogue. It comes from the examination. And here it comes from someone who can do both, and therefore has no incentive to push you toward either.
Where Fotona 4D sits among the options here
4D is one of several tightening tools. The general page on non-surgical skin tightening is the place to understand the whole set and compare the devices against each other; this page is specific to the 4D protocol.
If what you are after is resurfacing — texture, pores, scars, fine lines — the path is different: see laser resurfacing and CO2 laser. If what you have is a fatty double chin, 4D will not empty it: see facial endolift or submental liposuction.
What the sessions are like, and what to expect
It is an outpatient procedure, with no general anaesthesia and no significant downtime: you leave with a flushed, slightly swollen face, and that settles within a day or two. Normal life resumes almost immediately, with strict photoprotection.
It is not a single session. It is worked in a series — usually several spaced sessions — and the number is defined at the consultation.
The result has two timescales, and confusing them is the commonest cause of disappointment: there is an immediate effect — brighter, slightly tighter skin — which is partly swelling and is not the result; and there is a real tightening effect, which depends on new collagen and builds across 3 to 6 months. Anyone judging 4D at one week is judging swelling.
The result is not permanent: ageing continues. A maintenance schedule is set, and that is said from the outset.
All surgery carries risk and requires a prior medical assessment. Results may vary according to each patient, their anatomy and their individual healing process.
The equipment
The protocol runs on the Fotona SP Dynamis Max (Fotona, Slovenia): a high-power dual Er:YAG + Nd:YAG platform, probably the most versatile device in the practice. It is the same platform used to treat vascular lesions and onychomycosis on the medical side — which says something about its power, and about why a physician should be the one holding it.
Assessment and treatment are carried out by Dr. Arístides Arellano Huacuja, plastic and reconstructive surgeon (specialty licence 0002008), with more than two decades of medical-laser practice — a full member of the Spanish Society of Medical-Surgical Laser.
Cost is defined at the consultation, according to the number of sessions in the series. See the price list.
Dr. Arístides Arellano is a plastic surgeon holding a specialty licence: he practises under a Mexican medical licence (D.G.P. 1125959) and a specialty licence in Plastic & Reconstructive Surgery (0002008), both issued by the Directorate General of Professions (DGP), which reissued his certificate of professional standing in 2025. His career began before Mexico’s present-day specialty-board system existed: he belongs to the founding generation of plastic surgery in Puebla, the second generation of a surgical tradition started in 1971 by Dr. Francisco Arellano Ocampo. Trust is verified, not promised: both licences are public and anyone can look them up in the DGP’s National Registry of Professionals.
Approximate price
A session starts at $8,000 MXN and the course of 5 sessions at $24,000 MXN, approximate figures depending on the area treated and how many sessions your response calls for. Approximate price — the definitive cost is set at your private consultation with Dr. Arístides Arellano.
Trust is verified, not promised. All 210 scanned documents —degree, licences, diplomas, publications and certificates, from 1977 to 2025— are open in Dr. Arístides Arellano’s credential archive, alongside an explanation of the difference between a specialty licence and a board certification.
The plan · the series and the two timescales of the result
- The sessionOutpatient, no general anaesthesia. All four steps run in the same session, including the intraoral one. You walk out.
- Days 1–2Flushed, slightly swollen face. Settles within a day or two. Strict photoprotection from day one: subsequent sun exposure is what undoes the result.
- Immediate effectBrighter, apparently tighter skin. CAREFUL: part of this is swelling and it is NOT the result. Judging 4D at one week is judging swelling.
- During the seriesSeveral spaced sessions. The number is defined at the consultation. It is not a one-off treatment.
- Months 3–6 — the real resultTightening builds, dependent on new collagen. This is the result that counts, and the one that demands patience.
- MaintenanceThe result is not permanent: ageing continues. Maintenance is scheduled, and it is said from the outset. Results may vary.
Frequently asked questions
Does Fotona 4D replace a facelift?
No, and this is the most important thing on the page. 4D is excellent for mild to moderate laxity: it improves the jawline, the nasolabial fold and texture. If the tissue has already fallen, if there is structural jowling or genuine excess skin, no energy device lifts it: that is a facelift. Selling sessions to someone who needs surgery is charging them to postpone their problem.
Is the laser really applied inside the mouth?
Yes, and it is the step the protocol is named for. SmoothLiftin treats the dermis of the nasolabial fold and perioral contour from the mucosal side, without crossing the epidermis. That allows deep heating without the pigmentation risk of doing it from outside — particularly relevant in darker skin.
When do I see the result?
There are two timescales, and confusing them is the commonest cause of disappointment. The immediate effect — bright, apparently tighter skin — is partly swelling and is not the result. Real tightening depends on new collagen and builds across 3 to 6 months. Anyone judging 4D at one week is judging swelling.
Is one session enough?
No. It is worked in a series of several spaced sessions, and the number is defined at the consultation. The result is also not permanent: ageing continues and maintenance is scheduled. That is said from the outset, not halfway through.
How is it different from radiofrequency tightening?
They are different tools serving the same goal. The non-surgical skin tightening page compares the whole set of devices and is the place to understand which suits your case. This page is specific to the 4D protocol. The choice does not come from a catalogue: it comes from the examination.
How much downtime?
Practically none. You leave with a flushed, slightly swollen face and that settles within a day or two. Normal life resumes almost immediately, with strict photoprotection — which is not optional, because subsequent sun exposure is what undoes the result.
Every case is different. Discuss yours in a personal consultation.
Book a consultation on WhatsAppEvery figure published on this site is approximate and is not a quote. Any procedure or treatment first requires a private assessment consultation with Dr. Arístides Arellano —$800 MXN, charged separately— and it is at that consultation that the definitive cost of your case is determined.
Educational content; it does not replace a medical consultation. Results may vary from person to person.