Facial Volume Loss

Facial volume loss happens as the deeper tissues supporting the face gradually change. Fat compartments may reduce or shift, collagen levels fall and the underlying facial structure can provide less support than it once did.

These changes may make the cheeks or temples look less full, deepen existing folds and reduce definition around the jawline. They form part of natural ageing, although genetics, weight changes, hormones, smoking and sun exposure can affect when they become noticeable.

The pattern differs between individuals. A consultation should consider the whole face rather than focusing only on one hollow area or fold.

Read more about dermal fillers.

What is facial volume loss?

Facial ageing affects more than the surface of the skin. Changes can also occur in the fat beneath the skin, the connective tissues that support the face and the underlying bone structure.

Together, these changes can alter facial proportions and create shadows, hollows or deeper folds. Early signs are often subtle and may appear before someone notices obvious sagging.

Fillers may be considered when loss of support or localised volume is an important part of the change. They are not suitable for every sign of facial ageing.

Read more about what fillers are.

What causes facial volume loss?

Volume loss usually develops through a combination of natural ageing and individual factors.

Possible contributors include:

• gradual changes in facial fat compartments;

• reduced collagen and elastin production;

• changes in the support provided by facial bone;

• significant or rapid weight loss;

• inherited facial structure;

• repeated sun exposure;

• smoking;

• hormonal changes.

These processes do not happen at the same rate for everyone. Some people notice facial hollowing relatively early, while others retain fuller contours for longer.

Which areas tend to lose volume?

Cheeks and mid-face

The cheeks often provide support for the lower face. When volume reduces here, the cheeks may appear flatter and nose-to-mouth lines can become more noticeable.

Read more about cheek fillers.

Temples

Loss of tissue at the temples may create a hollow appearance and change the balance between the forehead, cheekbones and outer face.

Read more about temple fillers.

Under-eye area

Reduced support around the eyes can increase shadowing or make the transition between the lower eyelid and cheek more visible. This delicate area requires careful assessment.

Read more about under-eye fillers.

Jawline and chin

Changes in facial fat, skin firmness and bone support may reduce definition around the jawline and lower face.

Read more about jawline fillers.

Area around the mouth

Reduced support can contribute to deeper marionette lines, downturned-looking mouth corners or more noticeable folds.

Read more about mouth corner fillers.

How can you recognise facial volume loss?

Facial volume loss tends to develop slowly. Common signs include:

• flatter or less rounded cheeks;

• hollow-looking temples;

• increased shadowing beneath the eyes;

• deeper nose-to-mouth folds;

• more noticeable marionette lines;

• reduced jawline definition;

• a narrower or less supported lower face;

• facial features appearing more tired or drawn.

These signs can also be affected by skin laxity, facial movement and natural anatomy. A visual change should not automatically be assumed to result from volume loss alone.

Volume loss or skin laxity?

Volume loss and skin laxity often occur together, but they are different concerns.

Volume loss relates mainly to reduced support beneath the skin. It can create hollow areas, flatter contours and more visible folds.

Skin laxity develops when the skin becomes less firm and elastic. It may lead to looseness even when facial volume is relatively well preserved.

Adding filler to an area affected mainly by laxity may not produce the intended result and could make the face look heavier. A practitioner should assess the skin and deeper facial structure before recommending treatment.

How can facial volume loss be treated?

Hyaluronic acid fillers

Hyaluronic acid fillers can provide localised volume and structural support. Depending on the assessment, treatment may involve the cheeks, temples, chin or jawline.

The aim is usually to restore proportion rather than simply make the face look fuller. Product choice, placement depth and quantity should be adapted to the area being treated.

Read more about hyaluronic acid fillers.

Collagen-stimulating fillers

Some injectable treatments are intended to encourage gradual collagen production as well as improve support. Results develop over time rather than appearing only through immediate product volume.

These treatments are not suitable for everyone and require careful patient selection.

Combined treatment plans

Where ageing affects several facial layers, a practitioner may discuss more than one type of treatment. For example, volume restoration may be combined with a treatment focused on skin quality or firmness.

A staged plan can help the practitioner review each result before deciding whether additional treatment is appropriate.

Which approach may suit different levels of volume loss?

Early changes

When volume loss is mild, a small and targeted correction may be enough to improve facial support. Treatment should remain conservative because early changes do not usually require large amounts of product.

More established volume loss

When several areas have begun to change, the practitioner may assess how the cheeks, temples, chin and jawline affect one another. Treating one structural area can sometimes improve the appearance of another.

Widespread facial volume loss

Where changes affect much of the face, a whole-face assessment may be more useful than treating a single fold. This does not mean every area needs filler. Treatment may be staged, limited or combined with non-volumising options.

The extent of visible volume loss does not by itself determine the amount of filler required.

What results might be expected?

Depending on the treatment plan, fillers may:

• provide additional support to selected facial areas;

• soften the appearance of hollows or folds;

• improve balance between facial features;

• restore some definition to facial contours;

• create a less drawn appearance.

Hyaluronic acid filler can produce an immediate change, although swelling may temporarily affect the result. The area should be reassessed after the initial swelling has settled.

The outcome and duration vary according to the product, treatment area, quantity used, facial movement and individual metabolism. Fillers do not stop the ageing process, and maintenance treatment is optional.

Read more about how fillers work.

Risks and safety

Dermal filler treatment can cause temporary swelling, redness, tenderness, bruising or small irregularities around the injection sites.

Less common problems can include infection, inflammation, persistent lumps, product movement or an unwanted cosmetic result.

A rare but serious complication may occur if filler affects a blood vessel. This requires rapid recognition and treatment. Patients should receive clear aftercare information and know how to contact the clinic if concerning symptoms develop.

Hyaluronic acid filler can sometimes be broken down using hyaluronidase. This does not apply to every filler type and does not remove the need for careful product selection and injection technique.

Choose a practitioner who has appropriate training, detailed knowledge of facial anatomy and a clear process for managing complications.

Read more about filler side effects.

When might fillers not be the best option?

Filler may not be appropriate when the main concern is loose skin, poor skin quality or a change that is not caused by reduced volume.

It may also be unsuitable where:

• adding volume could make the face appear heavy;

• the expected result cannot be achieved safely;

• there is active inflammation or infection near the treatment area;

• medical history or previous treatments affect suitability;

• expectations cannot realistically be met.

A practitioner may instead discuss skin-quality treatments, tightening procedures, no treatment or referral for another medical opinion.

Choosing not to have treatment is also a valid outcome of a consultation.

Can facial volume loss be prevented?

Facial volume loss is part of natural ageing and cannot be prevented completely. However, general measures that support skin health may help reduce avoidable damage.

These include:

• using suitable sun protection;

• avoiding smoking;

• maintaining a relatively stable weight;

• eating a balanced diet;

• getting adequate sleep;

• following a consistent skincare routine.

These measures cannot preserve facial volume indefinitely or replace lost structural support, but they may contribute to healthier-looking skin.

Frequently asked questions about facial volume loss