I was on the heavier side when I was younger. I was teased in school and looking back, I developed an eating disorder and became a fitness fanatic wanting to be thin. So you can imagine, I wanted my face to be slimmer but as I age, I want my face to be fuller as I start to lose volume in places that I don’t want to.

We know a youthful looking face is framed by high cheek bones, full cheeks, full lips, defined chin and sharp jawline, giving an upside down triangle appearance of the face with no dark circles under the eyes and no deep lines and wrinkles. This global facial harmony is made up of fat pads, muscles and bones around our face that cushions important structures, protects vessels and nerves and allow movement.

I see a lot of patients in clinic with volume loss and although there are great treatment options, addressing the cause is also important as it will prevent things getting worst too quickly and ensure longevity of the treatment. The results are always better too.

In this blog, I go through:-

    1. Top 3 causes of facial volume loss
    2. Preventative steps
    3. Aesthetic treatments available


So first up, why do we lose this volume as we age?

Changes to fat pad as we age


Here are the top 3 causes below:-

1. Hormonal changes. 

Hormones affect the quality of the fat we produce but also where we produce it. As our hormone depletes with age (or illness, medication or being underweight), some of the fat pad on our face reduce in size (eg around the eyes and cheek) and other areas expand in size (lower face and neck).

I know it’s not fair but it’s Mother Nature at work.

Hormones also affect the health of our bones. As our hormones drop (particularly Oestrogen), our facial bones recede and flatten, shortening our jaw (worsening jowls) and flattening our cheeks.


2. Environmental causes. 

Smoking, UV damage, stress and pollution. All these produce free radicals which break down collagen and elastin, reducing the “Biological Velcro” that holds our tissues up and prevent gravitational descent.


3. Yo-yo dieting and excessive exercise.

This may sound attractive to lose weight and look good in a bikini but it’s detrimental to the face. Sudden changes in weight, consistent and frequent high impact exercise (eg long distance running) can cause hormone changes, inflammation, free radical formation and mechanical wear/tear… all affecting the volume of our face.


So how do we minimise and reduce the ageing effects of facial volume loss:-

  1. Avoid yo-yo diets and excessive exercise
  2. Eat healthily for a healthy weight and happy hormones
  3. Supplements to support skin and boost collagen production
  4. Sun protection
  5. Reducing stress
  6. Quit smoking and reduce exposure to secondary smoke
  7. Balance hormones and consider replacing hormones if depleted
  8. Improve skin and tissue quality (ie boost collagen and elastin) through skin products and treatments

I will soon write more blogs to expand on the points above.

But in the meantime, here are some that you may find interesting:-

For more information on hormonal balance, click here.

For more information on supplements, click here.

But for the purpose of this blog, I will expand on the possible aesthetic treatments to replace volume loss through non-surgical treatments.


With regards to treatments, we can REPLACE or REPOSITION volume. Which way comes down to the aesthetic eye of the practitioner and making sure the areas that are “heavy” eg jowls, neck and lower face is not made worst by putting more volume in the wrong place. In that instance, we would reposition the volume, lifting it to ensure a well balanced contoured face.

We can REPLACE volume with:-

  1. Hyaluronic Acid (HA) dermal fillers – most commonly used. The structure looks like synthetic sugar molecules and we have it naturally in our skin, joints and eye ball. It keeps the moisture in our skin and comes in different density to replacing finer volume eg under the eyes and lips to replacing larger volumes in cheeks and chin.
  2. Collagen stimulator dermal filler eg Ellanse – this has PolyCaproLactone (PCL) microspheres which new collagen forms around them in a controlled manner. This also last longer than HA up to 2 years. This is great for deeper volume replacement and usually combined with Thread lifts for maximum results.
  3. Fat transfer – this gives a very natural result and works well for severe volume loss.  However how much fat cells that survive really depends on the harvesting method and what other ingredients that is mixed with it. In good fat grafting cases following all the gold standards, 80-85% of fat cells survived.

While we can reposition some tissue with clever volume replacement, the best way I have found to reposition tissue if indicated is with thread lifting. It’s one of my favourite treatments but it’s usually in combination with a volume replacement treatment.

I must stress though thread lifting does have it’s limitation and is not a face lift so it’s important to have a consultation to assess your face and see what’s possible with non-surgical treatments to achieve the results you are looking for.


I hope you found this blog useful. For further information of the treatments mentioned above, please click on the links below.

For more information on dermal fillers, please click here.

For more information on Thread Lift Treatment, please click here


If you have any questions or would like to continue the conversation on this topic, you can follow me on my social media links below or email [email protected]


To your best self,

Dr Terry