Volume loss
Faces do not simply deflate. Fat pads descend and separate, bone resorbs at the orbital rim and the jaw, and ligaments loosen — which is why a face that has lost volume often looks tired and heavier at the same time. Putting product back where the volume used to be is frequently the wrong answer; supporting the structure that moved is usually the right one. This is the concern where we most often recommend treating somewhere other than where you are pointing.
Why this happens
The face is built in layers, and they age at different rates. The facial skeleton loses bone at predictable places — the rim of the eye socket widens, the mid-face support under the cheek recedes, the angle of the jaw softens. That is the foundation moving, and everything above it moves with it.
Above the bone sit discrete compartments of fat, not one continuous layer. As the ligaments that separate them loosen, those compartments descend and drift apart. A hollow appears at the top of the cheek at the same moment as a fullness appears lower down, which is why the same face can read as both gaunt and heavy in one photograph. The volume did not vanish; a good deal of it relocated.
The under-eye is where this gets misread most often. What looks like a hollow is frequently the shadow cast by a fat pad that has slipped below the orbital rim, plus skin that has thinned enough to show the vessels underneath. Injecting into the hollow adds weight to a shadow rather than fixing what is casting it, and in thin under-eye skin the product itself becomes visible.
What actually helps
Each of these does something specific about the mechanism above. The sentence under each one is what it does for this, which is not the same as what its own page says it does in general.
- Dermal filler
Placed to rebuild the support that has receded — most often deeper on the mid-face — so the tissue above sits where it used to rather than being pushed forward.
- Lip filler
The narrow case: lips genuinely lose their border and their vertical height with age, and a small amount restores the shape rather than adding to it.
- Facial balancing
The assessment that decides where any of this goes, which for volume loss is usually somewhere other than the place you noticed the problem.
- Biostimulators
For diffuse thinning across a broad area rather than one defined hollow — it prompts collagen over months rather than filling a space today.
What won’t work
- Filling the hollow you can see, when the hollow is a shadow cast by tissue that has descended. It adds weight without changing the edge that is casting the shadow, and in the under-eye it is how people end up with a puffy, faintly bluish look that is worse than what they started with.
- Adding volume to a face that already has too much of it. A substantial share of the people who come in asking for filler have had enough, and what they are seeing is the result of the last three rounds rather than an absence of product.
- Skincare, in any formulation, for volume. Topicals affect the surface and the upper dermis. Bone resorption and fat compartment descent are millimeters below anything a cream reaches.
- Treating volume loss as an urgent problem. It develops over a decade and it does not need to be corrected in one appointment — the results that look worst are almost always the ones done all at once.
Where we’d start, and why
- 1With photographs, taken at rest, from the front and from both sides. Volume change is a three-dimensional problem and it is close to impossible to assess honestly in a mirror at conversational distance.
- 2Then we work out what moved before we work out what to add. If the mid-face has descended, the first question is whether supporting it higher up resolves what you are seeing lower down — very often it does, using less product than treating the lower area directly would have taken.
- 3We treat one area, then wait. Two weeks for swelling to settle, and a review appointment before anything else is placed. Almost everything that goes wrong in this category goes wrong because a second area was treated on the same day as the first, before anybody could see what the first one did.
- 4If the honest answer is that the change you want needs surgery rather than injectables, you will hear that at the consultation and we will say what kind of surgeon to talk to.
What would make us decline
These are the answers we actually give in the room, and they are the reason the practice is called what it is called.
- Your face already carries a significant amount of product and you are asking for more. The answer there is a year off and, sometimes, a conversation about dissolving what is there — not another syringe.
- You are asking us to fill an under-eye hollow that is being caused by descended tissue and thin skin. We will explain what we are actually seeing, offer what genuinely helps, and decline the treatment you came in for if that is what it comes to.
- You want a specific number of syringes placed in one appointment because that is what you have budgeted for. We place what the assessment supports, in stages, and a syringe count decided before an exam is not an assessment.
- You are describing a result you saw on someone else's face and want the same amount in the same places. Their anatomy is not yours, and the amount that produced their result will not produce it on you.
What this is not
Sudden volume change on one side of the face, unexplained swelling, a lump you can feel that was not there last month, or loss that has happened over weeks rather than years is a medical finding. That is a physician's assessment, not an aesthetic one, and we will tell you to go and get it before we discuss anything cosmetic.
Questions about volume loss
Why would you treat my cheek when the problem is under my eye?
Because the edge that is casting the shadow is often at the top of the cheek rather than in the hollow itself. Supporting that edge changes the light falling across the whole area. It is counter-intuitive, it uses less product, and it is the approach most likely to look like nothing was done.
How do I know if I have already had too much?
Old photographs are the honest test. Compare a picture of yourself from six or eight years ago with one taken this month, in similar light. People who have gradually accumulated product usually see it immediately in that comparison and cannot see it in a mirror, because the mirror updates a little at a time.
Is it better to do a lot at once or a little at a time?
A little at a time, in almost every case. Staged treatment costs the same in total, takes longer, and produces results that other people describe as looking well rather than looking done. The only argument for doing it all in one appointment is convenience, and it is not a good enough one.
When is this something I should see a dermatologist about instead?
When the change is rapid, asymmetric, or accompanied by anything else — numbness, weakness, pain, a palpable mass, or skin changes over the area. Volume loss from aging is slow, symmetrical and does not hurt. Anything that is not all three deserves a medical opinion first.