As we age, our facial volume decreases. Skin volume, strength and elasticity is lost due to loss of collagen, which helps to keep our skin plump and firm. As a result, our skin becomes saggy, dull and wrinkles start to appear.

What Causes Facial Volume Loss?

There are many reasons that a full and round face shape can begin to lose volume, appearing sunken and more skeletal. A loss of fat in the facial region can happen due to the natural ageing process, weight loss, a shift in hormone levels, exposure to UV rays, smoking, injury, along with certain medical conditions that necessitate the consumption of specific medicines that prompt volume loss.

The role of collagen is to help provide a support structure for the skin that gives it a plump and firm appearance. When collagen naturally reduces over time, the elasticity of the facial skin also wanes. Combined with the fact that facial fat shifts and declines as we age, the loss of collagen and fat can make a face appear aged.

Facial volume loss happens when the face fat that was once evenly distributed around the eyes, cheeks, forehead, temples, and mouth shifts and diminishes. Round cheeks fall downward and sink, causing hollowness under the eyes. Lips begin to lose their plumpness and appear thinner with age.

Over time, fat can gather in certain areas that were formerly more taut, such as the lower jaw. When facial fat is stored in the lower face, it can cause unsightly jowls of baggy skin to hang low on each side of the lower jaw, as well as the neck.

Weight Loss and Extreme Dieting – maintaining a healthy weight can do wonders for an individual’s overall health. However, losing weight can exacerbate the ageing process and cause a naturally thin face to appear even thinner. When the small amount of natural fat is further reduced from an already thin face due to extreme dieting, it can create a worn out look, along with other health problems.

Individuals who are overweight and rapidly lose weight will also notice volume loss in their faces. Losing large amounts of weight in a short time can cause unwanted sagging of facial skin if the body is unable to adapt to the new body contours, leaving hanging skin on the cheeks and neck. Although weight loss is typically a positive experience for an overweight individual, too much fat loss in the face can cause unintended ageing of the skin.

Over-Exercising & “Gym Face” – ‘Runner’s face’ describes a person who spends plenty of hours in the sun, running long distances similar to a marathon athlete. Although the practice can help joggers maintain a healthy weight and clear their minds, it can also cause a gaunt-like facial appearance.

There is also a term called “gym face,” which is used to describe individuals who frequently practice long distance cardiovascular exercises in the gym. A thinner face can happen as a result of engaging in exercises that melt fat all over the body, including the face. In working out so intensely to burn off the fat covering the abdominal region and thighs, you may naturally induce facial volume loss as well.

Sun Exposure – excessive exposure to UV rays can also encourage facial volume loss due to the UV rays penetrating into the epidermis and speeds up collagen and elastin breakdown. When those two important skin structure components decrease, facial fat can be lost.

Hormone Changes – Oestrogen is a predominantly female hormone that dictates in part how much fat appears on the face and body, along with the quality of fat that appears. When oestrogen hormone levels start to decline as women age, fat can begin to thin and cause the facial skin to sag.

Facial Bone and Muscle Decrease – not only do the levels of face fat decline with age, but facial bone mass also reduces. Individuals may also experience facial muscle deterioration to an extent with age, making the middle of the face appear as though it has collapsed.

These types of more drastic changes are easier to spot in patients who are 70 to 80 years of age and older, with the loss of bone tissue generally happening in the central portion of the face and the nasal area.

Severe Illnesses, Medical Conditions, and Medical Treatments – weight loss attributed to certain medical conditions or medications can have a big impact on facial volume loss. When fat tissue beneath the facial skin is lost, it can cause the face to appear flat or create a convex facial contour.

Certain chronic diseases can also cause facial thinning. If you are experiencing an unexplained loss of volume in your face, see a physician to rule out various autoimmune diseases or connective tissue diseases. Conditions such as lupus, thyroid and immune system disorders, rheumatoid arthritis, or viral infections that destroy facial fat can have an impact on facial volume.

Facial lipoatrophy is the name of the condition whereby face fat tissue is lost in a localized form. It can happen when insulin is injected in certain regions during diabetes treatments, with human growth hormone injections, or as a result of multiple sclerosis treatments. Other medications or treatments may cause facial lipoatrophy such as steroid treatments, iron, penicillin, chemotherapy, and antiviral drugs – along with vaccines to prevent chicken pox, whooping cough, and measles. Facial wasting is one of lipoatrophy’s main symptoms, with the loss of facial fat being one of the most recognizable traits, in addition to fat loss in the legs, arms, and buttocks. The root cause of lipoatrophy is not known.

Smoking & Nicotone Use – smoking plays a vital and detrimental role when it comes to the health of facial skin and overall skin structure. Vitamin C levels in smokers are notably depleted in comparison to people who do not smoke. Lower vitamin C levels can result in a thinning of the layers of skin, a reduction of collagen and elastin, along with a decrease in muscle tone. Many of the protective factors that vitamin C brings to keep the skin soft, supple, and stronger are negatively affected when smoking, causing skin sagging and an aged facial appearance. However, chronic smokers who quit smoking can raise vitamin C levels and, in turn, improve the ability to form new collagen and the body’s ability to heal wounds.

Stress – research has shown the amount of damage that stress can have on a person, even causing an individual to age more rapidly. High cortisol levels and the “fight-or-flight” feeling contributes to heart problems and high blood pressure, as well as other health problems that can manifest on a person’s face. Counteracting the stress response with anti-anxiety relaxation measures helps, along with exercising.

Trauma and Injury – any physical injury to the facial region (Maxillofacial trauma) can cause a loss of facial volume. Burns, fractures, and cuts can damage the soft tissue areas around the eyes or the face, causing disfigurement to bones and fat pads resulting in loss of volume to affected area. Accidents may also create facial scars that leave indentations in the face or hollow regions. Trauma to the facial skin and underlying structures also includes severe cases of acne that may go so deep as to damage the supporting tissue beneath the skin.

Slowed Collagen Production

The natural ageing process can affect the skin’s firmness and elasticity due to decreased collagen production. Some surprising factors can contribute to the dermal layers of the skin losing their strength, such as a diet. A diet high in sugar creates AGEs, which are advanced glycation end products. AGEs are caused when sugar floating in the bloodstream mixes with fat and protein. AGEs stay in tissues, changing the quality of the skin by negatively affecting collagen and elastin. The visible results of such aged skin shows up most prominently on the face. However, changing the diet to reduce the amount of sugar consumed can help reverse the problem, along with taking supplements that contain hydrolysed collagen and hyaluronic acid.

Changing diet habits might be one of the simplest ways to try and increase collagen production and slow the signs of aging. Approaching facial volume loss issues with a multi-pronged approach, including improving lifestyle habits such as reducing sugar intake and avoiding harmful sun exposure can combine with professional treatments to help bring about the best results to increase collagen production.

Fat Pad Reduction: What are the buccal and malar fat pads?

Buccal and malar fat pads are fat pads that appear in the face, in differing areas of the cheek region. The size and position of these fat pads have a great impact on facial volume.

Lifting the Malar Fat Pad –  when the malar fat pad sags, it causes the nasolabial folds to become more apparent – but the malar pad can be lifted via surgery. The malar fat pad are considered as the most “critical” component of facial structure for determining the appearance of ageing in the mid-face. The malar fat pad resides in the cheek, sitting near the cheekbone area beneath the eyes. The fat pad provides a youthful curve to the face and makes the area around the eyes and cheeks look full. Over time, the malar fat pad slides in a downward direction due to the normal pull of gravity. That movement creates deep nasolabial folds while the relocated fat makes the eyes look hollow.

The Buccal and Deep Fat Pads – the face’s buccal space which can be found on both sides of the face in the lower cheek region – is a valuable area wherein dermal injections can have lasting fullness effects for patients, persisting for up to 24 months. A deep understanding of the facial anatomy and the way that fillers interact with fat pads in the face will provide the best aesthetic results from such procedures.

Signs and Symptoms of Facial Volume Loss

It is estimated that individuals can lose 20% to 50% of facial fat during the natural ageing process. Volume loss is most evident in certain parts of the face, such as around the eyebrows, where a reduction in fat can reveal the shape of the brow bone that was previously concealed. A skeletal appearance around the brow and cheek regions, lips that shrink and lose volume, and skin that appears more wrinkled, thinner, and not as moisturized are all signs of facial volume loss.

Volume Loss in the Cheeks – the cheeks can sag due to the lost face fat, moving from the eye area to a lower position. If your cheeks appear flatter and are sagging with loose skin near the area where the jaw meets the neck, which is called the jowls, you have likely lost part of your cheek fat.

Volume Loss Under the Eyes – not only can a loss of facial volume occur above the eyes around the eyebrows, but it can also happen beneath the eyes. Losing orbital fat near the area of the lower eyelids can create a hollow-eyed look circling the eye sockets.

Volume Loss in the Lips – one of the biggest indicators of the volume being lost in the lips is when fine lines begin to appear around the mouth. Once full lips may deflate and have less definition than before, looking smaller and thinner. Facial ageing includes a loss of lip contour and volume, which becomes more noticeable as the patient ages.

Please click on the links below for information on some of our treatments for Facial Volume Loss:

Thread Lifting
Dermal Fillers
Skin Boosters
Neogen Plasma Treatments


Contact us to find the best treatments available to help with loss of Facial Volume by booking a consultation with our Cosmetic Doctor (07)5539 9534