Facial volume loss and flattening
Ageing in the face is largely subtraction: fat pads descend and shrink, bone recedes at the orbital rim and jaw. Restoring support reads as looking rested rather than treated.
The face does not simply sag with age, it deflates and descends, and the distinction changes what treatment should do. Facial fat is arranged in discrete compartments rather than a continuous layer. These shrink at different rates and slide downward, so the mid- face flattens while tissue gathers lower along the jawline, which is why an ageing face reads as heavier below and hollower above. Underneath, bone is remodelling too: the eye socket widens, the mid-face retrudes and the jaw loses height and definition. Because the skin does not shrink to match, the same envelope now covers less support, and folds appear where tissue collects. This is why filling a nasolabial fold directly is often the wrong move. The fold is usually a consequence of the cheek having lost its support, so restoring that support addresses the cause, while filling the crease treats the symptom and tends to look heavy. The most natural results come from replacing volume where it was lost, in modest quantities, rather than adding volume where the problem is visible.
How we treat it
The plan is built on where support has actually been lost, which is rarely where the patient first points. Hyaluronic acid filler placed deep, on bone, at the cheek, temple, chin and jaw restores structural support and lifts the tissue above it. Small volumes in the right plane do considerably more than large volumes placed superficially. Sculptra works differently and suits a different problem: poly-L-lactic acid stimulates the patient’s own collagen over months, giving a gradual, diffuse restoration of thickness rather than defined contour, which reads as very natural and suits broad, generalised volume loss. It is a course, and the result appears slowly. The two are frequently combined, taking structure from filler and overall quality from collagen stimulation. Treatment is staged across sessions with review between, because the face is assessed as a whole and over-filling one area distorts the balance of the rest. Where laxity rather than volume is the dominant problem, filler is not the answer and should not be sold as one.
Medically reviewed by Dr. Sherwin Hariri, MD, Medical Director & Chief Longevity Physician. Last reviewed August 2026.
This page is for information only and is not medical advice. Suitability for any treatment is determined at consultation.
Common questions
Will filler make my face look overdone?
Not if the volume is modest and placed where support was lost. The overfilled look comes from repeatedly adding product to the surface rather than restoring deep structure, and from treating each area in isolation. Staged treatment with review, and a willingness to stop, is what keeps a result natural.
What is the difference between filler and Sculptra?
Filler adds volume immediately and gives definable structure: a cheekbone, a jawline, a chin. Sculptra stimulates your own collagen and works gradually over months, restoring general thickness rather than defined contour. Filler suits targeted structural loss, Sculptra suits broad, diffuse deflation, and they are often used together.
How long do the results last?
Hyaluronic acid filler typically lasts twelve to eighteen months depending on the product, the area and how much that area moves. Sculptra results build over three to six months and commonly last two years or more. Both decline gradually rather than abruptly, so the change is not sudden.
Would a facelift be better for me?
If the dominant problem is loose skin rather than lost volume, surgery addresses something injectables cannot, and saying so is more useful than selling a treatment that will not deliver. Volume restoration and surgical lifting solve different problems, and the consultation should tell you honestly which one you need.
Other concerns
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