Facial volume decreases with age. There, we said it. The good news, though, is that there are cosmetic procedures — both non-surgical and surgical — available to pause and even reverse the, ahem, deflating aging process. To better understand what causes volume loss and how to treat and prevent it, we tapped top dermatologists and plastic surgeons. Read on for their expert guide to facial rejuvenation.
What Causes Facial Volume Loss?
Fine lines and wrinkles, sagging skin, hollowing around the eye sockets, temples, and cheeks, thinning lips, and drooping jowls are all signs of facial volume loss, says Michele Green, MD, a board certified dermatologist in New York City. So, why does facial volume decrease with age? You can blame it on a coincident decline in collagen production. “As we age, the amount of collagen that is naturally produced begins to decline,” she shares. “We lose about 10 percent of our natural collagen by the time that we turn 30, and this decline continues at a linear rate, accelerating during menopause.”
To understand why that decrease in collagen production has such a visible effect, you have to recognize the fortifying role the protein plays. “[Collagen] is the main protein found in the human body, accounting for one-third of its total protein. It is primarily involved in providing a structure within the body and also keeping our skin looking firm, supple, and youthful,” Dr. Green explains. “The molecules act as supportive structures by connecting cells to each other, improving the strength and elasticity of the skin.”
Both men and women experience decreased facial volume, but hormonal differences play a role in when and how the decline occurs. “It has been shown in studies that the trajectory of loss is similar until 50, when women age much faster,” explains Benjamin Paul, MD, a double board certified facial plastic and reconstructive surgeon in NYC. The culprit? You guessed it, menopause. “The early post-menopause period is associated with the most rapid changes, which include a flatter face, the formation of jowls, loss of definition of the jawline, deepening of the nasolabial folds, thinner lips, a longer white lip, a longer nose, and enlargement of the ears,” he explains. And it’s not just facial volume that takes a hit. “In addition to fat loss, bone loss accelerates in the post-menopausal period changing the facial skeleton,” Dr. Paul adds.
Extrinsic Causes of Facial Volume Loss
While the natural aging process naturally leads to decreased collagen production, there are also lifestyle factors that can speed up the degradation process and/or impact the amount of fat in the face. The most common include:
- Sun Exposure: While you probably already know that ultraviolet (UV) rays lead to fine lines, wrinkles, pigmentation, and increase the likelihood of developing skin cancer, you may not know their impact on facial volume. “What's much less known is that exposure to UV rays can cause the accelerated breakdown of collagen and elastin in the skin, causing sagging,” Dr. Green cautions. Consider that the next time you think about skipping sunscreen.
- Smoking: In case you need another reason to quit, Dr. Green lets us in on the premature aging effects smoking has on the skin. “Vitamin C is a powerhouse of an ingredient that offers many benefits for skin health and plays a role in the natural production of collagen in the skin,” she explains. “Smoking can be linked to lower levels of vitamin c and can cause loss of collagen around the mouth and lips.” Additionally, it causes the tissue structures supporting the eyelids to weaken, leading to hollowness and sagging. “Dropping a smoking habit can help restore healthy levels of vitamin C in the body and boost collagen's natural production,” she shares.
- Weight Loss: Significant weight loss can lead to excess skin and laxity, but it may also cause the face to slim. As Dr. Paul explains, you’ll want to focus on correcting the sagging skin before addressing volume. Regardless, “it is best to approach surgery when you are at a stable and ideal weight,” he notes.
Non-Surgical Treatments to Restore Facial Volume
If you have started to notice signs of facial volume loss, there are several non-invasive treatments available that can help stimulate collagen production and restore lost facial volume.
1. Hyaluronic Acid Fillers
When you think of restoring facial volume you likely think of hyaluronic acid (HA)-based fillers like Juvéderm® and Restylane® that can be used to, well, fill in wrinkles and hollows, augment the lips, cheeks, and jawline, and provide an overall rejuvenating effect. “Hyaluronic acid is a sugar that is naturally produced by the body and contributes to a fresh-faced appearance,” Dr. Green says. Like collagen, the body slows down HA production as we age, so injectecting synthetic hyaluronic acid can help undo some of the effects.
2. Biostimulatory Injectables
But HA fillers aren’t the only injectable that can have a volumizing effect. Biostimulatory injectables, like Sculptra®, are unique in that they induce collagen creation. “Sculptra® is a filler that is unlike any other because it encourages natural collagen production in the skin, helping to strengthen the structure of the skin and correct skin laxity related to volume loss,” Dr. Green explains. Made of poly-L-lactic acid (PLLA), Sculptra® does not have the immediate effect that HA fillers do. Instead, the product is injected into the treatment area over several sessions (think: three to four). In the proceeding weeks and months, the plumping effects start to show. The results generated by the increased collagen production can last upwards of two years.
Also known as collagen induction therapy, microneedling is a minimally invasive cosmetic procedure that helps to diminish the appearance of fine lines, wrinkles, enlarged pores, and other textural irregularities in the skin by — surprise, surprise — stimulating collagen production. During treatment, tiny needles create micro-injuries in the skin, which stimulates the body’s natural healing response. While the collagen production from microneedling alone won’t necessarily move the needle (pun intended) once volume loss has set in, Dr. Green recommends it to patients preventatively to keep the skin plump and radiant. Coupling microneedling with radiofrequency (RF) or platelet-rich plasma (PRP) can further boost the benefits. “PRP is packed with growth factors that help to revitalize further and nourish the skin,” she says.
4. Radiofrequency Skin Tightening
Volume loss doesn’t occur in vacuum. With less fat available to support the skin, sagging undoubtedly sets in. To treat the laxity caused by volume loss — sans surgery — Dr. Green recommends radiofrequency (RF) skin tightening. Thermage®, for example, “uses RF heat technology to induce collagen production in the skin, generating a lifting and tightening effect and providing smoother, firmer skin in just a single treatment,” she shares.
Surgical Procedures to Restore Facial Volume
As Dr. Paul explains, “the best procedures for facial aging target the underlying problem.” For many, that means surgery. “A surgical procedure offers a long-term result,” says Melissa Doft, MD, a double board certified plastic and reconstructive surgeon in NYC. In addition to the lack of maintenance, Dr. Doft notes that more invasive treatments allow you to “correct” problems like “bulging fat, sagging fat, and lack of a prominent jaw” versus simply “camouflaging” them. With that in mind, below are some of the effective surgical options to consider when trying to restore facial volume:
There is a reason the rhytidectomy (a.k.a. facelift) is the gold standard for turning back the clock. Depending on the technique, the surgery can be used to address sagging skin and displaced fat. “Facial volume is not always lost, sometimes it sags or moves,” Dr. Paul notes. One such area of concern is the cheek. “When the face ages, there is a descent of the malar fat pads, which are located in the cheek region,” Dr. Doft explains. “There may also be atrophy or decrease in volume.” The solution? A plicated SMAS facelift “will restore the fat to where it once was,” she says.
2. Fat Grafting
Fat grafting (i.e. the transfer of fat from one area of the body to another) is often combined with a facelift to restore volume. “Fat is liposuctioned from the abdomen or thighs, cleaned, and then re-injected into the face to add volume,” Dr. Doft says. “Not only do I like to inject fat into the cheeks but also the nasolabial lines (laugh lines) and marionette lines.” In addition to enhancing the effects of a facelift, fat grafting can also serve as a natural alternative to synthetic fillers.
3. Chin Implant
Whether you realize it or not, the chin plays a tremendous role in the overall proportion of the face. “A small chin can lead to facial disharmony,” Dr. Doft says. “Many patients need more volume in their chin.” Placing a silicone chin implant along the mandible (read: jawbone) is her go-to chin enhancement procedure. “Adding a chin implant can be very powerful in balancing a large nose or defining the jawline,” she shares.
4. Lower Eyelid Blepharoplasty
Like the cheek, the under eye is another area of the face where fat migrates with age. “Many patients complain of a deep tear trough or deep groove under their eyes,” Dr. Doft says. This creates the illusion of hollows, dark circles, and bulging and is often due to fat being pushed against the lower eyelid. To correct this, she recommends a lower blepharoplasty with transposition of fat. “It removes excess bulging fat and repositions some of the fat along this trough — blurring the transition between the eye and the cheek,” she explains.
While you can’t defy gravity or slow Father Time, there are both non-surgical and surgical procedures that can help you restore some of the volume that is naturally lost with age. Be sure to keep your skin protected from the sun and consult with a board certified dermatologist or plastic surgeon to determine the best treatment plan for your needs.
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