Facial Volume Loss: What Causes It and How It Is Addressed

The majority of what people notice and describe as facial ageing, the hollowing beneath the eyes, the flattening of the cheeks, the deepening of the nasolabial folds, the softening of the jawline, is not driven primarily by changes at the skin surface. It is driven by what is happening beneath it: the loss and descent of fat, the resorption of bone and the thinning of supporting tissue. Understanding this changes how the treatment conversation makes sense.

The structural anatomy of facial volume

The face contains multiple discrete compartments of fat distributed across the deep and superficial planes. These fat pads do not behave as one continuous mass. They each have their own vascularity, their own rate of change with age and their own pattern of atrophy. As they reduce and descend, the tissue supported by them follows.

In the mid-face, the malar fat pad sits over the cheekbone and provides the fullness of the upper cheek. As this pad descends and the tissue loses volume, the cheek flattens and the fold between the nose and the mouth deepens, not because the fold itself grows but because the tissue above it has lost the volume that used to fill it.

Beneath the eyes, the deep periorbital fat reduces and the orbital rim becomes more prominent, contributing to the hollow and shadow that make people look tired.

Along the jawline, submental and jowl fat distribution shifts, volume is lost from the lower face, and the mandible itself gradually resorbs, reducing the skeletal foundation.

The bone component

Facial bone loss with age is clinically significant and often underappreciated. The orbital rim, which forms the bony support behind the eye, widens and deepens with age, making the eye appear more recessed. The pyriform aperture, the bony opening of the nose, enlarges. The mandible loses height and setback. These are not reversible changes. They define the envelope within which soft tissue sits and they determine what is achievable with volume restoration.

The skin and connective tissue component

Beyond the fat and the bone, the skin itself thins with age and UV exposure as the dermis loses collagen and elastin. The connective tissue ligaments that anchor the face to the underlying skeleton retain their attachment points but become less able to hold the overlying tissue in its youthful position. The combination of reduced volume and reduced structural integrity allows soft tissue to descend.

What treatment addresses

Dermal filler for structural volume restoration. Hyaluronic acid filler placed in the mid-face restores the volume lost from the malar fat pad, provides indirect lift to the lower face, and supports the overlying tissue. Filler placed along the jawline and chin restores skeletal projection and definition. The approach is not to fill every hollow but to restore the structural support that, when present, allows the face to look as intended.

The choice of product matters. Volume restoration in the mid-face uses a firmer, more structured product than the soft formulations appropriate for lips or tear troughs. Placed at the correct depth and in the right quantity, it produces a result that reads as improved structure rather than obvious filler.

Profhilo. Where the concern is the quality and hydration of the skin rather than structural volume, Profhilo is the appropriate answer. It delivers a high concentration of hyaluronic acid that spreads through the tissue, improves hydration significantly, and stimulates fibroblast activity, driving the skin’s own collagen, elastin and HA production. It does not add structural volume in the way that filler does, but the improvement in skin quality and subtle firming it produces is often among the most noticeable improvements a patient can make in their overall appearance.

Polynucleotides. In areas where skin quality and tissue thickness are concerns alongside volume, polynucleotides support the dermal environment through fibroblast activation and anti-inflammatory signalling.

PRP and iPRF. Autologous regenerative treatment used for skin quality improvement in the periorbital and mid-face areas where tissue thinning is the dominant concern.

What cannot be replaced non-surgically

Bone loss is not addressable non-surgically. Filler can compensate for some of its visual consequences, such as restoring projection to an area where the skeletal support has resorbed, but it does not replace bone. This is clinically important in planning: a significant orbital rim change, for instance, requires a realistic discussion about what volume restoration in the periorbital area can and cannot achieve.

Significant tissue descent that is structural rather than volume-driven, such as substantial jowling or significant nasolabial folding caused by descended fat, is most effectively addressed surgically. Non-surgical volume restoration can meaningfully improve mild to moderate presentations and slow progression, but for marked descent the honest conversation involves a surgical referral. At The London Road Clinic, with Dr Shahe Boghossian’s background in vascular and reconstructive surgery, this assessment is part of the clinical picture.

Frequently asked questions