Facial Ageing · A Physician’s Perspective
Facial volume loss, and why
your face looks tired.
The short answer
Much of what reads as ageing is not wrinkles or sagging but volume loss: fat pads deflate, bone recedes, and the face loses the scaffolding that gave it shape. Temples, cheeks, the tear trough and jawline are usually affected first. Because the real problem is missing support, chasing lines directly often looks unnatural. Biostimulators rebuild broad structure, filler adds targeted volume, and restraint matters as much as either.
Before you had a single line or fold, you were already losing volume. It is the quiet, structural part of ageing that nobody warns you about.
We tend to think of facial ageing as wrinkles and sagging. But underneath those visible changes is something more fundamental: the face is deflating. Fat pads shrink and slide downward, bone recedes, and the scaffolding that once gave the face its shape slowly disappears. Much of what we read as "looking tired" or "looking older" is really this loss of underlying volume.
Where volume goes first
The temples. Often the earliest place, and the most overlooked. Hollow temples narrow the upper face and cast a shadow that makes the eyes look tired.
The mid-face and cheeks. As the cheek fat pads deflate and descend, the mid-face flattens. This is frequently the hidden cause of what looks like a heavy lower face or deepening folds.
Around the eyes and the tear trough. Loss here creates the hollow, shadowed under-eye that no concealer quite fixes.
The jawline and chin. Bone recession and fat loss soften a jawline that used to be crisp.
Why chasing lines is the wrong approach
When volume loss is the real problem, treating the surface, smoothing a fold or filling a line, addresses the symptom and misses the cause. The fold is there because the support behind it collapsed. Restore the support and the fold often softens on its own. Chase the fold directly and you risk the overfilled, heavy look that comes from stacking product where structure is missing.
When a biostimulator makes sense
Sculptra and similar collagen biostimulators rebuild volume gradually and diffusely by prompting your own collagen. They suit broad, structural volume loss where the goal is restored support rather than a filled-in line.
When HA filler makes sense
Hyaluronic acid filler adds immediate, targeted volume in a specific place, and can be dissolved. It suits precise structural work, such as a defined area of the tear trough or a specific contour.
When to combine
Often the most natural result uses a biostimulator to restore the broad foundation, with a small amount of filler for precise definition where it is needed.
When restraint is the answer
Not every hollow needs filling. Over-restoring volume ages a face in its own way. Sometimes the right amount is less than you expect, and a good clinic will say so.
Frequently asked questions
How do I know if my problem is volume loss or wrinkles?
They often coexist, but volume loss tends to show as flatness, hollowness, and shadowing, especially at the temples, cheeks and under the eyes, rather than as fine surface lines. A telltale sign is that folds deepen because the support behind them has collapsed. A consultation can separate the structural component from the surface one.
Is Sculptra or filler better for volume loss?
They do different jobs. Sculptra rebuilds volume gradually and diffusely by stimulating your own collagen, which suits broad structural loss. Filler adds immediate, targeted volume in a specific spot and can be dissolved. Broad restoration often favours a biostimulator, while precise definition may call for filler. Many natural results combine both.
Will restoring volume make me look overfilled?
Not if it is done with restraint. The overfilled look usually comes from repeatedly adding product to chase lines rather than restoring underlying structure in the right amount. Over-restoring volume can age a face in its own way, so sometimes the right amount is less than expected.
Why do my temples and under-eyes look hollow?
These are among the first areas to lose volume. As temple and periorbital fat and bone recede, the upper face narrows and the under-eye develops a shadowed hollow. Restoring a modest amount of support in these areas often refreshes the whole upper face more than treating the areas people usually focus on.
Not sure which approach fits your face? A free consultation is the honest place to start. We will tell you what we would do, and what we would not.
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