Volume loss in the face can be very dramatic in some people and barely noticeable in others. But when it happens, it’s one of the biggest reasons a face starts to look older and tired, often before a single deep wrinkle has appeared. It’s also one of the most misunderstood and, frankly, most over-treated areas in cosmetic medicine right now. So let’s talk about what actually happens, what works, and how to avoid ending up with a pillow face.
What happens to facial volume as we age?
Here’s the unkind trick nature plays on us: as we get older, we lose fat where we want it, through the cheeks and midface, and we gain it where we don’t, down in the lower face and jowl area. The face essentially deflates up top and slides south.
That shift is what changes the shape of a face from the youthful upside-down triangle (full cheeks, tapered jaw) to the bottom-heavy shape we associate with ageing. You want that first shape, not the second one. Volume loss makes us look older, tired and drawn, and it does it quietly, so many people can’t put their finger on why their face has changed.
The full-face problem in reverse
Interestingly, I also see the opposite complaint. Plenty of younger patients have very full faces and hate it. They come in asking about buccal fat removal and slimming the lower face with ultrasonic liposuction, and we have a special liposuction cannula for exactly this.
But here’s the warning: you’ve got to be careful about taking out too much, especially with buccal fat removal, because it can age you quite a lot. That youthful fullness you dislike at 25 is precisely the volume you’ll be desperate to keep at 45. Remove it aggressively and you fast-forward the deflation. A conservative hand matters enormously here.
How is facial volume loss treated?
We run dedicated facial volume consults at the clinic. There are off-the-shelf products available that Australian regulations don’t allow me to name here (that’s what the consult is for) but what I can talk about freely is fat transfer, which we do a great deal of at this clinic.
Fat transfer takes your own fat and uses it to restore volume where it’s been lost. A few of the ways we use it:
- The pre-jowl sulcus trick: As jowls develop, a hollow forms just in front of them, what I call the U-turn part of the face. Here’s the clever bit: rather than chasing the jowl itself, you camouflage it by filling in that sulcus at the front. Fill the dip, and the jawline reads as one straight line again. It’s a simple idea that makes a remarkable difference.
- Cheek augmentation: For naturally empty or deflated cheeks, fat transfer can rebuild that high, dramatic cheekbone. My approach is to look at the line from the corner of the lip up to the top of the ear, and fill along that line so the cheek projects and then drops away cleanly. I had a case recently that amazed even me; she had a marvellous improvement in her cheek shape.
- Sleep lines: Those creases pressed into the face from years of side-sleeping can also be treated with fat transfer, though this needs a very careful, precise technique.
- The lower face (handle with care): Some people want fat placed in the bottom of the face, and this is where you have to be very, very cautious. Overdo it and you get the blowfish look, that puffed-out lower face that helps nobody. Fat there must be placed sparingly and cross-hatched carefully so it sits smoothly.
The overfilling epidemic
This is the big problem of the last few years, and I’ll be blunt about it. Some faces have had far too much put in them, fat or otherwise, and the result is the pillow face: puffy, uniform, oddly ageless in the wrong way, and unmistakably “done.”
Part of this is fashion, but part of it is commercial. Be wary of anyone whose answer to everything is more: more volume, more syringes, more sessions, because plugging as much product into a face as possible does wonders for the bill and very little for the face. There’s such a thing as a little volume loss, more volume loss, and there is very much such a thing as too much replacement.
Go to someone experienced, someone who will tell you where to stop.
When should you start treating volume loss?
Earlier than most people think, but gently. You can lose a little volume when you’re younger and more as you go on, and the wisest approach is to treat it as you notice it, in small measured steps, rather than waiting twenty years and trying to rebuild everything at once. Big one-off corrections are exactly how faces end up overfilled. Little and often keeps you looking like yourself.
Frequently asked questions
- What causes volume loss in the face?
Ageing shifts your facial fat: you lose it in the cheeks and midface and gain it in the lower face and jowls. Declining collagen and bone changes add to the deflated look. - Does facial volume loss make you look older?
Yes, often more than wrinkles do. Deflated cheeks and hollows make a face look tired and drawn, and the shift of fullness to the lower face changes the whole shape of the face. - What is fat transfer to the face?
Your own fat is harvested, prepared and injected into areas of volume loss: cheeks, the pre-jowl hollow, sleep lines. Because it’s your own tissue, it integrates naturally. - Can fat transfer fix jowls?
It can disguise them very effectively. Filling the pre-jowl sulcus, the dip in front of the jowl, restores a straight jawline without touching the jowl itself. - Is buccal fat removal a good idea?
Sometimes, but conservatively. Removing too much cheek fat when you’re young can age you significantly later, because that’s the very volume faces lose over time. - How do I avoid the pillow face look?
Treat volume loss gradually, use modest amounts, and choose an experienced practitioner who’s willing to say “that’s enough” rather than sell you more.
Facial volume is one of the most important, and most abused, parts of facial rejuvenation. Treated early, carefully and conservatively, it’s transformative. For a facial volume consult, head to absolutecosmetic.com.au and take care.
Dr Glenn Murray, Absolute Cosmetic
All procedures carry risk. Individual results vary. Seek a second opinion from an appropriately qualified health practitioner before proceeding.
