Our face loses fat as we age. And no, it’s not a good thing.

Youthful looking skin with good volume is one of the many benefits of estrogen—and good genes.

The loss of that precious layer under the epidermis causes our faces to get thinner and sag as we grow older, revealing more blood vessels and creating more wrinkles and folds. Thinner skin also breaks and bruises more easily.

Delicate lip tissue is also affected by facial fat loss: lips get smaller and thinner and wrinkles deepen. As we get older, the attractive poutiness of lips is progressively replaced by a stern and worn appearance. The loss of volume can also lead to deeper lip wrinkles and a constricted lip appearance. In some people, the changing balance of lips can even create a “toothless” look as the lower lips get thinner and the upper lips begin to sag.

Some people may begin to feel the gradual loss of the facial fat layer under the epidermis earlier than others. Pre-existing health conditions and the use of specific medications (such as corticosteroids) can accelerate the process.

Too much unprotected sun exposure can also lead to the breaking down of collagen and elastin (the protein that lets your skin “snap back” after you make a facial expression). Smoking is also a no-no: nicotine is just one chemical in cigarettes that causes premature aging and further degrades the collagen in the skin.

You can reduce some effects of aging by using a sunscreen with an SPF rating of at least 15. But loss of volume is inevitable as we grow older.

Your medical aesthetic professional can recommend the treatment that best suits your concerns—such as Juvéderm®, Restylane® or Teosyal®—to help you get smooth, full and natural-looking skin.

The signs of volume loss and sagging skin

Hollow cheeks

Your cheek bones will stay where they are, but the volume in your cheeks won’t. The loss of fat under our cheeks leads to the appearance of hollow, fallen cheeks.

Smile lines

The wrinkles that run from the bottom of the nose to the corners of the mouth are called nasolabial folds. They start as dynamic wrinkles from smiling, but with time they become folds and deepen as we lose volume in our skin.

Before and after of a refresh MD patient smile lines


Probably one of the first features that comes to mind when you think of sagging skin; jowls—the droopy skin located near the lower cheek and jawbone— are one of many unfortunate signs of aging.

Before and after of a refresh MD patient jowls

Marionette lines

Another obvious sign of losing volume in your skin is marionette lines—the vertical lines that run from the corners of your mouth down the sides of your chin.

Before and after of a refresh MD patient maionette lines

Lip corners

As we lose volume in the skin of our lower cheeks and around our mouth, we start to notice a down turn of the lip corners. Along with marionette lines, this drooping at the corner of the lips can give the appearance of a permanent frown.

Sagging Chin

Many people think the contour of the chin is largely due to the chin bone, but there is a lot of tissue and fat beneath the skin that helps give the chin its shape. Volume loss and sagging skin can cause a noticeable droopiness around the chin, similar to what occurs with jowls.

Before and after of a refresh MD patient sagging skin




Dermal fillers


with one of our aesthetic consultants