Ask the Expert: Why Does Skin Lose Volume?

Are you losing volume in your face?

Ask the Expert: Why Does Skin Lose Volume? |

Think back to how your complexion looked and felt in your younger years. Was your skin plump and firm? Would it quickly spring back when you pressed into it? Now, if you’re in your forties or beyond, you’re probably noticing your skin is losing its volume and, as a result, is showing the signs of ageing, wrinkles and sagging.

Young skin is fuller skin, but as we age, it gradually begins to lose volume. But why and how does your skin lose that plumpness? Well, we caught up with Dr. Shobhan Manoharan, Consulting Dermatologist at L’Oréal Paris and Director at Brisbane Skin and Westside Dermatology in Brisbane, to get the lowdown, plus find out which products can combat the process.

What causes your skin to lose volume?

It isn’t just time that can lead to a loss of volume – your lifestyle choices and the environment can affect the plumpness of your skin as well.

“Volume loss in the skin is caused by both genetic tendencies to ageing, and extrinsic factors such as ultraviolet radiation, smoking, diet and pollution.

You generally start seeing these changes in your forties and they progress from there,” explains Dr. Manoharan.

What are the signs you’re losing volume in your skin?

“Volume loss is characterised by the hollowing of cheek segments, temples, jawline, and the thinning of lips,” says Dr. Manoharan. “There are changes and degradation of every level of anatomy, from the bone to muscle and subcutaneous fat, to the various layers of the skin. Consequently, volume loss also contributes to creases, sagging skin and wrinkles.”

Let’s talk volume-boosting products! What active ingredients should you look for?

“The main ingredients to look for are vitamin A agents (retinols/retinoids), alpha hydroxy acids, vitamin B3 (niacinamide), vitamin C (ascorbic acid) and, finally, hyaluronic acids.”

An effective skin-plumping ingredient, hyaluronic acid is a natural moisturiser that’s present in the epidermis – the skin’s outermost layer.

It can retain up to 1000 times its weight in water and helps to boost the plumpness and volume of your skin.

However, as your skin ages, its ability to retain and naturally produce hyaluronic acid decreases, meaning your skin and facial features start to lose volume, and lines and wrinkles set in.

These days, many women are turning to hyaluronic acid injections to instantly boost their skin, but L’Oréal Paris has launched a line of products to plump up skin without the help of needles.

The L'Oréal Paris Revitalift Filler [HA] range is made up of the Revolumising Serum and Revolumising Anti-Ageing Moisturiser. Inspired by the effect of dermatological injections, the duo contain the highest concentration of hyaluronic acid yet* to help plump out wrinkles and boost the skin’s volume.

As for how it actually works, Dr. Manoharan explains. “L’Oréal has managed to formulate… hyaluronic acid of a low enough molecular weight [to] successfully penetrate the epidermis. This results in the further formation of hyaluronic acid within the epidermis, improves the protective barrier of the skin, encourages hydration, and, in short, ‘plumps’ skin.”

The L’Oréal Paris Revitalift Filler [HA] Revolumising Serum has an easy-to-use dispenser that delivers the perfect amount of product in just one pump, while also protecting the formula from the effects of air and light.

In addition to hyaluronic acid, the L’Oréal Paris Revolumising Anti-Ageing Moisturiser contains Fibroxyl, which acts as a firming ingredient to mimic the effect of a hyaluronic acid injection.

And you don’t have to wait months to see results – when the serum and moisturiser are used together, they can help to plump and firm the skin and increase its volume in just four weeks!

Forget cosmetic filler injections. Instead, try switching out your regular serum and moisturiser for these skin-plumping beauties – no needles required!

Is your skin losing volume? Would you to try the L’Oréal Paris Revitalift Filler [HA] range?

*Versus L’Oréal Paris Care


The Four Pillars Of Aging: Why Your Face Ages

Ask the Expert: Why Does Skin Lose Volume? |

For anyone looking in the mirror on a daily basis (hey, beautiful), the first signs of aging are on the surface: darker undereye circles that seem somehow larger than the last time, a pair of lines between your eyebrows, an odd collection of extra skin and fat at the bottom of your jaw.

But those outward changes are the result of deeper structural changes in your bones, muscle, and fat, and the seismic moves happening underneath your skin make a big difference in how you age. Here, we outline the four pillars of facial aging.


The four major areas of structural change are bone, muscle, fat, and finally, skin.

But before we dive into the woes of aging, here are the basics of face structure: your outer skin (epidermis) is packed from the inside with the hypodermis (also known as subcutis), which is where all your subcutaneous fat is found.

The hypodermis is what connects to the web of your facial muscles, which in turn link to your bone structure. We’ll explore these elements from inside out, starting with the bone.


Migrating + Losing Density

Despite their rigidity, bones don’t stay the same as we age—they lose mass, migrate, and cause major changes in our appearance.

This outline from Live Science on how our bones age explains how the eye sockets, nose, and jaw are major migration points.

“The facial skeleton experiences morphologic change, and an overall decrease in volume, with increasing age,” researchers wrote in the Journal of the American Society of Plastic Surgeons.

According to Dr. Margo Weishar, a CB-approved specialist in clinical and cosmetic dermatology, “Bone loss in the face can lead to narrowing of the temples and retraction of the jawline and mouth. The nose starts to descend.”

Dr. Shereene Idriss, a dermatologist with vast experience in lasers and other cutting-edge anti-aging technologies, explains what happens when bones migrate and lose density.

“The orbital rim (aka eye socket) widens, particularly along the outer inferior edges, giving your eyes a more sunken appearance with more prominent fat pads resulting in a tired look.” That retraction of the jawline that Dr.

Weishar mentioned, unveils “jowls and an unstructured neck,” says Dr. Idriss.

The kicker? Most of these changes happen much earlier in women—between young and middle age—and much later in men—between middle and old age.

Solutions: There are no skeletal approaches to anti-aging, but there are preventive procedures to avoid sagging. Keeping the skin taut is the best approach here.

“Heat is a potent source of energy that allows fibrous bands to tighten while stimulating new collagen to develop,” explains Dr. Idriss.

Radiofrequency (a favorite of Joanna Vargas) and ultherapy are great examples of preventive procedures you can do every couple of years.


Etching + Sagging

That underlying structure of facial muscles mentioned above is called the superficial muscular aponeurotic system (SMAS), and it sits between bone and fat. When bones give way, the muscles follow.

Dr. Idriss puts it this way: “The facial muscles and fat pads decrease in volume, while the casing holding them together (the SMAS) loses its elasticity, culminating in a true domino effect.”

Solutions: Before this loss of volume takes place, your muscles have the chance to work up lines from repetitive motions. “Muscular activity can result in “etched-in” lines due to repeated motion, explains Dr. Weishar. “This is where Botox/Dysport/Xeomin can really help—both in preventing and reversing early lines before they set in.”


Disappearing + Drifting

As babies, our faces are round and full of pudgy, subcutaneous pockets of fat.

As this Harvard Health article describes, that fat diminishes and rearranges itself slowly but surely, finding new pockets to inhabit as we age.

Usually, those pockets aren’t high on our cheekbones or perfectly arranged to balance our eyebrows and eyes. They drift downward, clumping around the chin, jaw, and neck.

This movement happens in your forties, in particular, and continues steadily as the years pass. Dr.

Heidi Waldorf, Director of Laser and Cosmetic Dermatology at The Mount Sinai Medical Center in New York City, told Women’s Health, “Although there are variations due to genetics, in general we lose the deep fat pads in the mid-face and those of the temples and the front of the ears first. Then we lose [fat] around the mouth and chin and along the jawline.”

The result? It looks your skin is falling and wrinkling (which it is) but the underlying cause is the deflation of fat.

Following the path of sagging skin, the perky button nose of your youth starts to turn downward. According to Dr. Waldorf, “This is partly due to lack of soft tissue support and also a result of the upper lip retracting downward and the nose following. The top of the nose at the bridge often sinks, causing a horizontal wrinkle, in addition to the vertical lines between the brows.”

Solutions: In this case, wrinkles are the primary target (rather than overall sagging or muscle, though of course, as we’re learning, everything’s related). Consider filler for crow’s feet and forehead wrinkles, combined with the radiofrequency, lasers, and ultherapy mentioned above.


According to Dr. Weishar, there might be more at play than the elements listed above: “There is an interesting theory recently being floated around that what really happens in aging is that the skin starts to expand and lose its elasticity, rather than the support being lost.”

It could be that your skin is just losing elasticity and stretching—simple as that—rather than this four-stage aging process. “Although I feel this is partially true,” Dr.

Weishar continues, “I still believe it is a combination of both. So there is a role for skin tightening—but I believe it should be balanced with addressing underlying volume loss as well.

” If you’re curious about the skin-stretching theory, check out this article.

Image: Kathryn Miller


There’s an array of anti-aging treatments depending on what stage of aging you find yourself in.
We have guides for the 20s and 30s, 40s, and 50s and 60s. 


Read client reviews, book appointments, and get advice from the experts in Charlotte’s Book. Only the best cosmetic doctors, skincare gurus, nutritionists, and fitness and wellness professionals make it into our book.


Sagging Skin and Volume Loss Solutions

Ask the Expert: Why Does Skin Lose Volume? |

Age sneaks up on the best of us. Over time, the skin’s structure breaks down. It begins to sag and volume decreases. The visible result of this natural process is skin that looks older, but you don’t have to live with sagging skin and volume loss.

The skin’s aging process could be divided into four stages.

Stage 1 affects people in their 20s and early 30s. During this time frame, the skin is voluminous and youthful. While early signs of aging – the appearance of fine lines when making facial expressions – can begin to show, they go largely unnoticed.

Stage 2 affects people in their mid to late 30s and 40s. Visible fine lines and wrinkles appear around the eyes and on the forehead. Bags under the eyes can begin to be problematic. The skin around the jaw can start to sag, and the early signs of years of sun damage can manifest as sunspots and age spots.

Stage 3 affects people in their 50s and 60s. Wrinkles are more visible, the skin around the eyes is loose, and there is often a significant amount of volume loss in the face. Skin can appear thin and shallow, and facial contours can begin to change.

Stage 4 affects people 70-years-of-age and older. Lines and wrinkles become prominent, particularly around the eyes and across the forehead. Cheeks and the skin around the eyes sag more visibly. Deep marionette lines often appear, and the skin around them droops.

The Beauty of Aging

Why does the face age? The dermis or skin stops producing the proteins that “fill” our skin – collagen and elastin. The rate at which production subsides varies from person to person and can be impacted by unique factors environment, genetics, and overall skin care.

When the skin is carefully cared for and maintained, the aging process can be slowed and minimized. While sagging skin and volume loss are natural, you don’t have to bow to them as early as your 20s and 30s. Your skin has the potential to look youthful as the years pass.

At Dermacare of Hampton Roads, we work with some of the top anti-aging and skin care solutions. Not only can we provide skin rejuvenation treatments, but we can also help create a skin care and maintenance routine to best benefit your unique skin.

Solution #1: Exilis Ultra and SkinTyte™ II

Skin tightening treatments Exilis Ultra and SkinTyte™ II heat the deep dermis and encourage it to produce new collagen and elastin. As a result, the skin looks and feels younger and tighter.

Solution #2: Dermal Fillers

Dermal fillers are an injectable treatment designed to replace lost volume instantaneously, and they can help replace lost volume at different skin depths.

The injections are usually made from hyaluronic acid, a naturally occurring compound found in the body.

At Dermacare of Hampton Roads, our expert cosmetic injectors work with Allergan Fillers, which are dermal fillers that restore lost volume in the face and lips.

Stop Sagging Skin and Restore Lost Volume

If sagging skin and volume loss are among your concerns, our team of skin care experts can help. We can discuss the pros and cons of all available treatment solutions and whether a combination of them will be the best option for reaching your goals within your budget.

In addition, our staff’s knowledge of skin care products is second to none. We can help you find the best products and design an optimal routine to slow – even reverse – the natural occurrence of sagging skin and volume loss. Let us help your skin age with beauty and grace.


Aging skin | Loss of volume

Ask the Expert: Why Does Skin Lose Volume? |

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As our skin ages, its structure changes. By our 40s, most of us are experiencing a loss of volume, sagging contours and deepening wrinkles. This is due to a combination of internal processes and external factors.

The way we age is partly due to our genetics. This intrinsic aging combines with environmental and lifestyle factors to trigger the slowing down of key processes and functions in the skin. It is this slowing down which causes the most visible signs of aging: fine lines and wrinkles, sagging skin and a loss of volume and facial contours, a loss of elasticity and a loss of radiance.

Sagging skin is caused by a decrease in volume-giving cells. 

Sagging facial skin is caused by a loss of volume

This loss of volume, together with wrinkles, a loss of radiance and a loss of elasticity, causes facial skin to start looking older. It can be difficult to identify a loss of volume and facial contours. The first signs of a loss of volume in the lips tends to be when lipstick starts to bleed.

A loss of facial volume tends to result in sagging skin, a flattening of the cheeks and the appearance of a “turkey neck”. It changes the overall appearance of the face which can look negative, sad or tired.

The fold that develops between the nose and the mouth, known as the nasolabial fold, is also linked to sagging skin and a loss of volume.

The triangle of beauty

A visual reference such as ‘the triangle of beauty’ clearly shows how a loss of volume changes the shape and structure of the face in several subtle but transformative ways.

The even distribution of volume in our facial skin when we are young helps it to look attractive. The main features of a younger looking face can be clearly seen as part of the ‘triangle of beauty’. These include:

  • High cheekbones
  • Full jowls
  • Smooth skin
  • A lean, well-defined jaw line

These features combine to create a face shape and structure that is wider at the top, tapering down to the narrowest point at the chin. The overall look is relaxed and positive.

The triangle of beauty is associated with a youthful, positive appearance.

As we age, the signs of a loss of volume mean the triangle is inverted. This is due to the following changes:

  • A wider, slacker jaw line
  • Sagging skin resulting in less defined facial contours
  • Flatter cheeks
  • Wrinkles on the forehead and brows 
  • The corners of the mouth point downwards
  • Hollowness of under eye area and temples

It’s the combination of these factors that equates to an aged appearance. As is seen here, the triangle is now turned upside down with the wider area towards the bottom of the face. As volume diminishes and skin sags the perception of the face is altered. The person can look sad or stressed and this can lead to incorrect judgements on their mood or outlook.

Over time the triangle of beauty inverts and leads to a negative, sad look on the face

A gradual drop in the ‘filler’ substances that keep skin looking firm and feeling smooth lead to a loss of volume, less defined contours and sagging skin in the different layers of skin:

1 Epidermis2 Deeper layers of the skin

The epidermis. As we age, the outermost layers of skin produce less hyaluronic acid and fewer lipids. Skin is less able to bind in moisture, becomes drier and, as a result, fine lines and wrinkles appear. Skin starts to sag, appears thinner and its texture may be dry and rough.

The deeper layers of the skin. A 1% annual loss of collagen worsens the thinning effect together with a declining level of functional elastin.

As elastin is partly responsible for the skin’s elasticity and strength, a decrease in these two substances together results in a sagging, less elastic skin.

The volume-giving cells that keep skin `filled out’ reduce in size and number, leading to a shrinking of these layers. The result is a more drawn and sunken look to the skin, with flattening of the cheeks.

Over time, the blood flow delivering nutrients slows, resulting in dullness and a tendency towards dehydration and slower healing. Skin undergoes a further loss of elasticity and deep wrinkles start to form.

It’s not just our genetics that determine how we age. There are a range of other internal and external factors that lead to a loss of volume in skin:

Hormonal changes

In puberty, estrogen levels are high. Skin is smooth and elastic and the skin contours are defined. As we age, hormone levels decline and volume-giving cells decrease in both size and number leading to a loss in volume and less defined facial contours.


As part of general skin aging a loss of volume is also caused by the same external lifestyle factors that also contribute to wrinkles and a loss of elasticity and radiance. These include: 

  • Sun: Spending too long in the sun can damage collagen, compromise skin structure and cause photoaging (premature skin aging caused by the sun)
  • Smoking: Nicotine and other chemicals in cigarettes further degrade skin collagen

These lifestyle factors combine to cause oxidative stress. This occurs when molecules known as ‘free radicals’ are formed internally and attack cellular structures including those that help the skin look smooth and firm.

Once the structure is weakened, and collagen and functional elastin decline, skin aging is accelerated.

The visible signs including fine lines and wrinkles, a loss of volume, a loss of elasticity and less radiance appear on skin’s surface.

As we age our bodies produce less estrogen leading to a loss of skin volume Overexposure to the sun is the primary cause of premature skin aging

Although a loss of volume is a complex concern and is in many ways inevitable, the visible effects can be treated in a variety of ways. 

Volume-giving skincare solutions

A daily skincare routine, using products specially formulated to treat a loss of volume, will give sagging skin the care it needs and can have a lifting effect. The following active ingredients (listed alphabetically) are used in anti-aging formulas to address the causes of skin sagging, loss of volume and poorly defined facial contours.


Magnolol is a highly effective active ingredient extracted from the bark of the Magnolia tree and is also known as Magnolia Officinalis Bark Extract.

It triggers the excretion of a bio-active substance in the dermal layers of skin which increases the synthesis of collagen and stimulates the number and size of volume-giving cells, “plumping” areas of diminished volume1.

It is a key ingredient in the Eucerin Hyaluron-Filler + Volume-Lift range which addresses a loss of volume by plumping up deep wrinkles and redefining facial contours for a lifting effect.

1 In-vitro studies

Oligo Peptides

Oligo Peptides stimulate the collagen network responsible for a firmer skin structure. They also improve collagen synthesis in the dermal layers of skin, thereby strengthening the dermal connective tissue1.

They are extracted from the fruit and seeds of the Anise plant, which was originally cultivated for its skin-enhancing properties and are also known as Pimpinella Anisum Fruit Extract.

Oglio Peptides are an important part of the Eucerin Hyaluron-Filler + Volume-Lift formula which plumps up deep wrinkles and redefines facial contours for a lifting effect.

1 In-vitro studies

Anti-age creams can help to restore lost volume and redefine facial contours. A daily face care routine, using volumizing care products, can help to reduce a visible loss of volume.

Hyaluronic Acid

Hyaluronic Acid is formed by skin cells and is part of the connective tissue of the skin. One of its key functions is to retain moisture, and it has the ability to bind in between 1,000 and 10,000 times its own weight in water (i.e.

one gram binds between one and ten liters). As we age, the skin’s natural ability to produce Hyaluronic Acid decreases and wrinkles start to form and deepen.

The Hyaluronic Acid in the Eucerin Hyaluron-Filler + Volume-Lift formula intensively moisturizes skin and plumps up deep wrinkles.

Dermatological treatments

If you remain concerned about a loss of volume in your skin your dermatologist may recommend one of the following treatments:

Non-invasive treatments:

Radio frequency technology is used to heat the deep collagen layers of the skin. This heat promotes the production of new collagen and tones existing collagen. The aim is to restore poorly defined facial contours. 

This treatment uses ultrasound to lift, tone and tighten sagging skin.

Mildly invasive treatments:

Injectables are used to temporarily replace volume and give instant, short-term results. Usually used on the cheeks, temples and lips or under the eyes. Injectable Hyaluronic Acid can also help with wrinkles.

Invasive treatments:

This method involves surgically removing fat from one area of the body and transplanting it to another. It is most commonly used to replace volume in the cheeks and results are long-lasting. Swelling is not unusual and the treatment usually requires a period of downtime.

Fillers help to temporarily replace lost volume The pros and cons of plastic surgery should be considered in advance.

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Facial Volume Loss Injectables by Nashville Skin Specialists

Ask the Expert: Why Does Skin Lose Volume? |

Some degree of aging can be expected as we get older. Fine lines or wrinkles, sagging cheeks, and shrinking lips are just some of the ways volume loss can affect our appearance.

With volume loss, it’s as though our face is losing its necessary support, causing our features to droop and sag.

Fortunately, there are many advanced cosmetic treatments that can add more volume to your skin to restore a more youthful appearance.

How To Rejuvenate Your Facial Volume

Sophisticated aesthetics treatments can help replenish lost facial volume. The cosmetic dermatologists and skin experts at Nashville Skin are specialists in the latest anti-aging treatments to help you meet your aesthetic goals. Our expert practitioners create individualized plans to help each patient experience the refreshed, youthful look they desire.

What is Volume Loss?

Facial volume loss is caused by a lack of facial support due to the natural loss of fat layers and collagen in the skin over time. When the face loses volume, the skin can begin to show fine lines and wrinkles due to diminished collagen and reduction in facial fat. This may cause a hollowness under the eyes, a flattened look to the cheeks, sunken temples, and reduced lip size.

Additionally, there can be increased skin laxity causing loose skin around the jawline or jowls. To make matters worse, vertical lines may appear on the lips, around the nose, and down from the corners of the mouth, which are known as oral commissures. Volume loss can also make the skin appear drier, thinner, and less firm and vibrant.

The main areas of facial volume loss include:

  • Under the eyes
  • Lips
  • Cheeks
  • Jaw
  • Forehead
  • Temples

What Causes Volume Loss?

Aging is the number one culprit in facial volume loss. When we age, our bodies begin to lose their supply of essential collagen and elastin, two proteins that help maintain our skin’s firmness and hydration.

Once these vital compounds begin to decrease, we experience skin that is tired-looking, dry, and saggy.

There are a number of other factors that can contribute to a loss of facial volume and the breakdown of elastin and collagen, including:

  • Lifestyle
  • Stress
  • Heredity
  • Sun exposure
  • Weight loss
  • Smoking
  • Certain Medications

Facial Volume Loss Treatments

Our skin specialists at Nashville Skin have an array of cutting-edge cosmetic tools to help improve the fine lines, wrinkles, and volume loss caused by aging or other factors.

While in the past, plastic surgery was needed to lift, tone, and tighten the skin, thankfully, innovations in non-surgical techniques dermal fillers offer patients anti-aging alternatives that provide beautiful results without the downtime a surgical treatment would typically require.

Though fillers aren’t permanent, they do offer long-lasting, natural-looking results that can last from six months to a year, if not more in some rare cases.

Dermal fillers can be used to improve lost volume and reshape specific elements of the face to achieve desired results. In addition to augmenting and sculpting the face, some dermal injectables are formulated to boost the skin’s ability to produce collagen and elastin, helping improve the long-term effects of aging.

At Nashville Skin, we work with Juvederm Volbella, Juvederm, Vollure, Juvederm Voluma, and Juvederm Ultra Plus XC to produce stunning results in improving facial volume.


Volbella was developed by Juvederm specifically for use in the lips and around the mouth area. Volbella can be used to improve lip fullness and soften the appearance of lines around the mouth. Volbella results can last up to one year.


Vollure is a great dermal filler to use for patients looking to improve the appearance of nasolabial folds, also known as laugh lines. Vollure has been shown to improve wrinkles for up to 18 months.

Juvederm Ultra Plus

Juvederm Ultra Plus is a dermal filler that is ideal for deep lines along the nasolabial folds and marionette lines. Juvederm Ultra Plus can last 6-12 months.


Juvederm Voluma is a wonderful filler for restoring lost facial volume to the cheeks and mid-face. Not only that, but Voluma is great for patients who want to augment their chin and profile. Voluma results can be long-lasting (18-24 months).

Juvederm Ultra XC

Looking to improve lip volume? Look no further than Juvederm Ultra XC! It’s the perfect facial filler to augment the lips and perioral area. Juvederm Ultra provides patients with beautiful, natural-looking lip volume for 9-12 months.

Learn more about this range of fillers at

For patients looking for a facelift alternative, Botox can be used in combination with dermal fillers to create a “liquid facelift” to rejuvenate the entire face without the downtime associated with a surgical procedure!

Q. When does facial volume loss begin to occur?

A. When exactly facial volume loss occurs can vary, but generally, it begins once a person enters their 20’s. While volume loss is gradual, facial definition can be lost in such facial areas such as the temples, lips, forehead, jawline, cheeks, and eye sockets.

Q. What is a facial filler procedure ?

A. The treatment times for dermal fillers can vary from 10 to 30 minutes, depending on the treatment area. Two of the main benefits of a dermal filler treatment is that all procedures can be done in the office and there is no anesthesia needed.

Pain is minimal and we make every effort to make sure the treatment is as comfortable as possible. There is no downtime and you are free to resume your daily activities, however, we advise patients to avoid exercise for 24 hours.

Side effects bruising and/or swelling can occur, but these only last a few days.

The Nashville Skin Experience

At Nashville Skin, we believe that each patient’s needs are unique and require a customized treatment plan to ensure that realistic aesthetic goals are not only met, but exceeded. When you come in, our first step is determining the proper treatment options.

Contact us today at one of our three convenient Nashville locations (21st Avenue S., Southern Hills Medical Center, Centennial Medical Center and St.

Thomas Medical Center – Lennox Village), or our Clarksville office to schedule a formal evaluation for effective volume loss solutions.

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