Male, 36. What to do about my midface volume loss and descent? (Photos)

Question

I'm male, 36, over the last 3-4 years, I have experienced midface volume loss and midface descent, with significant undereye hollowing, purple-colored bulges of undereye fat, and slight nasolabial folding (I think I do not have enough facial volume for significant nasolabial folds yet). Different doctors have suggested to me to have 1) a midface lift, 2) filler, 3) undereye implants & possibly cheek implants, 4) blepharoplasty. I recently had filler treatment in Korea, but the doctor didn't seem to know what he was doing; he placed soft filler in my undereyes (the hollows are still there, unchanged), and put soft filler around the nasolabial fold itself, making it more severe by adding volume above it. I thought state of the art is to add volume to the upper midface to lift the nasolabial fold, but maybe they don't do that in Korea. Another doctor recommended hard filler placed directly on infraorbital and zygomatic, to lift the midface and make the undereye hollows go away, which honestly sounds like the better plan to me. Long term, I'd like a definite solution for this. So what would be the best solution short and long term here? Can I just get filler for now? Long term, blepharoplasty, midface lift, implants, a combination of two, or all three?

Anna Chacon, MD, FAAD · Answer

Thank you for your detailed message and photos. At age 36, it’s common to begin noticing structural changes in the midface, including volume loss, descent of the malar fat pads, undereye hollowing (tear troughs), and early formation of nasolabial folds. Your observations are accurate, and it’s good that you’re considering both short- and long-term options.

Short-Term (Non-Surgical) Options:
Strategic Filler Placement
Yes, filler can absolutely help in the short term — but placement and type are critical. Soft filler directly in the tear troughs can often migrate or fail to address the root cause, especially if midface volume is not first restored.

Harder fillers (like calcium hydroxylapatite or cohesive HA) placed along the zygomatic arch and infraorbital rim can provide foundational support and lift, helping to reduce the appearance of tear troughs and nasolabial folds.

Volume should be restored in the malar and submalar regions before addressing the tear troughs directly.

Avoid overfilling the nasolabial folds — it's typically more effective to correct volume loss above them to reduce the fold’s appearance naturally.

Biostimulatory Injectables (e.g., Sculptra, Radiesse)
These can promote collagen production and improve facial structure over time without overloading the face with filler.

Skin Quality Treatments
Microneedling, radiofrequency, or PRP may help with skin firmness and texture in the midface, supporting the overall aesthetic improvement.

Long-Term (Surgical) Options:
Lower Blepharoplasty
For fat herniation under the eyes (the “purple bulges”), a transconjunctival blepharoplasty can remove or reposition the fat pads, especially if conservative filler no longer helps or contributes to puffiness.

Midface Lift
This surgically repositions the descended fat pads and soft tissue, restoring youthful contours. It's particularly beneficial if there’s sagging and not just volume loss.

Implants (Cheek and Infraorbital)
These offer a permanent structural solution, especially if your bone structure is naturally flat or has diminished with age. Infraorbital implants can support the tear troughs, and cheek implants can restore projection.

Ideal Approach:
Now: Correct filler placement — volumizing the midface using firmer filler in structural areas (zygoma, infraorbital rim), avoiding direct tear trough injections unless absolutely needed afterward.

Later: If filler is insufficient or results plateau, a combination of lower blepharoplasty + midface lift is often ideal for addressing both volume descent and puffiness.

Implants are considered in more severe cases or when a permanent solution is desired, though they carry risks and require careful planning.

Summary:
Yes, you can use filler now — but placement and technique matter.

Long term: a customized surgical plan (possibly a lower blepharoplasty + midface lift) may offer the most definitive and natural-looking result.

Avoid repetitive dissoling/filling cycles — they can stretch tissue and degrade results over time.

You're thinking about this in the right way, and the key will be finding a provider experienced in male facial anatomy and midface rejuvenation — whether non-surgical or surgical.

Male, 36. What to do about my midface volume loss and descent? (Photos)

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Male, 36. What to do about my midface volume loss and descent? (Photos)

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