How do I best address the loss of volume in my face? (Photo)

I'm 44 and concerned about how my face is beginning to look aged. I'm considering getting Juvederm Voluma in my cheeks and around my mouth. I'm also concerned with the dark circles under my eyes. With all of the options available, I want to make sure I'm making the best decision (financially and results wise). I'm also curious about how much I'm probably looking at spending. Thanks in advance for your advice and insights!

Doctor Answers 13

Volume Loss Of the Face

Volume loss of the face can make a person look older than they would like, or even result in a tired appearance. Depending on the area of volume loss and patient preference, either Voluma, a long term but temporary filler, of structural fat grafting, a permanent solution can create a natural, youthful result. However, if over-filled, or placed in the wrong area, the result can look over filled and unnatural. Look for a plastic surgery practice that performs a lot of fat grafting and voluma treatments and has many examples of their results.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

See the Best Filler Specialist

I suggest you do a lot of research in your area and find the best dermatologist or plastic surgeon who will advise. you -- not the most "famous" and not necessarily the one running bargain basement specials in every newspaper.  Ask friend.  Ask your doctor.  And then visit them and trust your gut.   An experienced practitioner can do more fill with less material and cost.

Michael A. Greenberg, MD
Elk Grove Village Dermatologist
4.9 out of 5 stars 17 reviews

Volume loss in the 40s!

It is not unusual for volume loss to accelerate during perimenopause and menopause.  Our bodies slow down collagen production drastically. Based on your pictures, you can definitely use some volume replacement in the mid face region.  If mid face is corrected, up you may not require any fillers for lower face.  Voluma is a great product for a lift and to reduce jowls. It is also a great filler for cheek enhancement. But it is not the appropriate one for the tear trough area.  When I treat my patients, I prefer a filler such as Voluma to help lift.  But for longevity, I have been using Bellafill, a collagen filler which lasts closer to 5 years for cheeks and tear trough.   Realistically, you continue to lose volume everyday.  So the volume put in will stay put for "x" amounts of years based on product.  But because volume loss happens everyday, a touch up filler should still be considered periodically.    If you require 2-4 syringes up front, then you are looking at a cost of $1200-2200.     I hope that helps!

Falguni Patel, MD, FACOG
Colts Neck OB/GYN
4.9 out of 5 stars 35 reviews

Voluma for mid face volume and fat loss often rejuvenates my NYC patients' face quickly and provides a natural appearance

Once the mid cheek loses its round convex surface and it plateaus and then indents, even a little, light does not bounce off the cheek as much and this hollowness creates a dull appearance. As soon as Voluma,  fat injections, or Radiesse is injected and the apple of the cheek expands ever so slightly, the refreshed appearance is realized often. In fact, many times, the smile creases no longer concern the patient once they see the more "healthy and vibrant" face from having the cheek prominence improved.  ( I usually say that babies have deep smile folds but cherubic cheeks and no one says babies look old !) The cheek bone may need to be addressed in some patients which may help raise the jowl slightly. In other patients the smile folds, and marionette lines are treated along with the angles of the corners of their mouth.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Voluma and Volume Replacment

I would definitely consider Voluma in the cheek area to replace lost volume.  It is an idea product and if you consult an expert you should have beautiful results.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Best Options to Restore Lost Facial Volume

The face will lose volume overtime. The loss of volume will cause:

  • 1)Loss of height and definition in cheeks
  • 2)Narrowing of the upper 1/3 of face
  • 3)Decent of facial tissue
  • 4)Irregularities of jawline
  • 5)Thinning of lips
  • 6)Change the overall balance of the face from and upside down egg to an oval shape
The addition of volume is best used to restore the balance, height and 3D definition to the face. This is the true art of facial fillers.

Volume can be added by 3 ways:

1)  Injectable fillers in the office
2)  Facial fat grafting
3)  Facial implants

Each of these options has their pros and cons.  Generally speaking, surgical options are more cost effective over the long term secondary to their longevity, but injectables are more affordable in the short term.  

I hope this helps  

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

How do I best address the loss of volume in my face?

From your photo, I believe you would be a good candidate for Voluma injections over the zygomatic arch and cheeks.  For the corners of the mouth and nasolabial folds, Juvederm Ultra plus XC would be a good option.  2 syringes of each product should suffice.  The cost of the 4 syringes should be approximately $3,000 to $3,500.  For the lower eyelids the options can include injectable fillers such as Restylane or a lower eyelid blepharoplasty.  Of the two, the blepharoplasty will give you the better and longer result.  Best wishes, Dr. Lepore.  

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.8 out of 5 stars 56 reviews

Volume Loss

Thanks your for your question and photo
Midface volume loss is a common early sign gof aging and probably starts in our mid to late 30's. Fillers are a great option to address these changes and Volume is certainly a great choice. I would start of conservatively using 2 or 3 syringes and then re-evalaute in ~6 months to perhaps add more at that time. Subsequent treatments will get spread further apart as the products do build up and you get some collagen deposition as well. It looks like you could benefit from a small amount of filler, after the cheeks are reflated, in the nasolabioal folds. Juvederm plus or Restylane Lyft are both excellent products for this area.
Often the changes under the eyes, in the tear trough area, can be improved with correction of the cheeks. If you don't feel this area has been improved enough then very conservative amounts of Restylane Silk can soften these changes
Best of Luck

Lee A. Gibstein, MD
Miami Plastic Surgeon

Facial volume loss

Great question and thanks for your pictures. You have volume loss in your cheeks and under eye area that has caused some sagging in your mid face. Replacing volume is the best option for you. Injectable fillers are what you will need and plan on using 2-4 syringes to achieve the best results- and the more you use, the longer the fillers should last- which is 1-2 years.  Voluma is great for the cheek areas to 'reinflate' them and I prefer belotero under the eyes. This combination of fillers will do the best. 

Other filler options include facial fat transfer- its a 'more permanent' option , however it does have more down time after.

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

How do I best address the loss of volume in my face?

Thank you for your question and for sharing your photographs.  When discussing non-surgical facial rejuvenation I recommend a top down approach, addressing the cheeks before the lower face.  When the cheeks are addressed the smile lines around the mouth, jowling, and lower eye areas can all be positively impacted.  As your pictures demonstrate mid-face/cheek descent Voluma can help lift this tissue supplying a good bang for the buck. Pricing will vary across the country, but anticipate 750-2000 depending on the amount used.  Be sure to see a board certified plastic surgeon in consultation. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 65 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.