Age 36, female - Volume loss in face (photo)

Question

I'm starting to notice facial volume loss, particularly in my cheeks, which is making my nasolabial folds appear deeper. I've always been a thin runner which served me well in my 20's but as a 36F, I think I'm starting to look gaunt. I’m looking for a natural-looking, cost effective treatment option. Should I consider cheek filler, direct nasolabial fold filler, or something else? What will give me lift without looking weird?

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concerns about facial volume loss. Here are some options to consider for achieving a natural-looking result:

Cheek Fillers: Adding volume to your cheeks with dermal fillers can help lift the mid-face area, which may, in turn, soften the appearance of nasolabial folds. This approach often provides a more youthful contour and can look very natural when done by an experienced injector.

Nasolabial Fold Fillers: Directly addressing the nasolabial folds with fillers can also be effective. However, focusing solely on this area without addressing overall mid-face volume loss might not achieve the most balanced result.

Combination Approach: Often, a combination of cheek fillers and nasolabial fold fillers can provide a harmonious and natural appearance. This approach allows for both lifting and smoothing effects.

Other Options: Consider non-invasive treatments like Sculptra, which stimulates collagen production for gradual volume restoration. Another option could be skin tightening treatments like radiofrequency or ultrasound-based therapies, which can improve skin elasticity and support overall facial structure.

Consultation: I recommend consulting with a board-certified dermatologist or plastic surgeon to discuss your goals and evaluate your facial anatomy. They can provide a personalized treatment plan that aligns with your aesthetic desires and budget.

I hope this helps guide you towards a suitable treatment option.

Anna Petropoulos, MD, FRCS · Answer

Hello and thank you for your question! It’s very common to start noticing volume loss in the mid-face by your mid-30s, especially if you’ve always had a lean build. This loss in cheek volume can make features like nasolabial folds look deeper, even if the skin itself hasn’t changed much. For a natural-looking result, there are a few good options:

1. Cheek filler (like hyaluronic acid-based products) helps restore volume where it's been lost, which can subtly lift the mid-face and soften nasolabial folds indirectly. It's a great choice if you're looking for immediate results with minimal downtime.
2. Sculptra, a biostimulatory injectable, works gradually over several months to stimulate your own collagen production. It’s ideal if you want a more natural, gradual improvement and longer-lasting results (often 2+ years), though it may require multiple sessions.
3. Direct nasolabial fold filler is sometimes used, but it tends to be less effective alone if the folds are due to mid-face volume loss. It’s best used in combination with cheek support or for fine-tuning. From the photos you provided, I do not believe this option would be the solution.

For lift and a natural look, starting with cheek (and temple!) enhancement—whether via filler or Sculptra—is often the most balanced, youthful approach. A consultation with a skilled injector can help tailor the choice to your facial structure and goals.

Best of luck!

Genie Alexander, RN BSN 
for Anna Petropoulos, MD FRCS 
Center for Classic Beauty
Boston & Danvers, MA

Michael A. Persky, MD · Answer

Hello Angie,
You are an excellent candidate for biogenerative volume replacement.  The most important aspect of your treatment as with any aesthetic treatment is to choose your treating physician very carefully based on their experience, skill, knowledge, results, and natural artistic vision.  I love treating patients with your facial volume loss with Sculptra which works by gradually stimulating your body to produce collagen and connective tissue.  I would begin with a "foundational" treatment under your muscle, over your facial bones stratigically to support your overlying tissues.  Two months later we would reassess your face and add more Sculptra where needed.  You likely would have two treatment sessions of two vials of Sculptra to achieve correction.  After that once a year maintenance may or may not be beneficial.  I would not recommend any direct filling of your nasolabial folds as that will make your lower face appear heavy and unnatural.  Feel free to contact me with any further questions or concerns.  Good luck and be well.
Michael Persky, MD
Encino, CA

Age 36, female - Volume loss in face (photo)

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Age 36, female - Volume loss in face (photo)

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Everything you need to know about Cheek Fillers

Our mission is to create a world where every investment in modern beauty is Worth It.