My face has become extremely gaunt both with aging and weight loss - high, good cheekbones but no fat - what will help? (Photos)

Question

I’m 70. I’ve always had a thin face even when very overweight. I was considered attractive but now I look like a skull with skin on it. I just don’t know what to do. I’ve tried fillers like sculptra and it did nothing. I’m looking for some answers please

Lexie Wang, MD · Answer

You need volume. Everyone loses volume in their face as they age, and if you say that you've always had a thin face, then it may be even more exacerbated in you. The reason you looik like a skull with skin on it is because that's literally what you are right now, unless you put some volume in between. If sculptra and filler didn't work, then fat would be an option. My guess is you're a thin lady so fat harvest from you yourself may not be possible, but you could also look at options like alloclae/renuva.

Mert Sizmaz, MD · Answer

Thank you for sharing your concerns so openly.
At this stage, the issue is not only volume loss. Based on your description and photos, there is also significant skin laxity and deeper structural descent. In cases like yours, adding more filler alone is usually not sufficient. When excess skin and tissue descent are present, volume replacement without repositioning the deeper layers often gives limited improvement.
The most effective solution in this situation is a deep plane facelift. This technique addresses not only the skin but also the deeper support structures of the face. By repositioning the descended tissues and tightening excess skin, it restores contour in a more natural and lasting way. Volume can still be added in a conservative manner if needed, but structural repositioning is the key step.
A detailed evaluation is necessary to determine the exact plan, but in advanced facial thinning with laxity, surgical correction provides the most meaningful improvement.
I hope this gives you clearer direction as you consider your options.
Mert Sızmaz, MD

Anna Chacon, MD, FAAD · Answer

Hello,

Thank you for sharing your concerns and photos. I completely understand how distressing it can feel to see your face change, especially when it has always been naturally thin. Aging and weight loss can both contribute to a loss of facial fat, leaving the underlying bone structure more pronounced. This is very common, particularly in the midface and cheeks.

You mentioned having tried Sculptra without much effect. Sculptra works gradually to stimulate collagen, but it may not provide enough volume if there is significant fat loss. Other options to restore fullness might include:

Dermal fillers specifically for volume restoration in the cheeks and midface (different types or layering techniques can sometimes provide better results than prior attempts)

Fat grafting or autologous fat transfer, which uses your own body fat to restore volume in the face, giving a more natural and longer-lasting result

Skin tightening or supportive treatments (like radiofrequency or laser-based procedures) if skin laxity is also contributing to a gaunt appearance

Every face is different, and the key is finding a treatment plan that restores balance without looking overfilled. Even subtle changes can make a significant difference in softness and vitality.

I understand how frustrating it can feel to try treatments that don’t give the results you hoped for, but there are approaches that can help bring back a healthy, natural fullness.

Take care,
Dr. Anna Chacon

Rajaie Hazboun, MD, MBA · Answer

Hi 1travelbug, thank you for posting your question and pictures here!please take my answer as a personal opinion and not as medical advice since I am not privy to your medical history and I have not conducted a medical exam on you.you do have a great bone structure which helps as you already have well defined high cheeks and a nice jawline. Unfortunately with age you lose some volume in the face mainly around the cheek area and the facial tissues tend to descend. just purely based on your pictures a comprehensive approach will give you the best results , I would address all the issues for the best results but you don't have to , you can be as aggressive with the management as you want though the results might not be as dramatic if you opt for a less extensive solution.- for the volume loss component I understand that you have tried fillers and sculptra in the past but there are other options available , ideally fat grafting is the best option , it looks natural, it's your own tissue and it also improves the skin quality , if you don't have fat to harvest , you can discuss with your surgeon other options like fat matrix or cadaveric fat such as renuva.- skin quality , besides having a good skin regimen from retinols and other topical skin solutions you will likely benefit from a resurfacing procedure to improve on the fine lines this can range from chemical peels , to lasers ( such as Co2 lasers) to dermabrasion , once your surgeon examines you he/she will be able to recommend the best modality.- tissue droop/ptosis : this is best addressed with a facelift, possibly a ip lift as well , this will reposition the tissues back into a more youthful position , this will actually help a little with the volume issue as the droopy tissue that is no longer filling the desired areas will be lifted back to it's correct position , this will also improve the deep rhytids/wrinkles .I hope this helps, best of luck!

Citrus Aesthetics - San Diego · Answer

First, I want to acknowledge how vulnerable this feels. Significant weight loss combined with natural aging can absolutely create a more hollow, gaunt appearance, especially in patients who have always had a thinner facial structure with prominent cheekbones.
By our 60s and 70s, facial aging isn’t just about “loss of fat.” We also experience:
Loss of deep and superficial fat padsBone resorption (especially in the midface and jaw)Skin thinning and collagen lossLigament laxity and soft tissue descent
So when someone says they look like this it’s usually a structural issue not just a volume issue. That’s why a single-product solution like Sculptra may not create the visible change you were hoping for.
In cases like yours, I approach this with a multi-modality approach. That often includes:
Strategic structural support with hyaluronic acid filler in deeper planes to rebuild framework (not just surface plumping)Biostimulatory treatments (like Sculptra AND Radiesse or other collagen stimulators) when appropriate but placed correctly and layered over timeSkin quality treatments (laser, RF microneedling, or regenerative options) to address thinning and crepinessOccasionally neuromodulators to soften harsh shadows created by muscle pull
The key is sequencing and artistry. Overfilling can make a thin face look unnatural, so the goal isn’t “more filler.” It’s restoring structure, softening transitions, and rebuilding support in a way that still honors your natural bone structure.
At 70, you are absolutely still a candidate for meaningful improvement &mdash; but it must be done thoughtfully and gradually. A comprehensive in-person assessment is critical to evaluate skin thickness, bone structure, prior filler placement, and overall tissue health.
When done correctly with a multi-modality approach, we can soften the hollowed look and restore vitality not change your face, but bring back balance and harmony.
Aesthetic treatments should always be discussed with and performed by a trained, licensed, and medically certified aesthetic provider. The recommendations above are for educational purposes only and do not replace an in-person consultation, examination, or personalized medical advice.

My face has become extremely gaunt both with aging and weight loss - high, good cheekbones but no fat - what will help? (Photos)

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