Volume loss and a bloated look when smiling. What has happened to my face and what will help? (Photos)

I recommend 1 syringe of Voluma on each side of the upper face and 1 syringe of Volux on each side of the lower face to create a more harmonious facial appearance.

It’s possible that your facial changes are related to a combination of natural aging, soft tissue redistribution, and potentially some fat loss from radiofrequency microneedling (Morpheus8) — especially if treatments were aggressive or done over thin areas. This can make the face appear more hollow at rest but paradoxically puffier or bloated when smiling, as underlying muscles and remaining fat shift differently.

Treatment depends on what’s most prominent: if volume loss is key, hyaluronic acid fillers or biostimulatory fillers (like Sculptra or Radiesse) can help restore balance. If skin laxity contributes, non-invasive tightening or collagen-stimulating treatments (in moderation) can be beneficial. Good skincare, hydration, and avoiding further fat-melting procedures are also important.

For the most accurate plan, consult an experienced board-certified dermatologist or facial plastic surgeon who can assess your facial anatomy in person and recommend a customized approach.

I would not be at all surprised if your prior treatments with RF energy has contributed to the volume loss in the face. I always discourage younger patients from having such treatments. My personal opinion is that no one should do Morpheus eight as it does resolve in volume loss, especially when done by an individual with little understanding of how the procedure works. My advice to you is undergo fat grafting, which can in the right hands create absolutely beautiful, natural and practically permanent results. I hope this helps and good luck from Leonard Grossman MD organic Plastic Surgery New York City.