Facial volume loss is the gradual thinning of the fat, collagen and bone that support the face from underneath. It shows as flattened cheeks, hollowing under the eyes, deepening creases beside the mouth and a less defined jawline. It is assessed and treated at Coastal Dermatology + Aesthetics in San Luis Obispo.
A face empties before it falls
Underneath the skin, a face is built on layered pads of fat, a collagen framework and the bone beneath both. From roughly your late twenties onward, all three thin and shift. The pads get smaller and slide downward, the framework loosens, and the bone itself gradually recedes at the eye socket and the jaw. The skin has not necessarily changed at all. What changed is what it was draped over.
That is why the effect reads as tiredness rather than as age. A flat cheek casts a different shadow than a full one. A hollow at the eye socket reads as being run down. A crease beside the mouth deepens not because a line formed there but because the tissue above it has less to sit on.
The most useful thing on this page: the folds people most want treated are usually not lines. They are shadows, and a shadow does not respond to anything applied to the surface. That is the whole reason “I have tried everything for this line” is such a common sentence, and why the answer is often in a different layer entirely.
What people usually notice first
- Looking tired in photographs when they feel fine
- Cheeks that have flattened, so makeup sits differently than it used to
- A crease from nose to mouth that keeps deepening
- Under-eye hollows that no amount of concealer covers
- A jawline that has lost its edge without any weight gain
The creases people most want treated are usually shadows cast by lost support underneath, rather than lines in the skin. That is why surface treatment does not reach them, and why identifying it correctly changes the entire plan.
What causes it
Fat pads that shrink and move
The face is not one continuous layer of fat. It is a set of separate pads, and they do not empty evenly. Some shrink, some slide downward, and the boundaries between them become visible as creases. That uneven emptying is why a face can look hollow in one place and heavy in another at the same time.
Collagen and bone, both quietly receding
The collagen framework thins from your twenties onward, taking firmness with it. Less obviously, the bone itself changes: the eye socket widens and the jaw loses height over decades. That is a small change in absolute terms and a large one in how a face reads, because everything above it settles differently.
Sun, weight change and genetics
Years of sun accelerates the collagen side of it. Significant weight loss empties the face along with everything else, which is why people are often surprised by how their face looks after it. And how early and how much all of this shows is substantially inherited, which is why two people the same age can be in entirely different places.
Fat, collagen and bone all thin, and they do it at different rates in different faces. The plan depends on which layer has given way most, which is a judgment made in person rather than from a photograph.
Emptied, or actually loose? The two-finger check
These two look identical in a mirror and they need entirely different treatment. Getting it wrong is the most expensive mistake in this category, because replacing volume in a face that is actually loose does not fix it, and tightening skin over a face that has emptied does not either.
Sit in front of a mirror, place two fingers flat on your cheek just below the cheekbone, and lift the tissue gently upward and slightly outward. Then watch what happens to the crease beside your mouth and to the jawline.
| What you see when you lift | What it points at | What that means |
|---|---|---|
| The crease beside the mouth flattens out and the cheek looks full again | Volume loss. You have restored, with two fingers, roughly what support does | Replacing or stimulating support is the route, and it is what this page is about |
| The crease stays where it is but skin gathers in a fold above your fingers | Loose skin rather than emptiness, where the skin has more surface area than the frame under it | Tightening is the route, and filling would make the fold heavier |
| The crease stays and there is a fine etched line inside it that does not move | A line in the skin itself, which sits on top of whichever of the above you also have | Surface treatment is what reaches it, usually alongside one of the others |
| Lying flat on your back does most of what your fingers did | Gravity is doing the work, which usually means volume with some laxity | Both conversations, in an order decided in person |
Most faces show a mix, and the mix is the plan. What the check gives you is a much better first sentence at a consultation: “when I lift here, this flattens” tells a dermatologist more than any description of what bothers you.
Areas we treat
Cheeks
The first and largest change, and where restoring support does the most for the rest of the face
Under the eyes
Where hollowing reads as tiredness more than anywhere else
Temples
Rarely noticed by name and frequently part of why a face looks drawn
Nose to mouth
Where the deepening crease is a shadow rather than a line
Corners of the mouth
Where the downward turn comes from loss of support rather than expression
Jawline and chin
Where definition softens, and where bone change plays the biggest part
Backs of the hands
The one place off the face people ask about, and it is the same process
Always have had a great experience here.
The Coastal difference
Where the volume goes matters more than how much
The instinct with a hollow is to fill the hollow. Often the better answer is to restore support somewhere else entirely, because a face is a structure and the place that looks empty is not always the place that gave way. Rebuilding the cheek frequently softens the crease beside the mouth without anything being placed in the crease at all.
That judgment is the whole service. It is anatomy rather than product, and it is why the same materials produce a natural result in one pair of hands and an obvious one in another. A board-certified dermatologist deciding where and how much, with several materials available and no reason to prefer one, is a different consultation from a room that carries a single product. It is also why the honest answer here is sometimes that you need less than you came in expecting.
Restoring support in the right place often softens creases somewhere else without anything being placed in them. That judgment is the service. The material is just the material.
Is it right for you?
This is a good conversation to have if:
- You look tired in photographs when you feel fine
- The two-finger check above flattened a crease you have been trying to treat on the surface
- Your cheeks have flattened and makeup sits differently than it used to
- You have lost a significant amount of weight and your face went with it
- You have tried surface treatment on a fold and it did not reach
Worth knowing before you book:
- If lifting the skin produced a fold rather than a flattening, loose skin rather than emptiness is the conversation to have
- A fine etched line inside a crease is a line in the skin itself and needs its own treatment on top
- Restoring support and stimulating your own collagen work on different timescales, and plans often use both
Some people leave this consultation being told they need less than they expected, or need it somewhere other than where they thought. That is a normal outcome and it is worth the visit on its own.
Holding onto the result
Worth doing
- Broad spectrum sunscreen, SPF 30 or higher, water resistant, every day, because sun accelerates the collagen side of this [2]
- Come back on the interval you agreed rather than waiting for the result to disappear, which usually means less work
- Keep your weight reasonably steady if you can, since the face empties along with everything else
- Photograph yourself in the same light every few months, since the change is gradual enough to be invisible day to day
Worth knowing
- Results built on your own collagen arrive slowly and keep developing for months
- Your face carries on changing underneath any result, which is what maintenance is for
- Restoring support in one area sometimes changes how a neighboring area reads, which is why plans are staged rather than done all at once
- The most natural results are almost always the ones built gradually
Treatments we offer
Replacing support, and stimulating your own. Pick a treatment to see how it works.
What treatment costs
What a plan costs depends on which areas are being treated and which materials suit them, and that is worked out at the consultation. You get the plan and its cost before anything is booked.
What it is
Loss of the support underneath, rather than a change in the skin
What it looks like
Flatter cheeks, hollows, deepening creases and a softer jawline
The tell
Lifting the skin gently flattens the crease, because the crease is a shadow
Why it matters
Treating the surface does not reach a problem that sits underneath it
Facial volume loss frequently asked questions
How long the two-finger check above takes. Lift the cheek gently and watch the crease beside your mouth. If it flattens, it is volume. If skin gathers instead, it is a different conversation.
Offered at
Want to know which one you have? Request an appointment
Fill out the form below, book online in Santa Maria (opens online scheduler), or give us a call. Cosmetic and aesthetic appointments need no referral. For medical dermatology in San Luis Obispo, we are accepting new patients by referral from your primary care physician; send the referral across and then use the same form. In Santa Maria, medical appointments are available without a referral for PPO patients, and for HMO patients we are in-network with Santa Maria Physician's Choice.
A consultation fee of $125 is due at the time of booking.
Sources and medical review
1. American Academy of Dermatology Association. “Many ways to firm sagging skin.” States that non-surgical options give “modest lifting and tightening” and “still cannot give you the results of a surgical procedure like a facelift, eyelid surgery, or neck lift,” and that these treatments should be performed by a board-certified dermatologist. https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin · Medical Organization
2. American Academy of Dermatology Association. “How to select a sunscreen.” Broad spectrum, SPF 30 or higher, water resistant, reapplied every two hours outdoors and after swimming or sweating. https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen · Medical Organization
Content on this page is for educational purposes and is not a substitute for professional medical advice. The self-assessment described on this page narrows the possibilities and does not replace an examination. Results and how long they last vary by material, area, technique and individual anatomy. Injectable treatments carry risks including bruising, swelling, lumps, asymmetry and, rarely, vascular complications, all of which are discussed individually before anything is scheduled. Individual results may vary. A consultation fee of $125 is due at the time of booking.