Volume Loss & Structural Wrinkles
Volume-loss (atrophic or structural) wrinkles are deep grooves and hollows that form when the support structures beneath the skin shrink. Unlike dynamic wrinkles (caused by muscle movement) or static wrinkles (caused by broken-down dermal collagen), they reflect aging of the deep layers as a whole: resorption of the facial bones combined with thinning and downward shift of the deep fat pads.
As the bony anchor points (the lower orbital rim, the pyriform aperture beside the nose, the maxilla and the jaw angle) recede, the retaining ligaments that hold the facial soft tissues in place become lax. The overlying tissues lose their support and slide downward with gravity, creating large volume-loss folds such as the tear trough, nasolabial fold, marionette lines, temple hollowing and sunken cheeks.
At Haute-Derma, we treat volume-loss wrinkles on the principle of restoring the bony support, rebuilding the deep fat compartments and refining the skin surface—bringing back natural, youthful contours without distorting the face.
Causes and Anatomy of Deep-Layer Aging
The pattern of volume loss is shaped by two main anatomical changes:
- Age-Related Facial Bone Resorption:
- Lower orbital rim and maxilla: These recede backward, removing the platform under the orbicularis oculi muscle and the cheek fat, which deepens the tear trough and hollows the eyes.
- Pyriform aperture: Bone loss widens the opening beside the nose, so the base of the nostril sinks and the nasolabial fold deepens.
- Chin and jaw angle (mandible): Resorption of the chin blurs the jawline, producing marionette lines and sagging jowls.
- Deep Fat Pad Atrophy and Descent:
- Fixed deep fat compartments (such as the suborbicularis oculi fat, SOOF, and the deep medial cheek fat) lose a great deal of volume over time.
- Weakened ligaments (zygomatic cutaneous and masseteric ligaments) let the superficial fat slide down and gather above the nasolabial fold and along the jawline, sharpening the contrast between bulges (superficial fat) and hollows (receding bone).
Types of Facial Wrinkles by Anatomical Layer
| Volume-Loss Wrinkles | Dynamic Wrinkles | Static Wrinkles |
|---|---|---|
| Facial bone, deep fat pads, ligaments | Superficial muscles of expression | Epidermis and dermis (collagen/elastin) |
| Hollows, depressions, sunken tissue | Creases that appear when muscles contract | Fixed shallow-to-moderate lines and grooves |
| Tear trough, nasolabial fold, temple hollows, sunken cheeks | Forehead lines, frown lines, crow’s feet | Fine crow’s feet, fine lines across the face |
| Strongly affected (sags with age) | Not gravity-dependent | Partly gravity-dependent |
| Rebuilding support (biostimulators/fillers) | Botulinum toxin to relax muscles | Mesotherapy / fractional laser / skin boosters |
How We Assess Volume Loss at Haute-Derma
- 3D structural analysis and the Merz volume-loss scale: We grade volume loss (from grade 1, mild hollowing, to grade 4, severe bone loss and deep fat descent) in the temples, mid-cheeks, nasolabial folds and jawline.
- Dynamic vector test: The doctor gently lifts the cheek tissue at a 45-degree angle toward the tragus to judge how much volume is truly missing at the bone compared with how much the superficial fat has sagged.
- Anatomical cannula mapping: We determine the exact injection depth (bone versus dermis) to stay clear of major vessels such as the facial artery and superficial temporal artery.
Multilayer Volume Restoration at Haute-Derma
Treating volume-loss wrinkles properly calls for a combined, layer-by-layer medical approach:
- Deep structural augmentation: Subperiosteal injection of new-generation collagen stimulators—PLLA (poly-L-lactic acid) or CaHA (calcium hydroxylapatite)—or a high-G-prime HA filler. The goal is to rebuild a firm platform in place of the lost bone and support all the soft tissue above it.
- Anchoring and SMAS vector lifting: Barbed absorbable threads (PDO/PCL thread lifting) placed in the SMAS layer for patients whose superficial fat has sagged heavily into the nasolabial fold and jawline.
- Surface refinement and dermal thickening: Microdroplet mesotherapy with polynucleotides (PDRN) and soft, flexible HA in the superficial dermis smooths out any fine lines that remain on the surface.
