Why filler goes in different places in your 30s and your 40s

When people ask me where I look first on a face, I tell them faces vary too much from person to person to simplify. But I have one rule: I first work out what structural support is lacking, then set priorities within a fixed amount of filler.

As we age, the facial bones are resorbed, the deep layer of fat under the skin shrinks, the skin loses elasticity so the shallow layer of fat sags, and the muscles weaken and stretch. As a result, the “inverted triangle” of a young face, fuller at the cheeks and narrower at the jaw, turns into a triangle.

That’s why filler goes in different places in your 30s and your 40s. When filler is placed in the right spots, where support has weakened, it reinforces support and volume and restores tension to the muscles, and this can bring the face back to an inverted-triangle shape. The result is different from filling whatever looks hollow at the time.

It’s also why I say a face is about harmony, not close-ups.

Here is what the research shows. The places where bone shrinks with age are well defined. According to a 2012 review, the upper jaw (maxilla) in the middle of the face and the area beside the nose, the upper inner and lower outer parts of the bony eye socket, and the area beside the chin shrink in a set, predictable pattern. A study comparing CT scans of 60 people also found that with age, the angle of the upper jaw became smaller and the bony opening beside the nose became wider. Fat shifts too. In a 2012 study comparing CT scans of 12 cadaver heads, the cheek fat compartments in the older group had moved downward, and the deep cheek fat had shrunk.

Because the areas that lose volume differ with age, the areas to fill should differ too. Saying that an inverted triangle turns into a triangle is a simple way to picture these changes. However, most of these studies were done in Western populations, and individuals vary widely.