Why weight loss makes your face look older

When it comes your face, thin looks older

You are doing everything right- you exercise, you eat a healthy diet, but your face is starting to look older and more tired.  Or, you’ve lost 20 pounds because you wanted to be more fit, but your eyes and cheeks are looking more sunken.

I hear this story all the time.  It’s unfortunate but true: round, full faces tend to look younger.

The baby face

When we are born, we have round, chubby faces.  Our cheeks are smooth and plump and there is nary a line to be seen.  After our 20’s, we begin to lose fat in our faces.  The fat cells shrink, or atrophy and the result is a more aged-looking face.  Shadows under the eyes (nasojugal folds), creases next to the nose (nasolabial folds), and wrinkles at the corners of the mouth (marionette lines) all start to appear.  Cheeks and temples start to sink.  And it happens to some of us more than others.

After massive weight loss

We naturally lose facial fat over many years, gradually.  But some will rapidly lose a dramatic amount of weight through bariatric surgery (lap band, gastric sleeve, etc.) or major lifestyle changes.  The massive weight loss population often sees a dramatic change in facial features and can see an accelerated process of aging when looking in the mirror.

This person below lost approximately 100 pounds in about a years time through diet and exercise alone. You’ll notice substantial aging changes: a sagging neck, more wrinkles around the eyes, forehead, lips, and next to the nose, and an overall deflated look. She is definitely healthier for having lost the weight, but the older appearance is a trade-off.

bariatric wrinkles









Fixing the effects of deflation

To counteract deflation from weight loss, the face can be re-filled.  The two best options to put back what was lost are

1. Filler injections – soft, biocompatible substances are placed under the skin to add volume.  These can include Restylane, Perlane, Juvederm, Juvederm Voluma, Radiesse, and Sculptra.  Of these, Juvderm Voluma, Perlane and Sculptra last the longest.  The procedure consists of an office visit and several pinches from the injections.  Downtime is minimal in most cases and results last from 1-3 years depending on the filler used (Sculptra can last more than 2 years but it is limited to cheek and temples mostly).

2. Fat injections – Your own fat is suctioned from one part of your body, like your waist or thighs and it is layered under the skin of the face.  The results are not always as predictable as fillers and there is some more downtime- usually 1-2 weeks of swelling and bruising.  But the results can last for many years, possibly permanent.

Below is an example of subtle rejuvenation via cheek volumization using Sculptra filler. Sculptra is very popular here in NY because it doesn’t require a long period of downtime and it is long-lasting.  Fat injections are more popular when other surgery is being done at the same time (e.g. eyelid lift, facelift, brow lift).

Sculptra NYC

Sculptra to cheeks





So should I get fat to look younger?

I have heard of people doing this, but you’re better off being healthy and thinner.  You can always visit a expert injector (I offer consultations in NYC) to add a youthful fullness back to your face without looking unnatural.  Ask to see before and after photos of other patients so you know that your doctor has similar aesthetic ideals.




Brett Kotlus, M.D.

135 E. 71 street

Phone: 212-882-1011