How Should We Address a Hollow Face vs. a Sagging Face?

Hello. This is Dr. Jo Hyun-woo of Iptae Plastic Surgery.

Today, I’d like to talk about hollow faces and sagging faces.

When it comes to contour surgery, these are also among the questions patients ask most often: hollow faces and sagging faces.

As people age, they often ask, “My face has become hollow—what should I do?” or “My skin has sagged—what should I do?”

So why do hollow faces and sagging faces happen?

To give the short answer, both are natural facial changes that come with aging.

It is a somewhat unusual illustration, but it shows the facial changes that occur with aging.

As we get older, the skin not only sags downward due to gravity, but it can also become hollow as fat is absorbed.

Another surprising fact is that the bones also shift slightly downward, and some areas undergo resorption.

In the bone illustration, the areas marked in black are the regions where the most resorption occurs.

Hollow face

The figure above shows how facial hollowness develops.

As you move from your mid-30s to mid-50s, the fat shown in yellow decreases.

Can you see how the cheek fat that was once full when you were young gradually decreases? The fat in the eyebrows and temples is also decreasing.

As shown above, a hollow face is a natural change that comes with aging.

So why does a sagging face occur?

Sagging face

As we age, this fat decreases and the volume of the bones also decreases. Just as air escaping from a full balloon makes the outside wrinkled, our skin also begins to sag downward due to gravity.

Of course, as the SMS layer of muscles that surrounds the face loosens and sags, the skin also becomes stretched and droops along with it.

This is how the face becomes sagging and hollow with aging.

As we have seen so far, hollow faces and sagging faces are connected in terms of why and how they occur, but there are various ways to address each one.

If you simply perform surgery to lift up loose skin in order to address aging, you cannot restore the lost volume in hollow areas, so the face may still look aged. Likewise, if you only add volume to hollow areas, you cannot overcome the aged appearance caused by sagging skin.

In other words, a face does not show only hollowness or only sagging. To address aging, both issues must be treated at the same time.

The safest and easiest way to address a hollow face is fat grafting.

If you restore lost volume with fat grafting and address a sagging face with thread lifting or a facelift, you can achieve a more youthful appearance.

Of course, skin that has lost elasticity can also be improved with skin booster injections that strengthen the dermis.

When I consult with patients, I always say that the appearance of the face is not determined by bone alone, but by the combined result of fat, muscle, and skin. To address this, I tell them that multiple procedures may need to be performed together for an effective result.

The same applies to aging: do not think of a hollow face and a sagging face separately. If you decide on surgery by considering them together, you are more likely to achieve a more effective and satisfying result.

This has been Dr. Jo Hyun-woo. Thank you.