Beyond “Volume Loss”
It’s common to hear that facial aging is caused by “volume loss.” This is partially true, but dramatically simplified. The reality is more complex — and understanding it makes the difference between effective treatment and artificial results. Facial fat is organized into distinct compartments, separated by fibrous septa. Each compartment ages differently: some atrophy (lose volume), others descend by gravity (ptosis), and some herniate through weakened structures.
“The most common mistake is treating all facial aging as ‘lack of volume’. Sometimes the problem isn’t lack — it’s that the volume is in the wrong place.”
- — Dr. Robério Brandão
The Main Compartments
Location: With aging: )) }
Deflation vs Ptosis: Crucial Distinction
Deflation (Atrophy)
Fat actually decreases in volume. The compartment “empties”.
- • Hollow temples
- • Tear troughs from SOOF loss
- • Flattened cheekbones Treatment: Volume replacement
Ptosis (Descent)
Fat didn’t disappear — it descended to a lower position.
- • Deep nasolabial fold
- • Jowl
- • Marionette lines Treatment: Repositioning (lifting)
⚠️ Common Error
Treating ptosis with filler. If malar fat descended (creating deep nasolabial fold), adding more volume doesn’t solve it — just creates a “swollen” face that still looks aged. The correct approach is to reposition (elevate) the ptosed fat.
Treatment Implications
Endomidface
Repositions ptosed malar fat back to youthful position over the zygoma. Corrects the cause of nasolabial fold, not just camouflages it.
Selective Filling
Ideal for compartments that truly atrophied: temples, medial periorbital region, lips. Small volumes, precisely positioned.
Combined Approach
Often the ideal: lifting to reposition ptosis + selective filling to replace volume in areas of true atrophy.
Frequently Asked Questions
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