In the course of aging, loss of fat volume generally leads to a hollow-looking face with sunken eyes and flattened cheeks, all considered hallmarks of an aging face. Restoring a more youthful appearance cannot be accomplished simply by lifting sagging soft tissue structures; rather, it has to be complemented with restoration of lost volume. To properly accomplish such a restoration, the physician must think in terms of three-dimensional shape and volume restoration of an aged-looking face. The combination of lost volume due to atrophic changes in fat and, to some extent, muscle and even bone tissue and loss of elasticity of the skin envelope and retaining ligaments of the face results in a typical sunken midface appearance, accented by facial lines, deep wrinkles, and creases. Recontouring the face in a well-planned, three-dimensional way, rather than just filling a line here and there, or haphazardly adding volume, can restore a natural appearance and actually provide a nice lifting effect for sagging skin. Essential to success is selecting the proper (injectable) filler (autologous fat or commercial products), the proper plane of injection (superficial or deep), and the proper amount of filler. Proper injection of filler in the deeper planes restores a naturally round contour. Dermal fillers, on the other hand, are best suited to minimizing superficial skin wrinkles and folds.

As with all aspects of aesthetic facial surgery, facial rejuvenation starts with proper patient evaluation, followed by explanation of the findings and proposed solutions.