Dermal Fillers for Mature Skin: How Treatment Approaches Change With Age

The way we approach facial aesthetics changes significantly as the face matures. Dermal fillers remain a cornerstone treatment for restoring volume and supporting structure, but what is appropriate for someone in their 30s can be entirely unsuitable for someone in their 60s. To achieve safe, natural outcomes, practitioners must understand the underlying anatomical changes of ageing and adapt their techniques accordingly.

The Science of Facial Ageing

Facial ageing is a multi-dimensional process, affecting every layer of the face:

• Skin: Collagen production declines by approximately 1% per year from the mid-20s [1]. Hyaluronic acid levels also fall, contributing to dryness, thinning, and wrinkling [2].

• Fat Compartments: Facial fat exists in distinct deep and superficial compartments, which shift, shrink, or hypertrophy at different rates [3]. Midface deflation is particularly noticeable, contributing to hollows and folds.

• Muscles: With age, repetitive contraction combined with skin changes etches dynamic lines into static wrinkles. Meanwhile, muscle tone can reduce, further exaggerating sagging.

• Skeletal Support: Perhaps the most underappreciated factor : bone resorption of the maxilla, mandible, and orbital rim reduces the structural frame of the face. This leads to loss of projection in the midface, widening of the orbital aperture, and retrusion of the jawline [4].

Ageing, therefore, is not simply “skin deep.” Effective use of dermal fillers requires a layered approach, tailored to these anatomical shifts.

Treatment Priorities by Age Group

Patients in Their 30s and Early 40s: Refinement and Prevention

At this stage, most patients have only early signs of volume loss. Treatments are generally light and focus on enhancement and subtle correction:

• Cheek augmentation: Restoring early midface volume loss prevents shadows and deepening nasolabial folds.

• Lip definition: Enhancing vermilion border or restoring lost hydration and early volume loss, always keeping natural proportions.

• Lower face contouring: Early jawline or chin definition to maintain harmony.

• Line softening: Treating early static lines with micro-aliquots of filler rather than “filling creases.”

Here, fillers are often combined with skin boosters or medical-grade skincare to optimise skin health, since the skin is still relatively resilient.

Patients in Their 40s and 50s: Restoration of Support

By this stage, midface descent, fat compartment changes, and skeletal resorption are more visible. The goal shifts towards restoring foundation and harmony:

• Midface volume restoration: Strategic placement in the deep medial cheek fat and along the zygomatic arch to restore tissues, indirectly improving nasolabial folds and marionette lines through improving facial balanace and harmony [5].

• Temples: Volume restoration here can rebalance the upper face and reduce lateral brow hollowing.

• Perioral region: Fine perioral lines may emerge, requiring subtle filler, but chasing lines directly should be avoided. Instead, support lips and chin, and focus on improving skin quality with techniques such as microneedling, skin boosters, peels, and medical grade skincare.

• Jawline and chin: Restoring mandibular volume and projection helps balance lower-face heaviness.

The principle is to rebuild structure, not to chase individual lines.

Patients in Their 60s and Beyond: Balance, Caution, and Combination

In later decades, volume loss is more advanced, tissues are thinner, and skin laxity is more pronounced. Fillers remain useful but must be applied with great care:

• Foundational support first: Restoring projection in the maxilla, chin, and jawline creates a scaffold that helps reposition tissue naturally.

• Avoid overfilling: Mature skin can appear heavy and unnatural if excessive filler is used, leading to “pillow face.”

• Complementary treatments: Combining filler with skin boosters, biostimulators (e.g. Profhilo, polynucleotides), and collagen-stimulating treatments often gives more natural results than filler alone.

• Individualised dosing: Older patients often require less per injection site but across multiple sites to achieve balance.

Sometimes, the best recommendation may be a combination plan or advising against filler altogether if it would not provide a natural result.

Why Less Is More

One of the biggest risks with treating mature faces is overcorrection. Overfilling:

• Distorts natural anatomy

• Adds heaviness to tissues already affected by gravity

• Creates the stereotypical “done” look that many patients fear

True artistry in aesthetics lies in restraint-knowing when not to add more filler, and when to consider skin treatments, energy devices, or even referral for surgical opinion if appropriate.

Evidence-Based Principles for Practitioners

• Layered approach: Treating bone, deep fat, superficial fat, and skin in sequence gives the most natural result [6].

• Anatomical knowledge: Understanding fat compartments and vascular landmarks reduces risk and improves outcomes [7].

• Individualisation: Each patient ages differently; chronological age is less important than biological age and lifestyle factors.

• Combination therapy: Filler is not the answer to every concern — addressing skin quality and elasticity is equally important.

Conclusion

Dermal fillers are a powerful tool for facial rejuvenation, but their role evolves with age. In younger patients, the focus is on refinement and prevention. In the 40s and 50s, it shifts to restoring lost support and harmony. In later decades, caution, balance, and combination treatments are key.

Natural, ethical, and safe results come from respecting anatomy, treating conservatively, and tailoring every plan to the individual.

References

1. Shuster S, Black MM, McVitie E. (1975). The influence of age and sex on skin thickness, skin collagen and density. British Journal of Dermatology, 93(6), 639–643.

2. Papakonstantinou E, Roth M, Karakiulakis G. (2012). Hyaluronic acid: A key molecule in skin aging. Dermatoendocrinol., 4(3), 253–258.

3. Rohrich RJ, Pessa JE. (2007). The retaining system of the face: Histologic evaluation of the septal boundaries of the subcutaneous fat compartments. Plastic and Reconstructive Surgery, 119(6), 2219–2227.

4. Shaw RB Jr, Kahn DM. (2007). Aging of the midface bony elements: a three-dimensional computed tomographic study. Plastic and Reconstructive Surgery, 119(2), 675–681.

5. Lambros V. (2007). Observations on periorbital and midface aging. Plastic and Reconstructive Surgery, 120(5), 1367–1376.

6. Rohrich RJ, Ghavami A, Lemmon JA, Brown SA. (2009). The individualized components of facial aging: volumetric considerations. Plastic and Reconstructive Surgery, 123(4), 1057–1066.

7. Pessa JE, Rohrich RJ. (2012). Facial Topography: Clinical Anatomy of the Face. Plastic and Reconstructive Surgery, 129(5), 932e–939e.