Facial lipodystrophy: fat loss in the face
Quick facts
- Definition
- A change in how fat is distributed in the face; in the face it usually appears as loss (lipoatrophy).
- Most affected areas
- Cheeks, the cheekbone area, temples and the area around the eyes.
- Causes
- Aging, major weight loss, conditions associated with HIV and its treatment, autoimmune diseases and rare syndromes.
- Approaches mentioned
- Fillers, biostimulators and fat grafting, depending on the cause and on how stable the condition is.
- Relevance in HOF
- Requires investigating the cause before treating and planning volume in several areas.
Facial lipodystrophy is a change in how fat is distributed in the face. In practice, the form most often seen in the face is lipoatrophy: volume loss in the fat compartments of the cheeks, temples and eye area, which leaves the face hollow with prominent bone contours. It can be part of aging or a sign of specific conditions, which is why the cause matters as much as the volume lost.
What causes fat loss in the face?
| Cause | What to look for |
|---|---|
| Aging | Gradual loss and descent of the fat compartments, along with bone remodeling |
| Major weight loss | Rapid facial volume loss after dieting, bariatric surgery or weight-loss medications |
| Conditions associated with HIV | Facial lipoatrophy was described mostly with older antiretrovirals; follow-up belongs to the treating physician |
| Autoimmune diseases | Some forms of lupus and localized scleroderma can cause fat loss in areas of the face |
| Progressive facial hemiatrophy | Loss of tissue on one side of the face, a rare condition requiring medical follow-up |
| Rare genetic and acquired lipodystrophies | Fat loss in characteristic patterns, sometimes with metabolic changes |
| Injected corticosteroid | Localized sunken area at the injection site |
Medications named as a cause should be discussed with the patient's physician. It is not the HOF professional's place to stop or change a treatment.
Why does it matter in HOF?
- Investigate before treating: unexplained, rapid or asymmetric volume loss calls for a medical assessment. The medical history should cover weight, diseases, medications and how long it has been developing.
- Planning across several areas: lipoatrophy rarely stays in one spot. The cheekbone area, temples, cheek and periorbital area are usually treated together. The topic is covered in facial volume loss after weight loss.
- Choice of material: volumization with hyaluronic acid, biostimulators and fat grafting are the approaches most often mentioned. The stability of the condition and skin quality weigh on the choice.
- Autoimmune diseases: call for extra care when indicating fillers, as covered in autoimmune diseases and fillers.
How does it show up in the assessment?
- Sunken temples: the orbital rim and the zygomatic arch become prominent.
- Hollow cheek: a depression below the cheekbone, with a shadow on the lateral face.
- Periorbital area: a deeper-set eye and a more pronounced tear trough.
- Asymmetry: greater loss on one side suggests a localized cause and calls for investigation.
- Old photos: help show how fast the change happened.
Also called: facial lipoatrophy, facial fat loss, hollow face.
Frequently asked questions
What is facial lipodystrophy?
It is a change in the fat of the face, usually with volume loss in the cheeks, temples and around the eyes, which leaves the face looking hollow. It may be linked to aging, to major weight loss or to specific diseases and treatments.
Can fat loss in the face be treated?
Volume is usually restored with fillers, biostimulators or fat grafting, at the discretion of the qualified professional. First, it is important to understand the cause and whether the condition is stable, because that changes the indication and how long results last.