In short. The cases where the problem is not volume at all, including tissue descent, skin laxity and active skin disease, and what those problems need instead.

Key points

  • Skin that has lost elasticity crepes, marks easily and no longer springs back.
  • Adding volume beneath it does not change that, and in thin lax skin volume can be visible rather than supportive.
  • Laxity belongs to skin treatments or to an operation, depending on how far it has gone, and not to either material here.

Both materials on this site add or rebuild volume, and there are faces for which that is not the problem. Those cases are set out here, because a patient offered an injectable for a finding it does not address has been offered the wrong treatment rather than a smaller one.

Descent, which is positional

A face that has descended looks lower rather than flatter: the mid-face has slid downwards, the jawline has softened, and a jowl sits beside the chin. Neither material repositions tissue, and adding volume to a descended face tends to make it heavier rather than higher. The treatment for descent is an operation, and an injectable delays the assessment rather than the need for it.

Laxity, which is a skin problem

Skin that has lost elasticity crepes, marks easily and no longer springs back. Adding volume beneath it does not change that, and in thin lax skin volume can be visible rather than supportive. Laxity belongs to skin treatments or to an operation, depending on how far it has gone, and not to either material here.

Weight that is still changing

Weight change alters facial volume, and a plan made while it is still changing is a plan made against a moving shape. The material placed at one weight may look wrong at another, and the areas that need treating may not be the same ones a few months later. Most clinicians ask that weight be stable before either material is used, which is a condition of planning rather than a refusal.

Skin that is inflamed, infected or has reacted before

An active skin condition, an infection in the area, or a previous reaction to an injectable are all reasons to wait or to choose something else. The assessment establishes what the previous reaction was and whether the same class of material can be used. Treating through inflammation risks a poor result and a complication, and a history of reaction needs to be understood rather than worked around.

Where the problem is something else entirely

Some complaints that arrive as volume loss are not volume loss. A face that looks drawn may follow weight loss that is still ongoing, a medical condition, or a change in the teeth and jaw that alters the lower face. A patient whose concern is the shape of the jaw or chin may need an assessment of bone rather than of soft tissue. Naming what is present is more useful than treating the area the patient pointed at.

When neither material is the answer

  • The change is descent or laxity rather than volume, and neither material repositions tissue or removes skin.
  • Weight has not settled, so nothing placed now could be judged fairly against a stable face.
  • Skin in the area is inflamed or infected, or a previous injectable has caused a reaction.

None of this closes the door permanently, and each resolves or is assessed in its own right. What matters is that the material matches the finding rather than the other way round. The skin laxity pages cover one of those findings, the facial volume loss pages cover another, and fat transfer is a third route.

Related reading

Frequently asked questions

How do I know if my problem is volume at all?

Volume loss makes a face look flatter: the temples and cheeks hollow, the skin thins, and the shape reads as drawn rather than as low. Descent makes it look lower: the cheek has moved down, a jowl has formed and the jawline has lost its edge. Laxity is a change in the skin itself. Both materials here add or rebuild volume, and neither repositions tissue or removes skin, so descent and laxity belong somewhere else.

Can filler be used to lift a descended cheek?

It can add volume to the area, and sometimes that makes the face look better, but it does not reposition anything. Placing volume into a face whose tissue has descended tends to make it heavier rather than higher, and it does not address the jowl or the jawline. Where the finding is descent, the treatment is an operation, and an injectable delays rather than substitutes for it.

What if my skin is inflamed or I have had a reaction before?

An active skin condition, an infection, or a previous reaction to an injectable are all reasons to wait or to choose something else. The assessment establishes what the reaction was and whether the same class of material can be used safely. Treating through inflammation risks both a poor result and a complication, and it is a postponement rather than an exclusion.

Risks & Limitations

  • Neither material repositions tissue or removes skin. A face whose change is descent or skin laxity is not a volume problem, and treating it with an injectable does not correct it.
  • A poly-L-lactic acid biostimulator cannot be dissolved. There is no enzyme that reverses a collagen response, and a result that is wrong has to be managed over months rather than corrected.
  • Nodules are the characteristic complication of collagen stimulators: firm areas under the skin that can appear weeks to months after treatment and are managed rather than dissolved.
  • The collagen response is biological and cannot be placed with the precision of a filler. An even response cannot be promised, and the result is judged at two to three months rather than at days.
  • Hyaluronic acid filler carries an uncommon and serious risk of vascular occlusion, in which material enters a blood vessel and compromises the skin it supplies; in the rarest cases this can affect vision.
  • Lumps, irregularity and migration of material can occur after filler, and in thin skin material can be visible. Dissolving usually works but may not remove everything.
  • Neither material lasts indefinitely. Filler is absorbed over months and maintenance means returning; a collagen response matures and then ages with the face. No honest duration can be given in advance.
  • Infection, an inflammatory reaction and a result that is simply not what was intended can follow either material. No result is guaranteed for either.

When to Seek Care

  • Pain, blanching or dusky discolouration of the skin after an injectable, or any change in vision — this needs immediate attention.
  • A firm, tender or visible lump appearing under the skin weeks or months after treatment.
  • Increasing redness, swelling, warmth or discharge in the treated area, particularly with a fever.
  • A change in the colour or texture of the skin over a treated area, or skin that is becoming mottled.
  • Numbness or altered sensation that persists, or pain that is increasing rather than settling.
  • A result that is visibly uneven between the two sides, which should be reviewed rather than treated at home.

References & Further Reading

  • American Society of Plastic Surgeons (ASPS) — injectable and soft tissue filler guidance
  • International Society of Aesthetic Plastic Surgery (ISAPS) — global standards of practice
  • National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
  • Cochrane Library — systematic reviews in soft tissue fillers and injectable complications

Medically reviewed by Ke He, MD (何锞), Deputy Director & Head of Skin & Laser Aesthetics. Last reviewed: 19 September 2026.

This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.