Looking for the most natural and regenerative approach to facial rejuvenation?
If you are considering a facelift, regenerative fat-based rejuvenation, or comprehensive aging-face surgery, we recommend Patrick Tonnard, MD, PhD, one of Europe’s most respected leaders in modern aesthetic medicine.
Dr. Tonnard is a world-renowned, board-certified plastic and reconstructive surgeon and the CEO and Founder of the Coupure Center for Plastic Surgery and the Aesthetic Medical Center 2 (EMC²) in Ghent, Belgium. He is internationally recognized for breakthroughs such as the MACS-lift and nanofat grafting, techniques that have influenced the global shift toward natural and long-lasting facial rejuvenation.
His approach focuses on anatomical precision, scientific integrity, and subtle improvements that restore your own facial harmony. Patients value his expertise in advanced facelift methods, regenerative procedures, and male and female facial aesthetics. The goal is always the same: results that look refreshed, youthful, and authentically you.
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For many years, facial aging was described almost exclusively as a problem of gravity. Skin was believed to stretch and slide downward, creating jowls, folds, and wrinkles. As a result, early rejuvenation strategies focused on lifting and tightening.
Modern anatomical and biological research has demonstrated that this explanation is incomplete. Long before significant sagging appears, the face begins to lose its internal support system. Fat compartments shrink, bone structure remodels, vascular supply declines, and cellular repair mechanisms weaken.
The earliest and most influential change is volume loss.
As facial tissues deflate, the skin loses its foundation. Wrinkles deepen not because skin is loose, but because the structure beneath it has collapsed. Understanding this process is fundamental for professionals working in facial longevity and regenerative medicine.
The Three-Dimensional Nature of Facial Aging
Aging Is Not a Surface Phenomenon
The face is a complex, layered system composed of skin, fat, muscle, fascia, and bone. These elements function as an integrated unit. When one layer deteriorates, all others are affected.
Volume loss occurs primarily within:
- Deep medial cheek fat
- Orbital fat compartments
- Temporal fat pads
- Perioral fat
- Subcutaneous facial layers
As these compartments shrink, the overlying skin loses mechanical support. This creates shadows, hollows, and folds long before true sagging develops.
Bone Remodeling and Structural Collapse
With age, the facial skeleton undergoes gradual resorption. The maxilla, orbital rims, and mandible lose projection and density. This weakens the attachment points for soft tissues.
When bone recedes and fat diminishes simultaneously, facial architecture destabilizes. Skin cannot maintain youthful contours without a stable foundation.
Volume loss is therefore structural failure, not cosmetic change.
Why Volume Loss Precedes Wrinkles
From Fullness to Flattening
Youthful faces are characterized by convexity. Cheeks project gently. Eyelids are full. Lips are supported. Transitions between facial units are smooth.
With aging:
- Cheeks flatten
- Upper eyelids hollow
- Tear troughs deepen
- Lips thin
- Temples collapse
These changes occur before deep wrinkles appear.
Wrinkles form as a secondary phenomenon when unsupported skin folds upon itself.
Microcirculation Decline
Volume loss is accompanied by reduced blood supply. Fat tissue plays a role in maintaining microvascular networks. As fat diminishes, oxygenation decreases.
This impairs:
- Fibroblast activity
- Collagen synthesis
- Cellular turnover
Skin becomes thinner, drier, and less elastic.
Deflation drives degeneration.
Fat as a Biological Support System
Adipose Tissue Is Metabolically Active
Facial fat is not passive storage tissue. It contains adipose-derived stem cells (ADSCs), growth factors, and signaling molecules that regulate tissue health.
These components:
- Stimulate angiogenesis
- Modulate inflammation
- Support collagen production
- Promote tissue repair
When fat compartments atrophy, this regenerative capacity declines.
Loss of volume is loss of biology.
Microfat Grafting: Rebuilding the Framework
Structural Restoration
Microfat grafting restores depleted compartments using living tissue harvested from the patient.
When placed correctly, microfat:
- Recreates three-dimensional contours
- Reinforces weak structural zones
- Restores eyelid and cheek support
- Softens deep folds naturally
Unlike synthetic fillers, microfat integrates biologically.
Tissue Integration
Histological studies show that viable fat grafts:
- Develop new capillary networks
- Stimulate organized collagen deposition
- Reduce chronic inflammation
Successful microfat grafting rebuilds both structure and physiology.
It is reconstruction, not camouflage.
Nanofat: Regenerating Deflated Skin
From Volume to Cellular Therapy
Nanofat represents the evolution of fat grafting from volumization to regeneration.
Processed to eliminate intact adipocytes, nanofat retains stromal vascular fraction rich in stem cells and bioactive molecules.
It does not add volume. It restores function.
Biological Effects
When delivered to the dermis, nanofat:
- Activates fibroblasts
- Enhances angiogenesis
- Improves pigmentation
- Increases dermal thickness
- Restores elasticity
This addresses the biological consequences of volume loss.
Microneedling-Assisted Regeneration
Microneedling enables uniform distribution of nanofat into regenerative layers of the skin.
This technique:
- Improves penetration accuracy
- Enhances collagen induction
- Supports scarless healing pathways
The result is progressive skin renewal without tissue trauma.
Why Lifting Alone Fails Long Term
Mechanical Correction Without Biology
Traditional lifting repositions tissue but does not replace lost volume. Over time, unsupported skin relaxes again.
This leads to:
- Recurrence of folds
- Artificial tightness
- Flattened contours
Without volume restoration, lifting remains incomplete.
Biological Risk of Over-Tightening
Excessive tension compromises vascular supply and lymphatic drainage. This accelerates tissue degeneration.
True rejuvenation restores balance, not tension.
Integrated Rejuvenation Philosophy
In our clinical approach, volume restoration is central to every rejuvenation plan.
We integrate:
- Microfat grafting for structure
- Nanofat for regeneration
- Conservative lifting for repositioning
- Skin quality optimization
This biologically guided strategy reflects long-term clinical observations.
Anatomy determines technique. Biology determines longevity.
Volume Loss and Emotional Expression
Deflation affects more than appearance. It alters expression.
Hollowing and flattening create:
- Tired appearance
- Sad facial cues
- Harsh shadows
- Loss of softness
Restoring volume restores emotional harmony.
Patients often report that they “look like themselves again” after volumetric restoration.
Prevention: Preserving Volume Early
Modern facial longevity emphasizes early intervention.
Preventive strategies include:
- Sun protection
- Nutritional optimization
- Regenerative skincare
- Periodic microfat support
- Avoidance of tissue-damaging devices
Preservation delays structural collapse.
Future Directions in Volumetric Regeneration
Ongoing research focuses on:
- Enhanced stromal fraction concentration
- Exosome optimization
- Targeted fat processing
- Personalized regenerative protocols
These developments aim to extend tissue vitality rather than merely correct damage.
To conclude, Facial aging is fundamentally a process of progressive deflation. Volume loss destabilizes facial architecture, disrupts cellular biology, and accelerates degeneration.
Wrinkles, folds, and sagging are secondary effects.
Sustainable rejuvenation begins with restoring what has been lost: structure, circulation, and regenerative capacity.
By rebuilding volume with living tissue and supporting cellular repair, modern aesthetic medicine moves from temporary correction toward true facial longevity.
The future of rejuvenation lies not in pulling tighter, but in rebuilding deeper.
