Significant weight loss, while beneficial to overall health, can result in profound alterations to facial structure. Rapid reduction of subcutaneous fat and soft tissue support commonly leads to pan-facial hollowing, skin laxity, and contour changes that contribute to a prematurely aged appearance.1,2 Traditional rejuvenation approaches often relied on hyaluronic acid (HA) fillers alone, providing immediate volumisation but requiring frequent maintenance and offering limited stimulation of underlying tissue biology.3 

In recent years, regenerative aesthetic medicine has advanced with the introduction of collagen-stimulating fillers such as poly-L-lactic acid (PLLA), calcium hydroxyapatite (CaHA), and polycaprolactone (PCL)-based products.4-6 These agents not only replace lost volume but also activate fibroblasts to promote neocollagenesis and elastogenesis, thereby improving dermal quality and offering longer-lasting outcomes. 

In this case, I selected Ellansé (polycaprolactone microspheres in a carboxymethylcellulose carrier gel) as the foundation treatment. Its dual mechanism provides both immediate volumetric correction and progressive collagen stimulation, with evidence supporting safety, efficacy, and multi-year longevity depending on formulation.7,8 For this patient, who was seeking natural yet durable rejuvenation after weight loss, I considered this approach well suited to her presentation and treatment goals. 

My method reflects a regenerative-first philosophy: using Ellansé for global restoration while reserving HA fillers for delicate areas (tear troughs, perioral rhytids) where precision and reversibility are paramount. This strategy is consistent with contemporary practice, which often combines biostimulatory products for structure and dermal health with HA for fine contouring to achieve natural, harmonised results.9 

Patient presentation  

The patient was a 53-year-old female who attended my clinic following significant and rapid weight loss. She expressed concern that this had left her face looking hollow, tired, and prematurely aged. Specifically, she disliked the deepening of her nasolabial folds, the downturn of her oral commissures, thinning of her lips, perioral rhytids, and hollowing under the eyes. Her main goal was to restore facial balance in a way that looked natural, leaving her refreshed rather than “done”. 

The clinical effects she described are well recognised in the literature. Studies have shown that weight reduction accelerates facial ageing changes through deflation of deep and superficial fat compartments, descent of soft tissues, and worsening of skin laxity.10-12 Patients often report looking older despite feeling healthier, creating a strong psychosocial motivation to seek restorative aesthetic treatments.13 

Clinical assessment  

On examination, I noted generalised mid- and lower-face volume loss, early jowl formation, and blunting of the mandibular contour. There was clear perioral tissue deflation, lip thinning, and rhytids, as well as tear trough hollowing.  

Dynamic assessment confirmed that loss of mid-face support was a key driver of the tired appearance, with secondary effects on the lower face and perioral region. 

These findings are consistent with published analyses of post-weight loss facial changes, which highlight mid-face hollowing and mandibular definition loss as particularly impactful on perceived ageing.14 This comprehensive static and dynamic analysis informed the treatment planning process, ensuring that structural restoration of the mid-face was prioritised before addressing more superficial concerns. 

Treatment plan options  

I discussed several treatment options with the patient, including: 

• Hyaluronic acid (HA) filler volumisation 

• Collagen-stimulating dermal fillers 

• Surgical lifting 

Given her desire for natural but long-lasting rejuvenation without surgery, I recommended a regenerative-focused plan. This involved using a collagen stimulator as the cornerstone of treatment to restore global support, combined with HA fillers for precision correction in areas where fine contouring and reversibility were important, such as the tear troughs and perioral region. 

This tailored, combination approach is supported in the literature, which emphasises the value of addressing both structural restoration and dermal quality in post-weight loss patients.15,16 

Rationale for chosen products  

In planning treatment for this patient, I selected Ellansé to address the broad facial changes associated with rapid weight loss.  

Its dual action offered immediate volumetric correction alongside progressive collagen stimulation, helping to restore structure and improve skin quality over time.17,18 For patients who are seeking durable results and wish to reduce the frequency of repeat treatments, I find this regenerative effect particularly valuable. 

To complement this, I incorporated MaiLi hyaluronic acid fillers. MaiLi Precise (G′ 140 Pa) was used in the tear troughs, where softness and accuracy were essential, while MaiLi Define (G′ 200 Pa) was chosen for the perioral region to correct rhytids and refine lip definition. HA fillers provided the level of precision, predictability, and reversibility needed in these delicate areas.19 

By combining a collagen-stimulating product for global support with HA fillers for targeted contouring, I was able to achieve a balanced result that met the patient’s wish for natural, long-lasting rejuvenation. 

Treatment protocol  

Before treatment, I carried out a full consultation, obtained informed consent, and completed 2D and 3D clinical photography. The patient was advised to avoid alcohol and NSAIDs for 24 hours prior to the procedure. Skin was prepared with chlorhexidine under aseptic conditions. 

For global restoration, I used Ellansé M, the two-year formulation within the Ellansé range. A total of 6ml was delivered via cannula techniques to enhance safety and minimise downtime. Product was placed strategically in the mid- and lower face to rebuild volume, restore contour, and support areas affected by deflation. 

For precision correction, I incorporated hyaluronic acid fillers from the MaiLi range: 

• MaiLi Precise: approximately 1ml placed in the tear troughs, where its softer rheological behaviour allowed smooth integration and reduced the risk of visibility or irregularity. 

• MaiLi Define: 4-5ml used in the perioral region to soften rhytids and refine lip definition, with its firmer rheology providing the necessary structure while maintaining flexibility in dynamic areas. 

Needle techniques were used in the perioral and lip regions to maximise accuracy, while cannula delivery was preferred for structural areas to reduce the risk of vascular events.  

Treatment followed a top-down sequencing approach, beginning with mid-face support before addressing the lower face and perioral concerns. This ensured that foundational restoration was achieved first, with refinements layered in afterwards to achieve natural and harmonised results. 

Aftercare and review plan  

Following treatment, I provided the patient with standard aftercare instructions. She was advised to avoid touching or applying pressure to the treated areas for several hours, and to refrain from strenuous exercise, alcohol, and exposure to extremes of heat or cold for 24-48 hours. I also explained the importance of monitoring for any unexpected symptoms, including vascular compromise, and provided clear guidance on when and how to contact me if concerns arose. 

A review appointment was scheduled for two weeks post-procedure to assess initial outcomes and ensure there were no complications. I also planned to reassess the collagen stimulation response at four months, with the option of hyaluronic acid touch-ups at 9-12 months if required. Looking forward, the longer-term plan may include adjunctive treatments such as polynucleotides, medical-grade skincare, or energy-based devices to further enhance skin quality and maintain results. 

Results  

At follow-up, I observed a notable restoration of mid-face volume, with improved projection and support contributing to a fresher overall appearance. The jawline appeared more defined, and early jowling was softened. Nasolabial folds and perioral rhytids were visibly reduced, and the lips had regained balance and contour without appearing overtreated. Tear trough hollowing was corrected subtly, giving the patient a less tired and more rested expression.  

The results appeared harmonious, with smooth transitions between treated and untreated areas, reflecting the regenerative effect of Ellansé combined with the precision of MaiLi fillers. 

The patient reported feeling “like myself again”, highlighting that friends and family had commented she looked well-rested and refreshed, rather than “done”. She expressed that the outcome aligned exactly with her goal of natural enhancement and emphasised the boost to her self-confidence. 

The patient said, “After my weight loss, my face looked hollow and tired. This treatment has brought my face back to life. I feel so much more confident, fresher, more radiant, and most importantly, still like myself.” 

Before and after treatment with Ellansé and MaiLi dermal fillers 

Key learning points  

This case illustrates how a regenerative strategy can be highly effective in patients presenting with facial deflation following weight loss. By combining full-face collagen stimulation with targeted HA correction in high-precision areas, natural and durable outcomes can be achieved. 

Practical takeaways include: 

1. Think long-term: Collagen stimulators such as Ellansé provide both immediate correction and progressive neocollagenesis, making them well suited for post-weight loss patients. 

1. Use HA selectively: Hyaluronic acid fillers are best reserved for delicate areas requiring immediate precision, softness, and reversibility, such as the tear troughs and perioral region. 

1. Sequence globally, refine locally: Address mid-face support and structural restoration first, then move on to superficial lines and fine detail to maintain overall harmony. 

Reflections  

This case reflects my broader philosophy in regenerative aesthetics: to move beyond simply replacing lost volume and instead harness treatments that actively improve the quality and resilience of facial tissues over time. In patients who have undergone significant weight loss, the challenge is not only structural support but also the restoration of harmony between skin, soft tissue, and underlying architecture. 

Collagen-stimulating fillers such as Ellansé provide a unique advantage in this setting, offering both immediate restoration and progressive neocollagenesis that enhances outcomes in the months following treatment. When paired thoughtfully with rheologically appropriate HA fillers, it is possible to achieve results that appear subtle, natural, and enduring. 

Ultimately, this approach reduces the treatment burden for patients by limiting the frequency of interventions, while maintaining flexibility to refine results with adjunctive therapies as needs evolve. I believe that regenerative strategies such as this will continue to define best practice in aesthetic medicine, particularly for patients seeking natural longevity rather than short-term correction.