While it's a fact of life that we all age, skin scientists and aesthetic doctors now believe that our faces age differently, with one of three distinct ways being dominant: sinking inwards with lost volume, sagging as skin moves downwards and away from the bone, or wrinkling with a larger number of lines on the forehead and around eyes and mouth.
 
Although many elements are external, genetics play a part, with some of us showing signs earlier than others, indicating which type of ager you’ll become.

“Facial ageing is highly complex and influenced by a combination of genetics, lifestyle, environmental conditions, plus anatomical differences,” explains Dr Ahmed El Muntasar, NHS GP, Cosmetic Doctor and EV Expert. “The reason we don’t all age the same way is due to variations in bone structure, fat distribution, collagen levels, skin quality and elasticity.

"Some people naturally lose facial volume over time, making them what is known as ‘sinkers.’ Others experience more skin laxity, referred to as ‘saggers,’ while some develop more pronounced lines and wrinkles, often categorised as ‘wrinklers.’ These patterns are shaped by both internal and external factors, meaning no two individuals will age the same.”

Looking at how our parents have aged, combined with how stringent we’ve been with skin-protective habits such as daily sunscreen, can help identify which type of ageing will likely be most visible. “We tend to experience a combination of all three ageing types, but usually one is more dominant,” advises Dr El Muntasar.

By identifying which category we most noticeably fall into, it follows that we can prioritise the best aesthetic options to help keep the face looking full, firm and sculpted, tailoring treatments to our own needs. So, which ager are you?

You’re a sinker…

“Sinking is a direct response to loss of superficial and deep fat,” says Dr Anna Hemming, EV Expert and Founder, Thames Skin Clinic. “Everyone loses volume, normally starting in your 20’s with the deep fat pads under the eyes, which causes a slow but gradual lowering of cheek volume alongside the natural reduction of fat.

"As the cheek falls, there are knock on effects such as lowering of the nasolabial folds (the line from the nose to corner of the mouth), and marionette lines forming. Other visible effects on the face from a reduction in fat and bone structure, include temple depressions and hollows in front of the ears.”

What to try
Recreating lost volume is key to regaining shape for those lacking fullness. “To lift the upper face, I recommend carefully-placed dermal filler into the deep fat pads,” advises Dr Hemming. “To help rejuvenate periauricular hollows, we can use also use injectable hyaluronic acid treatments such as Profhilo Structura, which rejuvenates, repairs and restores superficial fat, encouraging plumper lifting in this layer.

"PRP filler, made from the platelet-poor and platelet-rich components of a patient's own blood, will also create restorative volume. These are good options as they replace what the patient has lost, gently lifting areas back to where they were before the fat reduced or bone volume declined.”

You’re a sagger...

“People in this category often have a naturally soft or round face, with more fat tissue and less prominent bone structure,” says Dr El Muntasar. “The loss of collagen and elastin reduces skin’s ability to remain firm, while fat repositioning and loss lead to deflation in certain areas. Additionally, the ligaments and connective tissues that hold facial features in place gradually weaken, contributing to a downward shift in facial contours.

"As sagging progresses, it typically leads to a loss of sharpness in the jawline, drooping cheeks, deepening of nasolabial folds and marionette lines, plus hollowing in the under-eye area. A history of significant weight fluctuation can also contribute to sagging, as repeated stretching of the skin weakens its elasticity over time.”

What to try
“To address sagging effectively, a multifaceted approach is the best solution,” advises Dr El Muntasar. “Dermal fillers, particularly those using hyaluronic acid or bio-stimulants, can help restore lost volume and provide structural support to areas affected by sagging.

"Skin tightening treatments, such as radio frequency and microneedling, work to improve skin firmness and elasticity by stimulating collagen production. Collagen-boosting treatments, including the dermal filler Lanluma, and skin boosters including Hydromax, can also improve hydration and elasticity, helping to counteract the effects of sagging.”

You’re a wrinkler…

While a natural drop in the collagen and elastin that keeps skin firm means that we’re all susceptible to wrinkles over time, those most predisposed to them will be tackling the appearance of deep static lines. The good news is that skincare can be of huge benefit in improving the surface appearance.

“I like treating my patients with medical grade formulas such as ZO Skin Health,” says Dr Hemming. “They are not only restoring the skin cell function, but helping protect their skin from further decline at the same time.”

What to try
“Botulinum toxin will minimise wrinkles caused by muscle movement,” suggests Dr Hemming, “while simple measures such as using microneedling pens layered with radio frequency treatments give great results, as energy-based treatments help reduce wrinkles and tighten skin by triggering collagen production. Deep skin peels also fall into this category, alongside treatments using exosomes for better tightening, healing and minimising downtime.”

She also recommends hydrating options for plumping out wrinkles. “The original Profhilo treatment combined with Profhilo Structura gives a fabulous double effect, hydrating skin as well as restoring the fat to tighten and lift both layers. And when used effectively, CO2 lasers that remove surface layers of skin to trigger healing can tighten to the maximum.”