Facial Aging: Are You A Sinker, Sagger or Wrinkler?

By Kelly Wala, RN BSN February 14, 2014 23 Comments

facial aging

As people naturally age they fall into one of three distinct categories: “Sinker”, “Sagger”, or “Wrinkler”. Because each aging style exhibits distinct aging traits (illustrated in diagram below), different treatment options are better suited depending on the category you fall into.

facial diagramCommon facial aging traits (Source: https://www.zenaestheticdentalspa.com)

The Sinker

Is your face losing volume like a slowly deflating balloon? If so you’re probably a “Sinker”.

Sinkers are characterized by volume loss around key areas of the face which can cause a sunken hollowed out appearance. The temples, mid-face and the area below the cheekbones are the most common places where this volume loss occurs.

The natural aging process causes us to lose about 10% of the fat in our face at the age of 35 years and an additional 5-10% every 5-10 years thereafter. By the age of 55 you may have lost 40% of the fat in your face, which once gave it a plump, full, youthful appearance. Additionally the skin becomes thinner, and rougher in texture, contributing to a haggard appearance.

Rapid weight loss can often accelerate the visual effects of “Sinking”, including a hollow facial appearance and loose, wrinkly skin this causes on their face. At Westlake Dermatology, we help a number of patients who have lost a significant amount of weight and want to combat the accompanying negative side effects.

This style of aging is best combated with dermal fillers or a fat transfer procedure. By inserting a little extra padding to the hollowed out areas, we can plump the face, resulting in a vibrant youthful appearance.  Juvederm Voluma is the newest dermal filler recently launched that is the first and only FDA approved filler for mid-face volume loss.

The Sagger

If your skin looks like it’s sliding away from the bone structure beneath, you’re a “Sagger”.

As the skin’s connective tissues lose their integrity, your face begins to lose the battle against gravity. This saggy appearance occurs when the skin begins to lose its elasticity and becomes too lax. As we age the skin’s connective tissues, elastin and collagen weaken and break down, so the skin loses its youthful, springy texture.

The most successful anti-aging treatments for ‘saggy’ faces involve a combination of volume restoration, and collagen stimulation.

Younger patients can opt for Thermage, a non-invasive radiofrequency treatment. Thermage helps prevent the signs of aging, by stimulating the body’s production of connective tissues, thereby tightening the skin and reducing the saggy, aged appearance.

For more mature patients, we use Ultherapy, which is also non-invasive. This treatment uses ultrasound to stimulate the collagen within the skin, creating a lifting effect. This is our most popular treatment for skin tightening, and can turn back the clock by 5-10 years.

The Wrinkler

A “Wrinkler” will exhibit clearly defined patches of wrinkly skin, often located around the eyes, brow and lips. Usually these lines are caused by frequent fine motor movements of the face, repeated over many years. Examples include:

  • Frown lines from a brow frequently furrowed in concentration or concern.
  • Fine lines radiating from the outer corners of the eyes, caused by squinting into the sun, at poorly lit work, or at a computer screen.
  • Lines around the edges of the mouth caused by puckering lips to smoke or suck a straw.

The continuous repetition of the above actions causes minor lines and wrinkles that transform into permanent wrinkles over time. To help eradicate these aging wrinkles, we offer two treatment options: Botox, and Belotero.

Botox, our most popular anti-aging injection, is a muscle relaxant. Carefully positioned injections of Botox will relax the muscles beneath your skin, reducing the likelihood of new wrinkles forming, and smoothing the appearance of any existing wrinkles, but does not affect the expressiveness of your face.

Belotero is a new treatment, which involves injecting filler into the surface layer of the skin, the papillary dermis. This helps to fill out, and smooth fine lines and wrinkles, and is often use around the eyes, cheek and lips.

Preventative Measures

Whether or not your natural aging style is already apparent, there are a number of measures you can take to keep your complexion looking youthful:

  • The aging process is accelerated by exposure to sunshine, so stay in the shade, stay out of the mid-day sun, and slap on some sunscreen.
  • Keep your alcohol consumption to moderate levels. Excess alcohol can deprive the skin of the essential nutrients it needs to maintain a full, plump appearance. In the short-term, drinking alcohol can cause dehydration, which makes the skin look rough, dry and sunken.
  • Finally, ensure you are eating a nutrient rich diet, that will supply your skin with the vitamins and antioxidants it needs to stay healthy.

With healthy habits, and carefully targeted anti-aging treatments, you can turn back the clock and enjoy a more youthful appearance.


Kelly Wala, RN BSN

Kelly Wala is a Registered Nurse with a Baccalaureate Degree of Science in Nursing from Eastern Kentucky University. As an Aesthetic Nurse Specialist for the past 10 years Kelly specialized in a full complement of non-surgical aesthetic services such as facial injectables, laser and light therapy, body contouring, and skin care. Kelly was the first in Texas to perform the Injectable Threadlift.


23 Responses to “Facial Aging: Are You A Sinker, Sagger or Wrinkler?”

  1. Grace L. says:

    Ahhh I’m a Sinker

  2. Kelly says:

    “With healthy habits, and carefully targeted anti-aging treatments, you can turn back the clock and enjoy a more youthful appearance.”

    Wished I knew that 20 years ago 🙂

  3. Roger says:

    Awesome article.

  4. Julianne says:

    Great Post!

  5. Jenni says:

    Hey, I’m a wrinkler and just got Botox for the first time. I’m so happy to see myself younger than before. Thanks for sharing this great post!!

  6. Anthony says:

    Excellent post! This really has all of the info I needed concerning aging.

  7. walrus1998headshothippo says:

    Thanks for sharing 🙂

  8. Erwin says:

    Thanks for sharing 🙂

  9. Elvin says:

    Interesting thoughts on aging, makes sense! I shared on FB

  10. Reginald says:

    Great Post, I love this!

  11. Matt says:

    Thanks for sharing. Yet another thing I would like to mention is that fat loss is not just about diet fads and trying to shed as much weight as possible in a couple of weeks. The most effective way to lose weight is by taking it slowly and developing a more healthy lifestyle. That’s the way to long-term success!

  12. Taj says:

    Trying to correct some sinking issues now 🙁

  13. flo1962 says:

    Great post! I just wanted to point people to an additional blog I wrote on volume loss from aging: http://www.effortlessskin.com/blog/2015/07/why-does-the-skin-lose-volume-with-age/. I would appreciate the opportunity to share!!!

  14. tanya says:

    I’m a mom, have a job, and recently lost some weight, which is apparently the perfect recipe for an under eye disaster. I read alot of great reviews about the Made from Earth Vitamin Firming Serum and I was convinced to give it a try–and I’m so glad I did! I have been using it for just 1 week and I’m already really happy with the results. The wrinkles under my eye have lessened a lot and my upper eyelid looks so much tighter and less droopy, which was an unexpected bonus.

    • Joanne says:

      I’m at my wits end with all this ageing! I decided to get filler 12 months ago, I’m only 48 and all my friends the same age and older who’ve had no treatment look exactly the same as they always have but ive aged. I’ve spent thousands so far on filler and I look no different, I went to the hairdressers today and when I looked in the mirror I was horrified! If I told anyone how much money I’ve spent so far they wouldn’t believe me and they’d say I’d been had, I can’t understand why I’m ageing like this I don’t drink or smoke, I don’t step out of the front door without factor 50 sunscreen, I eat fruit and veg I take collegen drinks and skin vitamins and I use top of the range face cream that’s been scientifically tested to give genuine results to reduce wrinkles and firm the skin but I look worse every month. I sometimes wonder if I have something genetically wrong with my skin because I can’t put it down to anything else. I can’t begin to tell you how depressed I am about my face, I’ve stopped socialising, I’m paranoid that people are staring at me and talking about me, I avoid seeing people I use to go out with because i don’t want them to see how much I’ve aged, I can’t bare my reflection anymore and I hate myself. I’m 48 I dread to think what I will look like at 58, I just don’t recognise myself anymore all I see is a haggard old woman

      • Jen says:

        Aww I’m so sorry for you! If it’s any consolation I’m exactly the same – I’m 42 and look much older & it only happened over 2 years! I look at others and just don’t know why I’ve aged so fast. Hope you feel better x

      • Joan says:

        You are not alone same thing here to the point I have called in to work cuz I just can’t bare anyone to see me. I’m 46 and look like a skeleton like my eye sockets are too big and so dark under the eye makeup makes me look worse sunk in on sides of face every asymmetry is exaggerated patchy brown areas yet I never sun bathed never drank…. I look like such a hag! And stupid verticle lines on my cheeks where the skin always crimped when I smile. I hate my life for many reasons and my face is one of the minor reasons. I have not met anyone in my age group with the same messed up kinda face and I would never be able to afford anything to fix it. I was never gorgeous but I was at least acceptable looking 10 years ago

      • Chantal says:

        Hello 🙂
        I just wanted to let you know that I can relate and empathize with your post. If you need to chat with someone who understands, let me know and I will give you my email. 🙂

  15. Cindy says:

    Joanne, Jen & Joan: I’m not sure if any of you will see this but I felt compelled to reply. I’m 52 and have always appeared young until about 3 months ago, so I understand what you’re saying about aging overnight. I could see people (even my MOM!) looking at me recently baffled by the sudden and extreme age on my face. My sister, and even my microneedling technician looked at my face in horror. What I can say is I’ve been seeing improvement the last few weeks by hydrating, taking a probiotic daily, and by doing facial exercises. I got into the best shape of my life a few years ago by lifting weights. I noticed then that my body skin (legs, arms, everywhere really) began looking healthier and younger. I believe that if it works for my body it will work for my face. Find a good program, isolate the area you’re working on, and don’t overdo it. I think the facial exercises can help you. The reason we age is because the underlying muscles get weak. Keep them strong and they support the skin better. It can only help. I have been very happy with the results. Best of luck to you all. 🙂

  16. Casey says:

    I’m definitely a sinker and did fillers under my eyes but it turned out lumpy, so I had a top injector inject and enzyme to dissolve the filler and he hit a nerve(tear trough) and caused a right sided facial paralysis that has taken almost a year to come back. The right side of my lip wouldn’t lift and I had to do stroke exercises to rebuild the strength. It also created dry eye to the point where I couldn’t wear contacts… My under eyes look worse now then before filler and the right side of my face is flatter.. I believe the enzyme dissolved my own natural hyaluronic and collagen.. I’m so bummed as my face looks more aged and I really need some fillers but scared since what happened with the needle hitting a nerve.. Do you think just gaining weight would help my face hollowness?.. I’m 5/9 and weigh about 135?..

    • WD Staff WD Staff says:

      Hi Casey,

      Sorry to hear about those issues. It’s very hard to give a good treatment plan without seeing you in person. I can say that weight gain usually does not help with facial hollowness. I would suggest visiting a different provider (Board Certified Dermatologist) to discuss previous treatments and current issues. They may recommend using a different type of filler or a fat transfer potentially.

      Sorry we couldn’t be more help. But getting another in-person assessment sounds like the best way forward!

      Thanks,
      WD Staff

  17. Jennie says:

    I’m in my sixties and my face looks tired and haggard. My downward spiral started about 3 years ago. I noticed I was developing inflammation, but the numerous test results didn’t find anything alarming. I’m wondering if my sudden aging has anything to do with an auto immune disease. I seriously need botox and fat injections. My skin is laying flat against bone and muscles are clearly defined. I look hideous and catch people staring at me. Even my hairdresser doesn’t try to stare, but it is quite obvious.

Leave a Reply