Tessa: When it comes to facial fat, you're the go-to expert, and you have such a wealth of knowledge about why it behaves the way it does. So, what happens to our facial fat as we age, and why does it happen?

Ivan: Thank you for the kind words. We lose facial fat fitness in two ways. The first and most obvious is depletion. We lose fat cells in the face. This is caused when regeneration does not keep up with natural cell death. We believe the main cause of insufficient regeneration is sun exposure. UV rays create a low-level inflammation on the skin's surface. This inflammation slows down the regeneration program for facial adipocytes (fat cells). Age also slows down regeneration. The other main deviation from facial fat fitness is bloating. The facial fat cells get too big. This is then the main source of laxity in the face. So, loss of facial fat fitness accounts for the two main issues that most people ascribe to aging: hollowing and sagging.

T: I work with clients of all ages, and I've noticed that when it comes to our facial structure and volume, that age does not always have a direct impact. I have just as many clients in their twenties and thirties that have concerns with their volume and laxity, as clients in their forties and fifties. Why does that loss of volume affect some worse than others?

I: I completely agree with you. My clinical experience tells me that fitness is far more important than age in determining volume and laxity. In addition to sun exposure, high-intensity exercise has a strong negative impact on adipocyte regeneration. That high-intensity workout is the equivalent of a mild sunburn. During high-intensity exercise, the body switches all its programming to meet the immediate needs and shuts off the homeostatic regeneration program. This is why people like Gwynneth Paltrow have such prominent volume loss in their faces. We call it a gym groove. Laxity, on the other hand, is caused largely by insufficient exercise.

T: I find we just went through a good decade of facial filler obsession, everyone wanted to look like an Instagram filter, but I also think it created unrealistic expectations of how our natural facial structure is meant to appear. Now I feel the pendulum is swinging the opposite direction, overdoing injectables is becoming faux-pas. Celebrities are getting fillers dissolved, and people are turning towards treatments and skincare to achieve a more youthful and natural look. With that being said, how do fillers affect our facial fat, and do fillers have a negative impact on how our facial fat behaves?

I: The straightforward answer is, "I don't know." No one has studied this, in large part, because there is no financial incentive to do so. That said, I do believe that fillers are more likely to do harm than good. The body is very conservative about creating new cells, and that applies to fat cells. Before the body decides to make a new fat cell, it integrates a whole host of signals to decide whether it is needed. To the extent that fillers injected into the fat tissue distort those signals. For example, by augmenting the compressive force acting on the facial fat tissue – they would be expected to hold back fat cell regeneration. This could be the reason why more and more filler is needed each time to get the same level of inflation.

T: On the opposite spectrum, we also have many women wanting to see a loss of facial fat. A concern often expressed in my studio is wanting more sculpted cheeks and a more defined jawline. Why does facial fat deplete in some areas but increase in other areas? We may see a loss of volume in the cheeks, but then volume increases under the chin. I think inflammation and lymph-flow stagnation are factors that can make us look less defined. Is there a connection between facial fat, inflammation, and lymph flow?

I: Yes, there is a direct connection between lymph flow, inflammation, and facial fat fitness. When lymph flow is compromised, lymph fluid builds up in tissue. The fat cells absorb this fluid and become bloated. Large fat cells behave very differently from small, fit ones. They stop sending restorative signals – "make collagen, make elastin, make hyaluronic acid" – and they actually start to send inflammatory signals. This inflammation has a negative feedback effect on their own regeneration. When there are insufficient fat cells, each cell has to become bigger to take up the load. So this creates more laxity. So it's really a bad combination of bloated fat cells – fed by excess lymph fluid – and weak skin.

"The term "facial fat fitness" describes the natural state of the face where there are sufficient numbers of small fat cells. In this state, the curves of the face are full and tight. The goal with our face cream is to help people attain a strong, complete and defined look."

T: Let's talk Adipeau! One of the first things that really impressed me was your transparency with sharing ongoing clinical results, which you also share on your social (@adipeau) regularly, and it has many people in the industry excited because the concept of affecting facial fat within topical skincare is still very new. You've coined the term "facial fat fitness" as describing Active Face Cream. So tell us, what does Adipeau do for our skin and what exactly is facial fat fitness?

I: The term "facial fat fitness" describes the natural state of the face where there are sufficient numbers of small fat cells. In this state, the curves of the face are full and tight. The goal with our face cream is to help people attain a strong, complete and defined look. To this end, our face cream combines natural ingredients with proven regenerative and toning activities. So more, smaller cells. In our clinical study, we see really remarkable gains in both "completeness" and "definition." On average, the impacts are in the range of low-dose filler.