Katie Ross, MD

First, it appears that you have volume loss in the mid face, above the areas you are concerned about. This may been partially genetic due to your underlying bone structure but it occurs with weight loss and in everyone as we age due to loss of collagen, elastin, fat pads and bone resorption. Adding appropriately placed dermal fillers at the malar/midface area would help to give some lift and minimize the NLF's. Some filler in those folds as well as the oral commissures would also be helpful but the combination with PDO threads would give a better result since you would not want to make the lower face too heavy with a lot of filler. Lifting threads and smooth threads may be used in combination together with dermal fillers. Another option would be Sculptra which does work gradually over a few months to stimulate your own collagen but also needs to be done as a series for best results.
Be sure to discuss all options with an experienced physician/injector/surgeon. A lower face lift surgery is an option for lifting and tightening but it does not add volume unless fat grafting is also done.

There are a few contraindications to RF microneedling such as implanted electronic devices such as pacemakers, pregnancy and various skin conditions in the area to be treated. Generally, dental fillings and even dental implants should not be affected by the procedure but a buffer zone with cotton rolls or pads can be used inside the cheek to decrease any possible sensitivity. You should discuss this with your physician and be sure to have an experienced clinician perform your procedure.

Your photos indicate that you have multiple small, pitting type acne scars but the second photo also seems to show enlarged pores which are not necessarily scars. The bad news is that almost anything you do will take multiple treatments. The good news is that you have several options including resurfacing with a fraxel type laser or encouraging the collagen growth into those pitted areas with smooth PDO threads which can be placed in a grid like pattern underneath the scarred areas. Microneedling can also encourage new collage growth but the needles have to penetrate deep enough into the pits. All of the above type treatments would likely need to be done several times over a period of a few months. Be sure to consult with an experienced physician who can evaluate your skin conditions and help you make the best decision for you.

The photo is not of good quality but it appears to be a rather deep glabellar line. Neurotoxins such as Dysport and Botox work well on lines that occur with expression/muscle movement but they work less well on deep, static lines when used alone. Your lines appear deep enough that some other modality such as a filler or smooth PDO threads would help to lift & add volume to the crevice but you would still need a neurotoxin to help decrease movement in the muscles that are causing the line. Dermal fillers have more risk in that area. Another advantage of the PDO threads is that they will stimulate more collagen in the area as they dissolve gradually over 1-2 months. The threads can be repeated every 4-5 weeks until you have the desired results. Be sure to consult with a doctor who is experienced with injections including PDO threads and will review all of the risks & maintenance involved.

While certain neurotoxins may work better and/or last longer for an individual, the injection techniques are also important. We are also noticing a resistance that may occur after years of injections with the same products that may be due to building up antibodies to some of the neurotoxins. There are now 4 different neurotoxins available in the USA and another one may soon be FDA approved. I would also recommend smooth PDO threads to be used in that area which not only instantly add volume to minimize the lines but also help to build your own collagen in the area as they gradually dissolve over 4-6 weeks. Other treatments such as radiofrequency microneedling can be used and will work gradually over a period of months and can treat the whole face as well as other areas with skin tightening/rejuvenation.