Treatment options for these persistent lines include very carefully placed filler directly within the superficial dermis, using a very soft product and a very conservative approach. This must be done only by an experienced injector or plastic surgeon familiar with the anatomy, since the deeper layers are close to blood vessels where complications can occur. Another option in the right setting is facial fat transfer, sometimes using nanofat. Good luck!
It is difficult to give a precise answer without an in-person examination, but your question raises an important point about the balance between the brows and the upper eyelids. Botox in the upper third of the face typically relaxes muscles that elevate the brows, which can slightly lower them. In patients with preexisting excess skin of the upper eyelids, called dermatochalasis, even small changes in brow position can alter how the eyelid hooding appears. At your age, you may be a candidate for procedures such as upper eyelid surgery (blepharoplasty) or, in some cases, repositioning of the brow. These procedures can restore a more natural balance between the eyelids and brows and give a longer-lasting improvement than Botox adjustments alone. The best next step is to consult in person with a board-certified plastic surgeon who can assess your anatomy and advise you on whether surgical or non-surgical approaches will give you the most natural and satisfying result. Sincerely,Michael Chung, MDPlastic and Reconstructive Surgery
What you are describing could be related to the underlying muscles of the nose that become active when you smile. Botox can sometimes be used to soften this by weakening those muscles, but it requires very careful placement and a detailed knowledge of nasal anatomy. The main risk is that certain muscles are also responsible for helping keep the nasal valve open, and weakening them could affect your ability to breathe comfortably through your nose. The good news is that Botox is temporary, so if you and your injector decide to try it, the effect will wear off in a few months if you are not satisfied. It is very important to see an experienced injector or plastic surgeon who understands these nuances, as the injections are highly precise. Sincerely,Michael Chung, MDPlastic and Reconstructive Surgery
The best treatment depends on your anatomy, skin quality, and age. Fillers can enhance contour in certain patients, but they generally will not slim the lower face and can sometimes make it look heavier. Botox only helps if the masseter muscles are enlarged, which does not seem to be your main concern. If your fullness is due to fat, submental liposuction can provide definition. If there is also loose skin or jowling, then a neck lift or a combination of a lower facelift with a neck lift may be the most impactful option. The right choice can only be determined through a thorough in-person examination by a board-certified plastic surgeon, who can guide you to the treatment best suited to your anatomy and goals. Sincerely,Michael Chung, MDPlastic and Reconstructive Surgery
First, congratulations on your tremendous weight loss. That is an extraordinary accomplishment and something to be very proud of. It is common after significant weight loss to notice areas of facial hollowing, particularly around the mouth, cheeks, and temples. This can be accentuated if you are on medications such as GLP-1 inhibitors, since they accelerate fat loss in the face. Although some of these changes overlap with the natural aging process, they can appear earlier or more pronounced after such a significant transformation. Yes, the hollow area near your lip can often be improved. The most straightforward approach would be soft tissue augmentation. This can be done with either a dermal filler or with fat transfer. Hyaluronic acid fillers are the most common first step because they are precise, reversible, and provide an immediate result. Fat transfer is another excellent option, using your own fat to restore volume. Fat can provide a more natural and potentially longer-lasting correction, but the outcome is somewhat less predictable, and a portion of the transferred fat may resorb over time. Surgery is generally reserved for more advanced cases of facial aging or laxity. Given your age healthy skin elasticity, starting with either filler or fat transfer would be a very reasonable and conservative way to address this hollowing. It is important to do it carefully and conservatively, as even small amounts of volume can make a noticeable difference in the delicate perioral region. A consultation with a board-certified plastic surgeon will allow you to review the options in detail and decide whether a temporary filler or fat transfer best aligns with your goals. Sincerely,Michael Chung, MDPlastic and Reconstructive Surgery
