Unfortunately, your doctor is using the old-fashioned technique of simply "chasing after lines and wrinkles" with a simple filler, rather than addressing the underlying, age-related problem of volume loss in the upper and mid-cheek regions that is really behind the development and deepening of the smile lines. Frontal and profile views of your face encompassing a bit more of your cheeks would have given a clearer picture of what needs to be done to improve your smile lines and diminish the incipient jowl formation visible towards the sides of the corners of your mouth. Nevertheless, it does appear that volume loss of the malar cheek pad along with its downward and inward descent are contributing to the appearance of what troubles you. Merely treating the smile lines directly with a plain filler, like simple Juvederm ( which is intended for fine lines and wrinkles), was not likely to lead to either a satisfying or long-lasting result, and can sometimes even make things appear worse, as seems to be the case here. The appropriate way to address this problem is by dealing with the source of the problem--i.e. loss of volume in the malar cheek pads above and perhaps in the mid-face region to a lesser extent, as well. This can be easily accomplished, in a matter of minutes these days via the injection of a volumizing filler, such as Voluma XC (which would be my choice in my Upper East Side Manahattan practice) or Stylage XXL (my choice for this in my Israel satellite facility, where a far greater number of regulatory agency approved injectable volumizing fillers are available). The results of treatment in this fashion, which can be expected to last up to two years, would also appear natural, since they result from directly dealing with underlying problem that has given rise to the smile lines. As an added plus, the overall aging look of the mid-face would very likely be significantly improved, as well. Make sure you consult with a board certified aesthetic physician with experience and expertise in nonsurgical facial contouring, shaping and framing with volumizing fillers. Be sure to insist upon seeing his/her before and after photos before agreeing to proceed. Best of luck.
