I'm 23, Sharp Nose, Big Cheeks, and Wrinkles After I Smile. What Can I Do?

It bothers me that when I smile I get multiple pucker lines around my lips, deep dimples, and fine "parentheses" wrinkles which last for hours after. These are noticeable no matter what primer/foundation I'm wearing. As you can see, I have a sharp nose, large cheeks, and an overbite- are these contributing to the wrinkles? Would it require surgery to fix, or fillers, or both over time?

Doctor Answers 3

Do nothing!

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Alyssa, This photo shows a perfectly healthy youthful looking face. I would give strong consideration to doing nothing at all except daily SPF 30 that offers protection from UVA and UVB rays. Avoid tanning. Your skin looks great, just do the above to maintain it. However, if you must do something, do fillers. The photo looks as though you have a little less facial volume on your left. This is asymmetry and we all have it to some extent, so it is normal. However, we tend to associate facial symmetry with attractiveness. I might try a little Radiesse to the left malar, nasolabial and marionette areas. Or not.

Austin Dermatologist

Reducing Wrinkles Around the Mouth

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Wrinkles occur because:

  • contraction of an underlying muscle (the muscles of facial expression) corrugate the overlying skin (dynamic wrinkles)
  • As we age:
    • the dermis thins and loses elasticity;
    • there is a loss of facial fat (a gliding and padding layer between the muscle and skin;
    • facial muscles get thinner and may lose tone
    • some loss of facial bones contributes to the loss of facial volume

There are multiple possible methods for reducing wrinkles around the mouth (perioral wrinkles):

  • Slow down aging and loss of elasticity
    • ulta-violet/sun protection
    • good skin care regimen, including anti-oxidants
    • proper diet, hydration, exercise contribute to skin health
  • Weaken the muscles causing the wrinkling: BOTOX/botulinum toxin
  • Plump the deflated/depressed area: restore lost volume
    • fillers and/or fat grafting

The best option for you can best be determined in consultation with a specialist.

Whatever you decide to do, don't stop smiling!

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 46 reviews

Fillers are a simple solution for facial creases...

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You are young and have a very pretty smile.  The creases you are describing are moderately related to the features you suggest but more specifically related to your face muscles and the overlying skin.  To improve upon these, a combination of great skin care (moisturization and sun-protection) combined with the use of soft-tissue fillers may be able to give you the results you desire. If you are uncertain, starting with a soft-tissue filler with a shorter life-span (i.e. Juvederm/Perlane/Restylane) will allow you to test things out without committing to something long-term.  

 A consultation with an experienced aesthetic provider will give you more information and the opportunity to see if soft-tissue fillers are right for you.  I would not recommend surgery at this time other than possibly fat-injections/augmentation if you like the results you obtain with soft-tissue fillers - this has its own risks and benefits that need to be considered, and thus warrant a thorough discussion with your aesthetic provider.

Michael G. Brandt, MD
Toronto Facial Plastic Surgeon

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.