Will fillers help with sagging aging skin around mouth? (photos)

Thank you for your question. You are 44-years-old, and are ready for more filler to be applied to your cheeks and tear troughs, but are asking about improving the areas around your mouth and jawline, but you are not ready for a facelift. You ask what filler can be appropriate for this area. You also indicate you need lipo around your chin.
I can certainly guide you based on the photos you submitted, without the benefit of a physical exam. I’m Dr. Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. As a facial cosmetic surgeon, I’m experienced in all types of facelifting techniques, but these are not appropriate for people your age where loss of facial volume is a bigger concern than skin and tissue sagging, so I do use filler for facial rejuvenation.
Starting with the lines around your mouth, you are correct that fillers can likely help you. The lines at the corners of your mouth are called mesolabial folds, that are commonly referred to as marionette lines. These folds are also due to the same facial volume loss, and can be corrected with a thicker filler like Juvederm Ultra Plus, and perhaps an even thicker filler like Juvederm Voluma. I place these fillers deeper than most other doctors, at the bone level instead of the soft tissue level. By placing filler deeper, the filler doesn’t have the same tendency to shift, or look heavy or amorphous. Restoring volume can soften these lines, as well as the other mouth lines further up, and closer to the nose called the nasolabial folds, or commonly called parentheses lines. As the added volume lifts skin away from the bone structure, the treatment also has a lifting effect. Thicker hyaluronic acid fillers can last 1-2 years.
Deep placement of filler at the bone level, called Structural Volumizing, or the Y Lift, is especially important when placing filler at the cheek, so you may want to ask for it when you have cheek filler applied.
What happens at your jawline is that when volume is lost due to aging, an area in the jawbone called the mandibular notch hollows, so continuity in your jawline is interrupted with an indentation. I would place a hyaluronic acid filler like Juvederm Ultra Plus or Juvederm Voluma at the bone level to restore volume and continuity. I can also consider a harder filler like Radiesse, which is made of the material calcium hydroxyapatite, which is a material similar to bone.
As for the fat under your chin, yes, facial liposculpture can remove the fat permanently. Unlike non-surgical treatments for this area that may require several treatments, facial liposculpture is technically surgery, but it can resolve this issue in only one treatment that can be done in under one hour.
Meet with cosmetic surgeons who are experienced in facial surgery like facelifts, but also choose to do facial fillers when appropriate. Placement of filler at the deeper level does require extensive knowledge of the facial anatomy that only facial surgeons have, so doctors who don’t do surgery won’t be able to apply this technique. I hope you found this information helpful. Thank you for your question.

I think for best results your lower face should be addressed as a whole. I would recommend a combination of fillers for volume loss around the mouth, CoolSculpting/Kybella/Radiofrequency to help reduce double chin fat, define your jawline, and tighten loose skin. Results will not be obtained overnight, but they will be long lasting and ultimately give you the most satisfaction. Make sure you see an experienced physician provider for an in-person consultation and evaluation.

A combination approach will give the most improvement. I recommend fillers for the folds themselves but also lifting around the mouth and cheeks to build underlying anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments, J Plasma and peels to get the most conservative natural look. Please see a facial sculpting expert. Best, Dr. Emer