How do I permanently fix my smile lines and make them much less prominent for as long as possible? (Photo)

Full face photos would have been especially helpful for determining to what extent, if any, volume depletion in the upper cheeks may be playing in the development of your smile lines. However, if indeed the smile lines are the prime issue and longer-lasting results are sought above and beyond what can be achieved with fillers, I would suggest that subcision accompanied by the filler be entertained as one possible, natural, relatively inexpensive approach. Subcision which may be used for scars and folds (your issue) works by breaking up tethering fibers and stimulating new, native collagen and elastic fiber synthesis. The same needle or cannula be used to accomplish this can also be used to inject the filler. I would not recommend permanent fillers of any kind, as permanent fillers can translate--even five, ten or twenty years later--into permanent complications. So beware of these. You also need to note that permanent improvement is very unlikely, since changes in the surrounding tissues inevitably that will occur with aging will likely result in re-formation of the smile folds (in addition to other age-related changes) in the face. Make sure that you consult with a board certified aesthetic physician and best of luck to you.

Wrinkles can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like RF treatments, lasers, microneedling/PRP or sculptra to get increased collagen, tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

We usually do not treat smile lines in isolation but treat the face as a whole.  The photos do not show your whole face but often the cheek needs more volume and support because movement of the cheek fat pad is what creates the folds from nose to mouth.  Medical grade skin care is a must and collagen stimulation. At your young age you are still producing collagen so you are a great candidate.  There are several ways to approach your needs but none are permanent unfortunately.  As we continue to age and as your face and body matures changes will continue.  Combination therapy can be employed.  The helpful modalities include but may not be limited to skin care to include UV protection,  longer lasting collagen stimulating fillers such as Sculptra, Bellafill or hyperdilute Radiesse, energy based skin tightening, PRP.