Small fat pouch on each corner of my mouth. I'm 44 years old. Dermatologist recommends Sculptra, but I'm not convinced. (Photos)

Based on the angles of the photos, it is difficult to say, however at first glance I would be more apt to want to treat you with a hyaluronic acid filler than Sculptra to add volume and counteract the jowling. An in-person consultation would be critical in determining a treatment plan for you - this way I could see your face in its entirety and discuss your concerns and goals. If your dermatologist didn't convince you, I would suggest an in-person consult with another board certified dermatologist or plastic surgeon with experience injecting both Sculptra and hyaluronic acid fillers and get their opinion before having anything done.

These fat pouches are actually early jowling, which happens from either weight loss and/or gravity.  You appear to be very thin.  So, I agree Sculptra is probably the first thing to do, in order to replace the volume in your face.  This will provide a more full, youthful appearance.  I like to do this first, followed by threading if a lift is still needed (or I combine them), which works extremely well.