Smile folds, my face is starting to look gaunt on the lower half. (photo)

Thank you for the question.  Injectable biodegradable fillers are excellent solutions to volume loss in the temple and lower face (e.g. a gaunt or skeletal face).  Injectable biodegradable fillers are placed more deeply in these areas rather than just under the skin.  This deeper injections extend the life of the filler, because the body does not metabolize it as quickly.  Keep in mind that, although it creates a longer-lasting effect, this method does increase your chance of bruising. 
As always, an in-person consultation with a board certified dermatologist with cosmetic training is the best way to assess your needs and provide medical advice. 

What you are calling gaunt appears from the photo to be some flatting of the cheeks and in the volume loss mid cheek regions. When this occurs above the lower face begins to show changes of wrinkles and furrows, which I believe from the photo is evident in its incipient stages. To improve this volumizing fillers, such as Voluma XC, may be used to accent and augment the cheeks (improving midfacial contour), which should secondarily (by virtue of increasing projection and upward pull) improve the problems you are beginning to notice and be bothered by in the lower face. 

My suggestion is see someone who specializes in fillers and lasers.  You likely would do well with thermage, clear and brilliant, and fillers.  With the right placement you can get lift and the other devices will give you better texture/tone as well as tighten.  Best, Dr. Emer.

Using facial fillers can be a great way to improve the issues that you seem to be complaining about. Best of luck.

I think that you look just fine but if the smile lines bother you you can either use filler into the lines or in mid-face. I  usually prefer the approach that involves pulling up rather than filling but you might do fine with just a little filling and can always do more later. What you need to be doing is making sure to wear sunscreen every day, starting now. 

The "parentheses" lines around your mouth are called nasolabial folds. While filler placed directly in those folds does diminish them, that treatment is a dated approach to rejuvenating and in recent years expert filler injectors prefer to begin by replacing volume lost in your cheeks that we believe causes worsening of nasolabial folds.  I recommend you consider Voluma to your cheeks which will lift and diminish your nasolabial folds, and bring back a more youthful shape to your face.  If you still have nasolabial folds after the cheek lift, then only a small amount of filler will be needed to complete the job.

Thank you for your question. You look great!The smile lines next to the corner of your mouth cannot be corrected. Botox cannot be used because it would cause the corner of the mouth to weaken and droop.If in time the fold running from the nose down to the mouth, the naso-labial fold, becomes worse dermal filler injections can be used. For more information please check the following link: