Are these deep folds next to my mouth caused by sagging skin or are they caused by volume loss?

Your face looks normal so one option is to do nothing and leave it alone.

The contour of the face especially around the mouth it’s pretty complex. There are deep structures that pull in various vectors as part of the muscles of facial expression. The pull of these muscles is deep to the skin and creates contour irregularities on the skin surface. With age skin laxity develops but even more so it’s a lack of skin elasticity. Volume change happens as well and all of these variables contribute to some degree. It isn’t a one single problem. this is why you’re not getting a definitive answer. There isn’t one.

Volume restoration works well for some areas skin tightening or skin tension may work well in others. Nasal labial folds do very well with fillers while marionette lines are difficult to treat.

How about just accepting the way your face looks as being OK and normal.

Young men should spend less time looking in the mirror and more time pursuing their desires.

Best,

Mats Hagstrom MD