Which procedure would reduce the appearance of sagging around the mouth? (photos)

Question

I am a 42 year old woman who began using pretty minimal botox a year ago to treat crows lines and in the chin to try and reduce appearance of perioal mounds. I feel like my face is sagging more and more around the mouth. I am not ready for surgery but really unhappy with how much this ages me. What would be a good treatment to reduce the way my face is dragging down around the mouth?

Anna Chacon, MD, FAAD · Answer

Hi! I completely understand how frustrating it can feel to notice sagging around the mouth—it can really change the overall appearance and make you feel older than you are. Since you’re not ready for surgery, there are several non-surgical options that can help improve this area.

1. Dermal Fillers:

Fillers can restore volume in the cheeks, around the mouth (marionette lines), and along the jawline.

By supporting the tissues from underneath, they can lift and smooth the areas that are sagging, making the face look fresher and less “dragged down.”

Commonly used fillers for this area include hyaluronic acid-based products like Juvederm or Restylane.

2. PDO or PCL Threads:

Threads can create a subtle lift in the midface and around the mouth by mechanically lifting sagging tissue and stimulating collagen production.

Results are more gradual but can last several months to a year.

3. Energy-Based Treatments:

Ultherapy (ultrasound) or radiofrequency skin tightening can stimulate collagen and provide a gentle lift over time.

These are great if you want gradual improvement without injections.

4. Combination Approach:

Often the best results come from combining fillers for volume, threads for lift, and energy-based treatments for skin tightening. This addresses sagging from multiple angles.

A few additional tips:

Skincare with retinoids and peptides can improve skin quality and firmness.

Maintaining a healthy lifestyle—hydration, sun protection, and avoiding smoking—helps preserve results.

Essentially, non-surgical treatments can significantly improve sagging around the mouth, though they won’t replace a surgical facelift if the sagging becomes more advanced over time.

If you like, I can suggest a step-by-step plan for gradual, natural-looking improvement that doesn’t involve surgery.

Eric M. Joseph, MD · Answer

When somebody has indentations below the corners of their mouth, these tend to be called marionette grooves. Depending on your examination, microdroplet Silikon-1000 injections maybe considered for filling these areas permanently. I hope this helps to answer your question. Sincerely, Dr Joseph

Nelson Lee Novick, MD · Answer

So, if you don;t want surgery you're in luck. In fact, very few ethical physicians, I would venture to say, would even suggest or recommend surgery for the minimal sagging you appear to currently have around the mouth. The rather minimal marionette lines seen in the photos provided are routinely treated, practically every day, in any active cosmetic dermatology practice. The results of treatment in this way are typically immediate and treatment engenders little to no significant downtime. You would be wise to consult with an experienced, board certified cosmetic dermatology filler expert. Hope this helps and best of luck.

Camille Cash, MD · Answer

From the submitted photos it appears you would have the best result from a combination of treatments.  Fillers can be used to add volume and improve facial contours.  Morpheus8 is a great adjunct treatment which combines RF technology with microneedling to improve overall skin tone and texture.  We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

Sheryl D. Clark, MD, FAAD · Answer

Hello Fabulous:

Your photos show furrows and loss of jawline definition due to normal bone loss which begins after age 35. Since you have less volume of skeletal bone for your skin to drake over, you see some furries and sagging beginning. The treatment for this is to replace the volume at the locations and depths where it has been lost, with fillers, By careful planning with understanding of the anatomy and also the rheology of fillers and using blunt-ripped cannulas, you can have a safe very natural result with a small amount of filler that will last at least 2 years. Please consult an advanced expert with years of experience for the best result.

All the best from New York City, 
Sheryl Clark MD, FAAD

Darryl J. Blinski, MD · Answer

Ions best option is seen in the posted. Photos is a mini interior facet with muscle supplication. Feed $5000-$8000. Best of virtual consult with.

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