How can I fix this indent above one side of my mouth without filler? (Photo)

Question

I am almost 50 years old. I am pretty happy with my skin overall but in recent months this wrinkle-like divet has appeared over one corner of my mouth. It’s just on one side. I should also mention i recently had a lip flip which made it more noticeable, but it was there before that. My question is, what can be done to help this? I dont like the look of filler and am worried it would make it worse anyway. Please help, thanks!

Anna Chacon, MD, FAAD · Answer

Thank you for your question and for sharing your concerns. The indentation above one side of your mouth is a common area where volume loss, skin laxity, or changes in muscle activity can become more noticeable with age. The fact that it became more apparent after a lip flip suggests that subtle changes in muscle movement may have unmasked or accentuated the area.

If you prefer to avoid fillers, there are several other options to consider:

1. Microneedling or Radiofrequency Microneedling:
These treatments stimulate collagen production and can help improve skin texture and mild indentations over time.

2. Laser Resurfacing:
Fractional lasers (such as Fraxel or CO2) can help remodel collagen and improve the appearance of fine lines and shallow depressions.

3. Platelet-Rich Plasma (PRP):
PRP injections or microneedling with PRP can enhance skin healing and collagen production, leading to gradual improvement in skin quality.

4. Topical Retinoids:
Prescription-strength retinoids can help stimulate collagen and improve skin texture, though results are gradual and best for mild concerns.

5. Subcision:
For deeper or more tethered indentations, a minor in-office procedure called subcision can release the underlying fibrous bands and allow the skin to lift.

6. Neuromodulators (Botox, Dysport, etc.):
In some cases, strategic placement of neuromodulators can help relax overactive muscles that may be contributing to the indentation, though this is less common for this specific area.

A personalized consultation with a board-certified dermatologist or facial plastic surgeon can help determine which approach is best for your specific anatomy and goals. Each option has its own benefits and downtime, so discussing your preferences and expectations is important.

I hope this helps clarify your options!

Nelson Lee Novick, MD · Answer

Subcision, which I have been performing for thirty years, is an excellent method for elevating all kinds of skin depressions, indentations, and divets from all causes. Subcisions are based on the stimulating new native collagen and elastic fiber synthesis, which is why the result are typically long-lasting to permanent. At least from the photo provided, only a superficial subcisions would be needed to achieve the desired smoothing.  You would be wise to consult with an experienced, board certified cosmetic dermatologist with expertise in performing subcisions. Hope this helps and best of luck.

Camille Cash, MD · Answer

There are a few options you can consider to address the contour concern near your mouth.  The first is SkinPen.   This is a microneedling treatment that improves skin texture.  Several treatment sessions are generally needed.  Another option is Morpheus8.  This combines microneedling with RF technology to improve skin tone and texture.  And yet another option are laser treatments.  See a board certified plastic surgeon near you to learn more.

How can I fix this indent above one side of my mouth without filler? (Photo)

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