What is causing these shadows above my mouth and how do I fix it? (Photos)

Question

My upper gum area seems to protrude out more than most people’s, causing the shadows I’m showing here. However, none of my dentists or orthodontists have ever said anything about it, so I’m not sure if it is that my mouth is over projected or that my midface is sunken…or maybe something else? What do you think is the cause and what can I do about it? (Female in my 20s. I’ve had some cheek filler.)

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. It sounds like your upper gum or maxillary area might be a bit more prominent anatomically, which can definitely influence how shadows fall along the nasolabial folds. This kind of projection can make the folds appear deeper because the facial contours naturally cast more shadow in that area. Since you’ve already had some cheek filler, it’s possible that your midface volume is pretty well-supported, but the contrast between your cheek volume and the forward-set maxilla could still emphasize the folds. If it’s bothering you cosmetically, rather than adding more filler to the folds (which could make things look heavier or more unnatural), a better approach might be subtle contouring in nearby areas—like along the lateral cheek or even the temples or jawline—to balance the projection. Sometimes even a small adjustment in facial framing can shift the focus and soften shadows. I hope this helps and best of luck!

Nelson Lee Novick, MD · Answer

It is difficult to say from the photos provided, however, if there is volume deficit in the mid-cheek area above, this could account for the smile fold indentation you outlined in the photos. If so, then a sufficient amount of a properly injected,  appropriately robust HA contouring filler would provide the lift necessary to both maintain a heart-shaped face AND smooth the transition between the cheek and the mouth, essentially eliminating the problem indented area. 
However, if the prior filler cheek augmentation was properly performed with the appropriate filler in sufficient amounts, then the indentation can be lifted and smoothed directly with a low viscosity, malleable, cohesive HA filler in order to smooth the transition. 
You would be wise to consult with an experienced, board certified cosmetic dermatologist and best of luck.

Anna Chacon, MD, FAAD · Answer

While I am unable to view photos or provide a specific diagnosis without a physical examination, I can offer some general information that might help you understand potential causes and solutions for the shadows above your mouth.

The appearance of shadows in the area above the mouth could be influenced by several factors, including:

Facial Anatomy: Natural variations in facial structure can cause shadows. This might include a prominent upper jaw (maxillary protrusion) or a relatively recessed midface.

Soft Tissue Volume: Loss of volume in the midface or around the mouth due to aging or genetics can create shadows or an over-projected appearance.

Dental Structure: The alignment and position of your teeth and bite can affect the appearance of your lips and the surrounding area.

Skin Texture and Tone: Variations in skin tone, texture, or even pigmentation can create the appearance of shadows.

Considering that you have had cheek fillers, it's possible that this has altered the way light interacts with your facial features, potentially enhancing shadows in other areas.

Possible Solutions:

Consultation with a Dermatologist or Plastic Surgeon: A professional evaluation can offer insights into whether further cosmetic procedures, such as additional fillers or other treatments, might help balance your facial features.

Orthodontic Evaluation: If dental or skeletal alignment is contributing to the appearance, an orthodontist might suggest braces or other treatments to adjust your bite or jaw position.

Makeup Techniques: Using makeup to contour and highlight specific areas can effectively reduce the appearance of shadows.

Skincare Treatments: Addressing any pigmentation issues with skincare treatments or laser therapy might also help.

For a personalized plan, I recommend scheduling a consultation with a dermatologist or a facial plastic surgeon who can assess your specific concerns and goals.

Mustafa Aydinol, MD · Answer

Hello!Thank you for sharing your photos and explanation.
The shadows you are noticing are likely related to volume loss in the midface and perioral area rather than true overprojection of your mouth. To correct this, I would recommend treatment with PLLA-based fillersThese fillers stimulates your own collagen production over time, helping to gradually fill and smooth out the shadowed areas you pointed out, while also providing subtle lift and support to the cheeks and zygomatic (cheekbone) area.
This approach would not only address the shadows but also enhance overall facial harmony, giving you a natural, youthful look.An in-person consultation would allow for a customized plan tailored to your anatomy and goals.
Wishing you the best on your journey!

Leonard Grossman, MD · Answer

Every single Dr and Dentist that you’ve seen are doing the proper thing especially when it does not interfere with your general health. They’re not supposed to tell you what you can have done. Every single person has some kind of an issue, but it doesn’t mean that a Physician or Plastic Surgeon for that matter has the right to tell you that it should be corrected, especially if you’re not aware of it and never asked about it. You on the other hand are aware of your issues. The photographs are of a very limited nature, but based on my experience, I believe that you may have very flat cheeks. Lack of fat in the cheek area creates those little folds around the nasolabial area. If I am correct, I would recommend fat grafting to the cheek area. With a proper technique the results should be permanent and natural. I hope the self and good luck from Leonard Grossman, MD, organic Plastic Surgery NYC

What is causing these shadows above my mouth and how do I fix it? (Photos)

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