What fillers/Botox can help these shadows? (Photo)

Question

I’m in my mid-20s, and have had cheek filler in the past to resolve some overall thinness and lack of volume in my face. I’m planning to have them redone in a couple months, but am looking into additional areas to get done (possibly chin filler, masseter Botox, etc) to fix this shadowing that has bothered me forever. It goes from my chin up to my cheek, and may be related to my upper lip projection. What can help with this?

Anna Chacon, MD, FAAD · Answer

I understand what you mean by the shadow running from the chin area upward toward the cheek. In the mid-20s, this type of shadowing isn't necessarily a sign of aging or a lack of volume. Often, it comes from the natural anatomy of the face—how the cheek, lower face, lips, chin, and jawline project relative to one another.

Cheek filler may soften some of the overall hollowness, but adding volume directly into every area that looks dark or shadowed isn't necessarily the best approach. Sometimes the shadow is created by a transition between structures rather than an actual volume deficiency.

A few things could potentially contribute:

Chin projection: If the chin sits slightly farther back relative to the lips and midface, increasing chin projection can sometimes improve the overall facial profile and reduce certain shadows around the lower face. This doesn't mean that more chin filler is automatically needed; too much can make the chin look heavy or overly prominent.
Cheek volume: Since you've previously benefited from cheek filler, maintaining appropriate midface support may help the transition between the cheek and lower face. The goal would be subtle structural support rather than simply making the cheeks larger.
Lower-face anatomy: The shadow may follow natural depressions and the attachment points of facial muscles. These areas shouldn't necessarily be filled just because they appear darker in a photograph.
Masseter Botox: This is most useful when the masseter muscles are enlarged from clenching or grinding and create a wider or heavier lower face. It generally wouldn't be my first choice for treating a linear shadow from the chin toward the cheek unless there is clear masseter hypertrophy contributing to the appearance.
Upper-lip projection: Your observation about the upper lip is interesting. The relationship between the upper lip, chin, and midface can affect how light falls across the lower third of the face. If the lip projects forward relative to the chin, adding filler without considering that relationship can sometimes make the proportions look less balanced.

I would therefore avoid approaching this as "Which filler goes into the shadow?" Instead, I would look at the entire facial profile and the relationship between the cheek, lips, chin, and jaw. Sometimes a small adjustment in one structural area can improve the shadow considerably, while filling the shadow itself can leave the face looking overfilled.

Also, because you've had cheek filler before, it's worth confirming how much product remains before adding more. Ultrasound can sometimes be useful when there is uncertainty about residual filler or its location.

In your situation, I would favor a conservative, anatomy-based approach rather than automatically combining cheek filler, chin filler, and masseter Botox. The goal should be to improve the way light transitions across your face while preserving your natural facial expressions and proportions.

Anna Petropoulos, MD, FRCS · Answer

Dear kw9078,

Thank you for your question! This area of the face is tricky for many people. The shadowing is typically due to age- or weight-related volume loss, though there can also be other factors such as muscle tension in the lower face that would be treated with botox. In our office, we would do a full facial evaluation to determine if any volume loss is occurring in the upper face and temples that could be contributing to the shadowing as well. In addition, Sculptra and other biostimulators are a fantastic option to help add volume back in some areas. These products work to enhance your body's own collagen production wherever they are injected. As I'm sure you have seen with cheek filler, increasing volume in one region of the face may help decrease shadowing nearby.

If you would like to learn more or see how we would approach your concerns, please feel free to contact our office and schedule a consultation. We would love to meet you! 
All the best, 
Genie Alexander, RN BSN 
for Dr. Anna Petropoulos, MD FRCS 
Center for Classic Beauty 
80 Lindall St. Danvers MA 
396 Commonwealth Ave. Suite A1 Boston, MA 
978-739-9500

What fillers/Botox can help these shadows? (Photo)

Answers (2)

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