What can be done to minimize the appearance of an indent on my face when I smile? (photo)

Question

I have not had any HA fillers done under my eyes, only PRF. I’ve actually had the indent my whole life but now it’s showing up worse as I age. I’m pretty sure it’s due to facial asymmetry so I’m wondering what procedure I can have done to fix it. It’s most prominent when I smile.

Citrus Aesthetics - San Diego · Answer

What you’re describing is actually very common, especially when an indent has been present your whole life and becomes more noticeable with age. In many cases, this type of indentation is related to natural facial asymmetry, differences in muscle movement when you smile, and age-related volume loss which then can cause visualization of underlying ligaments, rather than a single structural issue.
When an indent becomes most visible during expression, it tells us that both dynamic muscle movement and static volume changes are likely involved. Because of this, the most effective and natural-looking results typically come from a multi-modality approach, rather than one single treatment.
Depending on your anatomy, a thoughtful plan may include:
Strategic, conservative filler placement (not necessarily directly in the indent) to restore structural support and balance asymmetryBiostimulatory treatments such as PRF, Sculptra, or collagen-stimulating modalities to improve skin quality and long-term support
In some cases, energy-based skin tightening to improve overall tissue integrity as we age
The key is understanding why the indent appears, whether it’s muscle dominance, skeletal asymmetry, volume loss, or a combination, and then layering treatments in a way that preserves natural facial movement. Treating this as a single “fill the line” issue can often make the asymmetry more noticeable, which is why a personalized, full-face assessment is so important.
A provider experienced in facial anatomy and expression-based concerns can evaluate your smile dynamics in motion and design a plan that enhances balance without overfilling or freezing expression.
Aesthetic treatments should always be discussed with and performed by a trained, licensed, and medically certified aesthetic provider. The recommendations above are for educational purposes only and do not replace an in-person consultation, examination, or personalized medical advice.

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