What are my best options to fix the deep lines in the corner of my mouth?

A combination approach would give the most improvement. Deep wrinkles and smile lines can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like J Plasma, RF treatments, lasers, microneedling/PRP, salt facials, Cosmelan for skin tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Hello and thank you for your question.  An option for you to consider is PDO Threads.  PDO threads add volume and lift with little to no down time.  I would consider this a lower face lift but by using PDO threads to do the lift you could return to work immediately after.  The results continue to improve over the next few months to give you a natural lift without the use of fillers.  They can be used in combination with fillers as well as with a Platelet-Rich Plasma facial.  Hope this answer helps and best of luck from the Art of Ageless Aesthetics.

Thanks for the photo. Fillers continue to evolve, both in product choice and techniques to deliver them. I have had good success with a new Juvederm product called Volux to treat challenging marionnettes, chins and jawlines that previously did not respond adequately to other hyaluronic acid fillers. There is a considerable period of time following treatment with Volux of swelling and stiffness while the product settles into place, but the end result is a definite improvement over previous treatment results. Seek out a provider who has been using Volux for at least 6 months as your case is challenging. Best, Dr. Tkatch

Hello there,
       A lower face and neck lift is ideal to address your concerns. That being said, there are other options. I know you said you have tried different things, but I usually will do a combination of treatments to give the best result. 
     I will typically address the mid-face/lateral cheek area with filler to lift the tissue. I then would tighten the tissue itself with either Exilis Ultra or Ultherapy. Lastly, to address any volume loss/shadowing leftover, I would address the actual marionette line/jawline/jowl with filler. Hope this helps.
Sarah RN BSN 

It sounds as though you have tried many methods to treat this area.  Typically it does well with fillers, but if you haven't been satisfied you may want to try Silhouette InstaLift.  This is a procedure done in the office to lift the lower and mid face.  The results last up to 18 months.  See a board certified plastic surgeon near you to learn more.

I think fillers would be a good treatment option if you want to avoid surgery. I would treat the marionette lines and prejowl hollows with filler. I would also consider adding some filler to the chin. Finally, I have found success using Kybella off label to treat the jowl fat itself.

A small pouch of fat that is sitting above the marionettes line becomes more pronounced when the person tilts the head downward. this little bulge of fat is present in almost all young individuals and I would urge you to look at your own photographs when you were considerably younger as in between 16 and 25 years of age. The photographs do not show your whole face which is important as the whole face is still connected. Sometimes fat grafting in the completely different areas will tighten the skin and restore the more youthful appearance of the face. I would urge you to go to a plastic surgeon who specializes in fat grafting to treat the area outside of your mouth. I hope this helps and good luck from New York City plastic surgery