What can be done to reduce the lines and the pouchy sags just to the outside and below my mouth corners? (Photos)

Hi @DESIGNKAT. Thank you for sharing your photos. I recommend a combination treatment of Morpheus 8, dermal fillers, and PDO threads.

Best of luck,

Dr. Nima

A combination approach will give the most improvement. I recommend fillers for the lines themselves but also lifting around the mouth and cheeks to build underlying anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments, J Plasma and peels to get the most conservative natural look. Please see a facial sculpting expert. Best, Dr. Emer

From your photo, you are very lean so volume replacement, which is what is lost as we age, is the perfect solution for correction.  Sculptra injection (usually a series of 2 or 3 several months apart) would increase the volume in a natural way and add stiffness to the skin as well.  Sculptra is also the longest lasting of the fillers and can be maintained with follow up treatments every 12 to 18 months.

Combination treatment will work best. I would start by addressing facial volume loss using a collagen stimulating filler like Sculptra Aesthetic. I would follow this up by placing the newer flexible gel hyaluronic acid based filler, Restylane Refyne, into the lines themselves. Finally, I would consider skincare and possible skin resurfacing treatments to improve the quality of the skin itself. 

This area of concern will require a multi-faceted approach.  Most often I will address this area using fillers to support, add volume, and fill the fine lines.  Sometimes I would add novathreads, both smooth and barbed,  to lift and stimulate the area.  This might be combined with micro-needling, peels, and laser treatments to further help the skins surface.  A consultation with a provider that offers a combination of the above services would be best. 

Hey there - thanks for the question.
You do appear to have some cheek volume loss which would be contributing - so you may want to consider a cheek lift with fillers before replacing the lost volume in the lower face.
Unfortunately you probably wont get drastic results with just ml per side and may need to get a number of treatments over a few weeks or months.

Getting Radiesse or Sculpta injections into buccal, temporal, preauricular and perioral areas should correct this problem.