How to the fix bone structure around my mouth causing lines/shadows? (Photo)

Question

I'm 19 and I don't know how to solve this issue. I noticed these lines/shadows and thought they could be smile lines, but after trying Gua Sha and other exercises, also streching my skin, I noticed that nothing changes, so I came to the conclusion that it's probably a bone structure problem and don't know how to fix it or which procedure is the one that could help me with this situation.

Nelson Lee Novick, MD · Answer

At least from the photo, it would appear that there is a side-to-side depression above the upper lip and below the nose. The careful and precise use of an HA filler can help to smooth this depression and create and smoother transition between the vermilion of the upper lip and the columella of the nose.
To test this, an experienced injector can use plain saline injections or diluted anesthetic solution into the region, as a test, which should give a decent idea of what can be expected with actual treatment. 
In the hands of an expert injector, actual treatment should take no more than about five minutes to perform, with immediate results and little to no significant post-treatment downtime. 
Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

At 19, it's very unlikely that what you're seeing is caused by aging or true "smile lines." From your description, and based on what you're noticing when you stretch the skin, I think you're asking an important question.

If the shadows don't disappear when you pull the skin taut, they are often related to your natural facial anatomy rather than wrinkles. Several factors can contribute to this:

The way your cheek fat transitions into the area around the mouth.
The underlying bone structure of the maxilla (upper jaw).
The attachment of facial ligaments and muscles.
Natural volume distribution in the midface.

These features are largely determined by genetics, so facial massage, Gua Sha, or facial exercises are unlikely to change them permanently.

The next step depends on what is actually creating the shadow.

If the area is simply a normal depression caused by facial contours, treatment may not be necessary at all. Many young adults have subtle lines or shadows that become more noticeable under certain lighting but are considered completely normal.

If the shadow is due to a slight volume deficiency, small amounts of hyaluronic acid filler placed strategically—not directly into the line itself—can sometimes soften the transition. The goal is to restore balance rather than add noticeable volume.

If the issue is truly related to skeletal structure, fillers can camouflage it to some degree, but they cannot change the underlying bone. Surgical procedures that alter bone structure are generally reserved for significant functional or structural concerns and are not typically recommended for subtle cosmetic shadows in someone your age.

One thing I would be cautious about is treating these areas too aggressively at 19. Your face is still youthful, and excessive filler can create an unnatural appearance. In many cases, less is more, and sometimes the most appropriate recommendation is simply observation until facial volume naturally changes with age.

From your description, I don't think you've done anything wrong, and I certainly wouldn't blame yourself for not seeing improvement with Gua Sha or exercises. If the shadow is anatomical, those methods aren't expected to change it.

Overall, I would first determine whether the shadow represents a normal facial contour, a mild volume deficiency, or a true structural issue. Once that distinction is made, the appropriate treatment—if any—is usually much more conservative than people expect.

How to the fix bone structure around my mouth causing lines/shadows? (Photo)

Answers (2)

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