What can I do for these awful lines on my cheeks when I smile? I'm only 38. (photo)

I recommend a combination approach with fillers for the lines themselves and to provide anatomical support along with Sculptra for collagen building. Lasers and microneedling/prp will improve texture and tone, while ultherapy and rf treatments can provide skin tightening and lift. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

It appears that treatment with soft tissue fillers would be one of the options to treat deep facial lines in your case. There may be some other options like micro and nano fat grafts as well. Treatment of finer facial lines is usually with chemical peels like TCA.A consultation with a board certified plastic surgeon with good reputation in facial rejuvenation should be your next step. Good luck.

A full face photo at rest (not smiling), as well as a side view, both at rest and while smiling would have been very helpful. Nonetheless, your problem is so relatively common that some general comments are in order. The age at which these lines appear depends upon individual genetics, as well as prior history of exposure to sunlight and smoking. While these lines tend to become more pronounced with dynamic use of the muscles of facial expression, after years of daily motion, the lines typically become "etched" into the surface of the skin and are visible even at rest. Unfortunately, Botox (and the other neuromodulators) that are so effective for upper face (forehead, between the brows and crow's feet) dynamic wrinkling cannot be used in the lower face without risking affecting the ability to smile and emote naturally. However, the use of fillers, such as Restylane Skin Boosters or Prophillo (bot not yet available in the U.S.), or Restylane Silk and Belotero Balance, injected in a microdroplet grid pattern and/or a fanning technique to hydrate the skin can often result in considerable smoothing as a result of not only the improved tissue hydration, but due to stimulating new, native collagen and elastic fiber synthesis (bio-remodeling).  One or more treatments may be needed for optimal results, which take between four to six weeks following treatment to achieve. Be cautious when you hear about claims for this or that, relatively expensive, supposedly "next big thing" to come along light or energy-based device, as much of what you hear is simply marketing hype and advertising copy with little hard science to back it up. Make sure you consult with a board certified aesthetic physician with experience and expertise in the sophisticated uses of fillers and be sure to ask to see his/her before and after photos before agreeing to proceed. Best of luck to you.

The current gold standard treatment for what we call the "accordian" lines in the lower cheek is tightening the skin there with a frequency treatment such as Viora® or Exilis®. 

Hi,
Thanks for your question. A combination approach is best. In our clinic we use  a series of Sculptra treatments to build a scaffolding / network of collagen in this area as well as for its skin tightening effects. If you want immediate results other dermal fillers can be used. If after these treatments you still note persistent lines in I would recommend a skin tightening device. I hope this is helpful.
Best, 
Kevin Cavanaugh, MD

This is a good question.  This is a natural phenomenon that occurs when we all smile.  It is different in each person as to the deepness of the creases.  The most obvious answer is fillers.  There are many on the market and they will all work in some way shape or form.  Since you have only provided one photo, it is difficult to be accurate with my next statement.  If there is excess skin, some patients may benefit fro, a mini - lower facelift.  This can be measured and examined in person.  If there is enough excess skin for a mini facelift, then removing skin via a facelift would give a much better result than fillers.  If I were to perform a mini facelift, I would also add Fat transfer to those creases at the same time.  This improves the creases just the same as filler does.  And the mini-lift adds another component to the result.  Doing this together will give a longer lasting result and much better in the long run if there is excess skin.  It will also refresh you 7 to 10 years younger.Hope this helps.

From the picture- you may benefit from cheek fillers (voluma) and also consider some filler (Juvederm) into the folds themselves if the cheek fillers don't provide an adequate lift. I would follow this up with a "tightening" procedure to make the skin look more youthful and vibrant- such as with a chemical peel and/or laser. Best. 

 Hi, those lines represent folds of excess skin and the presence of "jowls" despite being only 38 years of age.  I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts on women in their late twenties and early thirties that had early jowl formation.  Non smiling photos of your face from the front and side would help in the evaluation.  Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face if the cheeks are flat in the front.  If there's excess fat in front or below the cheeks, liposuction can be combined to further shape the cheeks and face.
 "Jowls” in the lower face represent sagging facial tissues and are the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
Hope this helps.