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.