Best procedure for premature aging around mouth and eyes? (Photo)

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

Thank you for your question and for providing photos. You don’t appear to be a candidate for any surgical intervention at this time. Though you’ve tried dermal fillers with unsatisfactory results, the formula, dosage, and place of administration should all be taken into account to achieve optimal results.
You also mentioned that you’ve tried Morpheus8. While one treatment is sufficient for many patients, multiple microneedling sessions may be required to achieve the best outcome. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or injector. They will be able to review your concerns, goals, and cosmetic history to determine the best course of action for you.

I have been injecting fillers for several decades with very gratifying results for treating the kind of cheek augmentation that would seem appropriate here, as well as for straightening the angles of the mouth. The use of a robust HA filler, such as Voluma XC for the cheeks and Restylane Lyft (both of which are robust HA fillers) for the angles of the mouth when injected appropriately should give quite durable results. Now, if you were injected say with plain Restylane or ordinary Juvederm, and say you paid "per syringe" (which is a more novice injector way of "selling" filler treatments), your result would not be expected to last very long, since neither is robust enough to withstand mechanical demands imposed by these particular locations. The lack of success with the relatively expensive, faddish "bells and whistles" energy-based devices is also hardly surprising, since, unfortunately, the hard science to support their use lags woefully behind the heavy marketing hype to promote them. Before jumping to the next faddish treatment, you would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.