Sagging and lines around mouth, best treatment? Voluma? Laser? Botox? (photos)

I'm noticing my skin sagging by my mouth and deeper lines (is it the marionette lines?). What would be best for this? Filler? It seems worse on my left side than right.

Doctor Answers 12

Sagging Mouth and Combination of Fillers and Thermage

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Since the jowls are the area that bother you I would recommend a combination of fillers and Thermage.  Thermage will tighten the skin in this area and Voluma and Restylane Lyft will give you an immediate mid-face lift and help with the corners of the mouth as well.  Please consult an experienced board certified dermatologist for the best cosmetic results.  Best, Dr. Green


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Thank you for your question. Voluma adds volume to the cheeks and mid-face, which commonly become drawn as the human body ages and collagen production. Voluma is often used to enhance the lips and lines around the mouth. I suggest that you move forward and consult with a board certified facial plastic surgeon.

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Combination of fillers

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Based on your photo and description, I would probably recommend a combination of fillers. Yes, Voluma could be a great choice to add volume to your mid-face and "lift" your cheeks. Then, I would probably recommend a thinner filler to treat any remaining lines around the mouth. Schedule a consultation with a board certified plastic surgeon in your area to be assessed in person and discuss your best options. 


Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 38 reviews

Voluma Question

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Thank you for your question! My aesthetics nurse, Annie Bruno, RN typically treats the mid-face with voluma (if applicable to the patient) first for lower face sagging as this is helpful with vertical lifting. Adding volume to the natural cheek bone structures of the face will help with cheek "sculpting", but also lower face sagging, the tear trough area, as well as nasolabial folds. Additional juvederm xc, or juvederm ultra plus can then be added if necessary. I would advise breaking up your appointments and injecting no more than 2 syringes of product at a time. Injecting slowly can greatly improve accuracy and outcomes. I hope this is helpful to you!

Be well, 

Dr. Todd Hobgood, MD

Todd Christopher Hobgood, MD
Phoenix Facial Plastic Surgeon
4.9 out of 5 stars 57 reviews

A Filler Can Help Sagging Skin and Balance Sides of the Mouth

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Sagging skin around the mouth is usually due to a combination of skin laxity and volume loss.  Therefore, the ideal approach is to address both problems.  When the fat pads around our mouth begin to shrink in size due to genetics and age, the overlying skin loses support and forms deeper folds.  You’re right to notice that this is happening to a greater degree on your left side than on your right.  Use of filler in these areas can correct this problem.  Similarly, over time our skin begins to lose collagen and elasticity due to age and photo damage.  This leads to a degree of skin laxity that can also contribute to sagging skin around the mouth.  To address this issue, non-surgical methods for skin tightening such as focused ultrasound or radiofrequency can be quite useful.  Combining both filler and skin tightening will provide the best results for you.  As both of these procedures require a degree of skill, experience, and training, best to consult with a Board certified dermatologist for further information.

Douglas Wu, MD
San Diego Dermatologist
4.9 out of 5 stars 53 reviews

Best Treatment for Sagging Skin Around Mouth

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Thank you for your question and photos.  Voluma would be an excellent choice for treating the areas of concern that you have expressed.  Because Voluma has a tighter matrix than other fillers, it is perfect for being administered deep to the cheek bone, which, in turn, provides lift while minimizing the sagging you are describing.  Often, problems on the left side of the face are more noticeable for folks because of many years of sun exposure on that side of the face while driving our cars.  I hear my patients complain often that the left side of their face needs more support.  In conjunction with Voluma, you could do a series of radio frequency skin tightening that will only give you even more improvement.  Reach out to your favorite plastic surgeon's office and tell your injector your needs and you will be on your way to feeling better.  Wishing you so much bliss on your journey!

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Marionette lines and sagging skin: Voluma or laser

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hello, based on your pictures I would recommend a combination treatment.  The mid face can use some "lifting" filler such as Voluma or restylane lyft.  Your left check appears full in the picture despite the marionette noticed on that side.  In the pic, your right cheek looks a bit flat.  This is where Voluma would be great.  Now you can use softer fillers for the lower face for a quick fix, but I think long term, a co2 fractional laser treatment may be far more superior to soften the lines.  Ultherapy for lower face is another option, but you won't see any wows right away.  Good luck!

Sagging and lines around mouth, best treatment?

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Thank you for sharing your question and photograph. I see your areas of concern and I would advocate for Voluma into your cheeks, with a greater amount into your right to achieve improved symmetry.  You can then use a thinner filler, such as Juvederm to fill in any remaining depressions of the smile lines and marionette lines.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

Sagging And Lines Around Mouth, Best Treatment? Voluma? Laser? Botox?

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Thank you for your question and for sharing your photograph.  Based on your photo, the use of fillers such as Juvederm and possibly Voluma would most effectively address your concerns.  Beautiful and natural results can be achieved.  Please be sure to see an expert injector for an in-person consultation to fully discuss your goals and expectations in order to determine the best treatment plan.  Hope this helps and best wishes! 

Improving the sagging around the mouth

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This can be improved with fillers. I would use Restylane or Restylane Lyft. Placement in the marionette lines and NLF will help. Sometimes sagging is related to loss of cheek support but you appear to have good volume in this area. Infini can always be added for tightening the skin in this area as well.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.