Why do my cheeks puff up so much when I smile? (Photo)

Thank you for your question and for providing photos. Botox injections can slim down the lower third portion of the face and slenderize the jawline when injected into the masseter muscle, with results lasting approximately 3-4 months.
For a more long-term solution, buccal fat removal can improve cheek and jawline definition while reducing a rounded appearance in the lower part of the face. By removing the buccal fat pad, fullness in the area between the cheek and jawline is reduced to create a more defined and contoured appearance. Since buccal fat is not regrown, the results of this procedure are permanent. This approach should also reduce the weight carried around your mouth and reduce the appearance of the lines you’re referring to. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or injector. They will be able to discuss your concern with you and help you decide on the best treatment option.

First of all, we would have to make sure that you are at your ideal weight since it can impact the overall shape of the face. Then, the buccal fat pad removal procedure (also known as bichectomy) would be the first line procedure and can help tremendously when performed on patients who are unsatisfied with the roundness appearance of their face.