Double lines around mouth even after Voluma in cheeks and chin. How can I improve this and what is this from? It ages me (Photo)

After weight loss from stress I noticed the lines around my mouth have become more pronounced. A year ago I had filler in my nasolabial folds from a PA and I looked like a chipmunk so I reversed with the dissolving enzyme. Although controversial, I believe it disintegrated some of my natural hyaluronic acid and attributes to the bulges/double. I've had voluma in cheeks and 1 vial in chin but they are still here. Ive heard mixed results abt Sculptra (lumps). What are my non-invasive options?

Doctor Answers 5


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There is only so much that can be seen from a photo. What you are experiencing is going to take finesse to fix so I would suggest that you schedule a consultation with a board certified plastic surgeon in your area who can assess your face in person and then discuss the best filler options for your needs.


Kouros Azar

Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 38 reviews

Volume replacement after weight loss

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It can sometimes be difficult to fill in around folds of skin that appear after weight loss.  It appears that your lower cheeks need some volume.  I prefer Juvederm Plus blended with lidocaine fanned into the lower cheeks to plump them up.  The folds should look less noticeable after you "reinflate" the area behind them.

Lorrie Klein, MD
Laguna Niguel Dermatologic Surgeon
4.9 out of 5 stars 217 reviews

Volume loss

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Thank you for your question.  I think that you should have a consultation with a board certified dermatologist who is an expert injector to discuss in person the best treatments. From the photos that you shared (thank you) I think some Juvederm injected in strands with a cannula across the folds ( inject from the chin out to the cheek) would restore the more youthful contours and not look "chipmunk" like.

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I find that sculptra is the best foundation and other fillers can be layered on top.  Fine fillers are good for the fine lines, but contouring requires a combination approach with fillers, lasers, skin tightening.  Please see an expert. Enzymes do not damage your natural HA, the pH is completely different and many studies have shown absolutely no effect on your natural HA.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Volume loss

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Dear annie2221,
When looking at your profile it seems you have had some unhappy times after filler and botox over the last year, so it can be tough to know what's what right now. Your impressive weight loss, stress, Botox in various areas, and previous injections make it a bit hard to track where you are now.The weight loss definitely can make you feel you have aged quickly over a short period of time, and it is understandable that you want to soften this. There is an old saying that there comes a time where a woman has to decide if she "cares more about her a** or her face". Whats good for one area may be tough on another, and fillers can't always fix everything.
One word of caution that I have is that the Botox in your masseter muscles for grinding and clenching can result in a significant volume loss along your lower jawline and an increase the nasolabial folding. If this is not really medically necessary I would consider stopping that (maybe you have). It know that in an early post you wanted to decrease the volume along the jawline, but I don't know if that's a great idea. When I had Botox placed there for the same reason I really disliked what it did to my NL folds and marrionettes, so I chose to just stick with my night guard.
You have very full lips, and felt like filling the NL creases made you look like a chipmunk. It can be that your volume being more central in your face naturally, and then enhanced more here with fillers, is kind of creating an imbalance. I personally like using Sculptra in the periphery of the periphery of the face, and I too am surprised by all of the negative comments about it on RealSelf. I also am not sure if I agree with their personal assessments on some of the photos shown. Some look great and sound completely devastated. Again, it's just photos. I have had a few patients with visible nodules, but they were thankfully about a decade ago when we were still figuring this product out. This does take a long time to go away so you are just stuck with it for a while (a couple of years) if you don't like it. Maybe you could try injection the area first with a little saline to see if you like the look before proceeding.
This is all just conjecture because the photos are limited in scope and an exam is really necessary. Who every you see should have access to all of your medical photos, treatments, and notes on what you did and didn't like to help them decides what is best.
I hope this was helpful, and I hope your wedding was wonderful!

Stacey Folk, MD
Denver Plastic Surgeon
4.8 out of 5 stars 25 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.