50 years old. How can I fix these indents around my mouth? (Photos)

Question

50yo with good results from filler, scupltra, botox etc. I have facial volume loss with cheek hollowing due to ageing/normal body weight. Also Indents around mouth which bother me despite good other results. What can i do to get rid of these? I'm worried filler is too bulky or is it just ensuring no overfil?

Nelson Lee Novick, MD · Answer

At least from the photos provided, it would appear that volume deficit in the central cheek regions are responsible for both the indentations and the drooping Marionette lines around the angles of the mouth. The very fact that when smiling the indentations become much less evident supports this , since , in the third photo, smiling essentially pushes volume upward and backward thereby diminishing the indentations.. 
Accordingly, the appropriate use of a robust HA filler cautiously injected (so as not to overfill) into the cheek hollow is likely not only to address the cheek Indentation itself, but also to secondarily improve the marionette lines. Should it still prove necessary, a robust HA lifting filler can be used for further improving the angles of the mouth. You would be wise to consult with a board certified cosmetic dermatologist filler injector expert and best of luck.

Frank Agullo, MD · Answer

I get it that the weight would scare you. So do not just shove filler into the crease. These indentations sit at your mouth corners, in the marionette and prejowl zone, and filler only ends up bunching into a big heavy line. The crease is tethered down, so nothing's lifting it from below. And the crease filled only adds bulk and camouflages the tether.

Solution: two things: Step 1. Lift with firm filler injected deeper to support the prejowl pad and jowl and lift the pad slightly and the crease should relax from below. Step 2. Release: If you feel that the crease is anchored down from below, I will subcise to break that up a bit and then inject some product or your Sculptra into the space where I release it, rather than over the line. You finish with a few units of Botox into the muscle pulling down the sides of your mouth (your DAO muscle). This softens the crease, removes shadow and you do not end up with a heavy jowl. I cannot know for sure how much of that is a tether versus a true volume loss problem without a visit, though.

#StayBeautiful,

@RealDrWorldWide

Anna Chacon, MD, FAAD · Answer

What you’re describing is actually very common in the early-to-mid 50s—even in patients who have already done a good job maintaining facial volume with treatments like filler, Sculptra, and Botox. The face doesn’t just lose volume evenly; it shifts in different compartments, and that’s why you can end up with relatively smooth cheeks but still notice “indentations” or shadowing around the mouth.

Those indents around the mouth are usually related to a combination of midface descent, subtle fat pad deflation, and ligament tethering. Even when overall volume is well-treated, these transition zones can still look a bit hollow or “cut in,” especially with certain lighting or facial movement.

One important point is that this area is very sensitive to overcorrection. It’s not just about adding more filler—it’s about where it’s placed and how superficially or deeply it’s injected. If filler is placed too directly into the indentation itself, it can sometimes look heavy or puffy without actually improving the shadowing.

In cases like yours, I usually think more in terms of restoring structural balance rather than filling the line directly. That can include:

Subtle support of the midface (cheek/lateral support) to gently lift the area
Very conservative, strategically placed filler around the piriform and perioral support zones rather than directly into the crease
Using biostimulatory agents like Sculptra in carefully selected planes to improve overall tissue quality over time
Sometimes combining with skin-tightening modalities if there’s mild laxity contributing to shadowing

The concern you mentioned about looking “too bulky” is valid—and it’s exactly why less is often more in this region. The goal is not to erase every line completely, but to soften the transition so light reflects more evenly across the face.

A lot of the best outcomes here come from refinement rather than volume addition—small adjustments, layered gradually, instead of one larger correction.

So in short: yes, it’s absolutely possible to improve these indents, but the strategy is usually more about restoring balance and support than simply filling the area where you see the indentation.

50 years old. How can I fix these indents around my mouth? (Photos)

Answers (3)

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