What are these shadows under the corners of my mouth? How can they be fixed? (Photos)

Question

I am now 19 years old and I’ve always had these.Even when I was 11 years old.I am 1,68 and 52 kg but even with a smaller weight,I still had those.I don’t understand what are they and how can I fix them.Are they from fat or maybe my bone structure ?

Carl Truesdale, MD · Answer

The shadows at the corners of the mouth (sometimes called marionette lines or oral commissure shadows) are one of the most aging features of the lower face. They usually come from one or a combination of:
Volume loss in the prejowl area, the small triangle of tissue just lateral to the chin. As this deflates, the corner of the mouth loses support and creates the shadow.
Loose tissue descending from the cheek and jowl area, which deposits along the labiomandibular crease and exaggerates the shadow.
Hyperactive depressor muscles, primarily the depressor anguli oris (DAO), which actively pull the corner of the mouth down with expression.
Treatment options:
Filler in the prejowl area can soften the shadow significantly when volume loss is the dominant cause. HA filler placed deep against bone works well. Lasts 12 to 18 months.
Botox to the DAO can lift the corner subtly and reduce the depth of the shadow with animation. Very low dose (2 to 4 units per side) is the safer starting point because overdosing creates an unnatural look.
For deeper cases where descent and laxity are the issue, surgical lifting (lower facelift or deep plane) is the more definitive answer. Filler alone in these patients can make the appearance worse over time because adding volume to descending tissue creates a heavier look.
What I'd do in your shoes: start with a thorough exam to figure out which of the three causes is dominant. The fix is different depending on the diagnosis. A consultation that examines you at rest and with animation gives more information than photos alone.

What are these shadows under the corners of my mouth? How can they be fixed? (Photos)

Answers (1)

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