Do I need Botox? Or is there any other way to get rid of this around my mouth? (Photos)

Question

So I’ve been noticing more around my mouth this puffiness on the sides/corners of my mouth and I don’t know what it is? I’m 25 and started noticing it more this year. It’s a really big insecurity for me and I can see it everytime I try to take pictures of myself and I feel like it makes me look old :/ is there any way to get rid of this??

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. What you’re describing—puffiness or slight sagging at the corners of the mouth—is often related to early marionette lines, minor muscle imbalance, or mild volume changes in the lower face, even at your age. At 25, it’s unlikely to be true age-related sagging; instead, it may be caused by the orbicularis oris and depressor anguli oris muscles pulling the corners down, which can create shadowing or a “pulled” appearance. Botox can help subtly by relaxing the depressor anguli oris (DAO) muscles, allowing the mouth corners to lift slightly and reduce tension, but it must be done very conservatively to avoid a frozen or unnatural look. In addition, small amounts of hyaluronic acid filler along the marionette lines or just lateral to the corners can smooth the area and reduce the appearance of puffiness or shadow without overfilling. I hope this helps and best of luck!

Nelson Lee Novick, MD · Answer

In my experience, this is not that uncommon. I have had success using a malleable, cohesive, low viscosity HA filler to soften the shadowing and smooth and elevate the depression that the puffiness creates to the rear of it. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler injector expert. Hope this helps and best of luck

Anna Chacon, MD, FAAD · Answer

What you’re describing is something many people start to notice in their mid-20s — a subtle fullness or puffiness at the corners of the mouth that can make the lower face look a bit heavier or tired, especially in certain lighting or angles. This area, sometimes called the marionette zone, can be influenced by natural facial structure, mild volume loss, or even how expressive your smile muscles are.

At your age, Botox is not always the first solution. Often, gentle approaches that restore balance—like small, precise amounts of filler to support the corners of the mouth or improve contour—can help. Sometimes even small lifestyle adjustments, like staying hydrated and maintaining a consistent skincare routine with ingredients that boost collagen (like retinol or peptides), can make a visible difference over time.

If muscle activity is contributing to the puffiness or downturn, a touch of Botox can help relax the area subtly, giving a smoother, more lifted appearance. But the goal is always to keep your expression natural while addressing what bothers you most. What you’re seeing is very common—and with a few tailored adjustments, that balance and freshness you’re looking for can absolutely be achieved.

Citrus Aesthetics - San Diego · Answer

Hi! Thank you for sharing your concern. I completely understand how noticing changes around your mouth can feel frustrating, especially when it starts affecting photos or your confidence. At 25, puffiness around the corners of the mouth can often be caused by a combination of factors: muscle tension, early volume changes in the cheeks or lips, subtle skin laxity, or even lifestyle factors like hydration and posture.
While Botox is commonly used to relax certain muscles and soften lines, in your case, a multi-modality approach is usually the most effective. This can include:
Dermal fillers: To subtly restore support and smoothness around the corners of your mouth without overfilling.Muscle modulation (like Botox or other neuromodulators): To relax overactive muscles that contribute to downward pull or puffiness.Skin treatments: Microneedling, gentle resurfacing, or energy-based treatments can help improve texture and support collagen.Lifestyle factors: Ensuring proper hydration, facial exercises, and posture can sometimes make a subtle difference.
The key is assessing your unique facial anatomy and creating a plan that addresses both the muscle and volume factors, rather than relying on just one treatment. That’s what a multi-modality approach does, it targets the root causes for natural, balanced results.
It’s completely normal to start noticing these changes in your mid-20s, and addressing them early can actually prevent more pronounced changes in the future. A personalized consultation will help determine exactly which combination is best for you.
Aesthetic treatments should always be discussed with and performed by a trained, licensed, and medically certified aesthetic provider. The recommendations above are for educational purposes only and do not replace an in-person consultation, examination, or personalized medical advice.

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