What fillers will help with the loose skin I see when I smile? (Photo)

Question

What fillers will help all the loose skin I see when I smile ? Also my upper lip now looks to disappear when I smile, can a cheek filler help correct that or lip filler? I can see teeth shifted. When I am not smiling I have signs of cheeks drooping like I always look sad. I also am petite yet feel like the excess skin on face makes me look heavier. I would like skin to tighten up, I am 47. Thanks.

Jason Emer, MD · Answer

A combination approach will give the most improvement. I recommend fillers for the lips and cheeks themselves but also lifting around the mouth and cheeks to build underlying anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments, J Plasma and peels to get the most conservative natural look. Please see a facial sculpting expert. Best, Dr. Emer

Robert F. Jackson, MD · Answer

While injectable fillers can augment your upper lip so it doesn't disappear when you smile, they can't help with the drooping in your cheeks that concerns you. A non-surgical option like Silhouette InstaLift™ could be a possibility to refresh your appearance more than fillers can on their own but without the costs and downtime associated with cosmetic surgery.

Ray Bayati, MD · Answer

Hello,Thin upper Lips and disappearing when you smile: 4 units of Botox above the lips to relax the muscles and improve gummy smile. Lip filler (choice of Vobella, Restylane Slik and Belotero ).Droopy cheeks: adding volume in cheek and the apples would help to improve look and it is called Liquid facelift. (radiesse, Voluma and Restylane Lyft).loose skin around mid/lower face: Platelet rich plasma (PRP) + fillers combination would work. aka Vampire facelift, microneedling would also stimulate skin cells to build more collagen and elastin.Fat grafting is another technique but the results may not be as predictable.Hope the Best, Ray Bayati, MD Elite Medical AestheticsSacramento Area, California

Hardik Doshi, MD, FACS · Answer

Dawn,
Thank you for the picture posted as it helps to determine the exact areas where skin redundancy is present. Excess skin in the smile region is often seen due to a combination of volume loss (aging or weight fluctuation) and loss of skin elasticity. As we age, we lose both with the added component of sagging due the effects of gravity. Volume restoration (i.e. through fillers) should be used cautiously in the mid cheek region since over filling can give you an unnatural pear shape to the face. Depending on the amount of laxity seen, non-invasive interventions utilizing heat transference, lasers, ultrasound, or radiofrequency can also be considered. However, with significant skin laxity, surgery may often be needed. A consultation with a trusted aesthetic surgeon is recommended so that all modalities of treatment can be discussed to help you achieve the best results. I wish you all the best!

Michael Nguyen, MD · Answer

Dermal filler products that are FDA approved and made of hyaluronic acid (HA), a natural component of your skin, is a preferred choice and recommended among many injectors for your areas of concern regarding volume loss of the upper face, adding volume or fullness to lips, and smoothing moderate to severe lines and wrinkles around the area of the mouth. I encourage you to do a full facial evaluation first with a board certified physician for a treatment plan. Thank you for your question and good luck!

Maurice M. Vick, Jr., MD · Answer

I recommend fillers to replace volume we lose with aging. This usually starts at about 40 years of age after that it has been estimated that about 5cc"s (5 one cc syringes of filler) needs to be replaced every year or so. I add Peleve treatments (Radio frequency) to tighten the skin. Best Wishes, Maurice Vick MD

Victoria Dobbie, BDS · Answer

Hello Dawn
Loose skin when you smile can develop due to a number of changes as we age.
Cheek drooping due to loss of padding in the fat pad as you have described. The excess skin then slides down the face and can sit in the area we can see on your photo. Solution cheek enhancement with dermal fillers. 
Secondly the skin itself thins and sits looser in the lower 1/3 of your face. Solution a skin tightening treatment with Ultherapy or Radio frequency depending on the condition of your skin.
Thirdly the affect of the muscle insertions around the mouth can exaggerate these lines especially when smiling. Solution lower face botox.
Kind regards
Victoria

Diana L. Elias, MD (retired) · Answer

You have the changes which all slender fit women begin to show in the late 40's-early 50's. Primarily it is a general loss of subcutaneous fat in the entire face with a subtle loss of skin elasticity. You represent my most challenging group of patients. First of all, we cannot correct all of the things you see completely (without making you look weird). The key is to use conservative fillers in the peri-oral area and lips (I like new Allergan products Volbella and Vollure). Then consider either filling the lower lateral cheeks (slightly!) or performing a limited jawline lift.

What fillers will help with the loose skin I see when I smile? (Photo)

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