I am not interested in surgery, would filler reduce the appearance of deep grooves on the corners of the mouth? (photos)

Question

The corners of my mouth have always turned downward somewhat, but with age (61) the grooves are getting deeper. Would a filler improve the corners of my mouth? I had a very bad experience with Restylane once, so I am wary of fillers but also not ready for any surgery.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos and for explaining your concerns so clearly. What you’re describing—the deepening grooves at the corners of the mouth, sometimes called marionette lines—is a very common change with age, as skin elasticity decreases and volume loss occurs in the lower face.

Fillers can, indeed, help soften these grooves and improve the downward turn at the corners of the mouth. By strategically placing filler in this area, we can restore some support and create a smoother, more uplifted look. That said, your concern about a prior negative experience with Restylane is important. Sometimes issues arise from the type of filler used, the placement technique, or even how the body responds to the product.

If you wish to avoid traditional hyaluronic acid fillers, there are alternatives that may be considered, such as collagen-stimulating injectables (like Sculptra or Radiesse), which work gradually to improve skin structure and may feel more natural over time. Additionally, non-invasive treatments like skin tightening with radiofrequency, microneedling with PRP, or even biostimulatory injectables can complement filler or sometimes be used instead.

You’re absolutely right to want to avoid surgery if you’re not ready—that’s a very personal decision. Based on your photos and your goals, a careful, conservative approach with filler or alternative injectables could make a visible difference without committing to surgery.

Lexie Wang, MD · Answer

You can do botox/neurotoxin to decrease the downward pull of the muscles in the corner of the mouth so that you make that movement less. Filler will help soften the deep groove/indentation, but I recommend against getting it very superficially because otherwise it will just look like it's floating. You also need to be prepared to be realistic about how much of an improvement you will get with non-surgical options.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Based on your concerns, I recommend treatments with Morpheus8 to help tighten the skin. Morpheus8 is an advanced fractional radiofrequency (RF) microneedling device used for non-surgical skin tightening and rejuvenation. It combines microneedling with RF energy to target deeper layers of the skin, stimulating collagen production and improving skin texture and firmness. This treatment is excellent for promotes skin remodeling and collagen synthesis, which can reduce wrinkles, tighten sagging skin, and improve overall skin tone. I hope this helps and best of luck!

Nelson Lee Novick, MD · Answer

You did not specify what problem you had with Juvederm, but whatever it was, it could have related to being treated by inexperienced injector, the wrong choice of filler for the area being treated, the wrong area treated to get the job done, etc. 
From the photos provided, there appears to be significant volume Loss in the cheeks, which is responsible for not only the flattening of the cheeks themselves, but for the depth of the smile lines and to some extent the deep Marionette lines at the angles of the mouth and even the jowls along the jawline. 
So, the use of a robust HA volumizing filler in the cheeks would not only create a more feminine, oval, heart-shaped face and ogee curve, but would secondarily improve the under-eyes, the smile lines, the jawline and the marionette grooves on the sides of the mouth. 
Additional robust filler can then be used to further more directly elevate and smooth the marionette grooves still further, which, when the cheeks are now appropriately revolumized will respond much better to treatment. (Injecting the grooves first, without addressing the cheeks first, would be an exercise in futility, as would using simple fillers, such as ordinary Restylane or simple Juvederm; (appropriately chosen more robust fillers are required here). When performed properly, one treatment session of about 30 minutes should be sufficient to yield immediate, on-the-spot results, and engender little to no significant post-treatment downtime. 
The bottom line is that you would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert. This is no place for novice, amateur, inexperienced injectors accustomed to just using plain Juvederm or simple Restylane for filling smile lines. Hope this helps and best of luck.

John Tang, MD · Answer

In reviewing your photos provided, I do think you can help this area without surgery.  It would take a comprehensive approach which would include not only fillers in the marionette lines (corner of mouth but also the line that goes towards the jawline) but also you will need to help lift the corners by also addressing the sunken cheeks (which will help to lift the corners) and also some product (ie Sculptra) to help lift the lower face which will also help to lift the marionette lines.  If you try only to fill the corners, you probably wouldn't see much improvement plus it is possible to be overfilled here which is probably why you had a bad experience.  If you are able to do an in person consultation, I could show you more easily the effects of lifting the cheeks and lower face and how that would help the marionette lines.  Good luck.

Hung William Song, MD · Answer

This is a very common condition that can be treated without surgery. Fillers, if placed correctly can absolutely help reduce the appearance of the groves in the corner of your mount. The best results will be if you combine a regenerative treatment with the fillers. AutoCorre HD combines fillers with PRF to instantly correct the creases and stimulates your own collagen for long term results.

Camille Cash, MD · Answer

From the submitted photos you may have some improvement with filler, but you also have skin laxity.  You may consider combining the fillers with other treatments such as FaceTite or Moprheus8 which are nonsurgical options to improve overall skin tone and texture.

Joyce Davis, MD · Answer

Simply filling in the folds won't work in someone this age; since the pull of gravity won't allow the filler to lift.  I would have filler injected along the cheek bone and along the jaw- up to the preauticular area.  This will pull back the folds.  More than 1 syringe of a heavy filler will be necessary.

Kurt Kuhlman, DO · Answer

I would consider a 2 step approach.
First consider Kybella injections just lateral (outside) of your "grooves" and to your jowls. Perhaps 1cc total to all 4 areas. Repeat this every 6 weeks for about 3 sessions. This should significantly reduce your Marionette lines and jowls. Kybella injections reduce the fat in these areas permanently.
Then have a dermal filler injected along your significantly reduced marionette lines for a great result.
Make sure your injector is very experienced with these type of injections.

Leonard Grossman, MD · Answer

With all due respect, you are asking for a whole lot. The ageing process has done what it normally does, in ages. The Face loses volume, making everything collapse onto the lower portion of the face. By trying to re-create, the support column of the collapsed building, will not restore the building shape. Fillers may help somewhat, but I’m not sure if you will be happy with the final outcome. I will NOT go further because you’re not interested in surgery. I hope this helps and good luck from Lengrossman empty organic Plastic Surgery.

I am not interested in surgery, would filler reduce the appearance of deep grooves on the corners of the mouth? (photos)

Answers (10)

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