32, lines around mouth. Do I need a mini facelift or something else? (Photos)

Question

I’m 32 and have the lines around my mouth. I’ve had filler injected in cheeks, marionette lines, and below the mouth. I haven’t seen much of a difference, but I’m open to try anything. I’ve asked before and a few responses I had asked for more photos. I’ll supply more on this post. I appreciate your feedback!

Thomas A. Mustoe, MD, FACS · Answer

Unfortunately the skin around the mouth has relaxed and filler is not going to help without adding so much volume that it looks unnatural. Non invasive skin tightening procedures also don’t work well in this area. It is conceivable that microneedling could help slightly but I Woukd not be optimistic. Conventional minikifts that don’t RealSelf and lift the superficial muscle layer (SMAS) will only give temporary benefits. A properly performed deep plane lift will address the midface relaxation and can be done through limited incisions.

Ali Riza Öreroglu, MD · Answer

In this case, a lower facelift may be an appropriate option. While 32 is considered relatively young, persistent lines around the mouth despite filler treatments often indicate early soft tissue descent rather than simple volume loss. A limited lower facelift that repositions the SMAS layer can provide more natural and long-lasting improvement, especially in addressing marionette lines and definition loss in the lower face. The procedure can be complemented with micro fat grafting when needed to restore volume in a more refined and permanent way compared to fillers. However, a thorough in-person evaluation is essential to determine the exact cause of the perioral lines, as factors such as skin quality, facial structure, and muscle activity also play a significant role.

Gary M. Horndeski, MD · Answer

You would benefit from an eccentric lip lift. This does 4 things: shortens the distance between the nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This takes 1 hour to perform under local anesthesia and costs $4,000.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Jaeil Lee, MD · Answer

At age 32, a mini facelift is generally not recommended, as true skin laxity is usually minimal at this stage. Based on the photos, the lines around the mouth appear to be more related to volume loss and structural support, rather than significant sagging.
If fillers have not provided enough improvement, options such as fat grafting or a more strategic volume approach may be considered. The best treatment depends on your skin quality and facial structure, and should be determined after an in-person consultation.

Richard R. Orr, MD · Answer

Ive been in practice over 30 years.  You have NO jowls.  Your neck is only just beginning to show some hint of laxity, that no one would notice.  I warn my patients that the lines and indents around the mouth will only be improved upon a little with a facelift, even a full.  
Injectables are like a can of paint.  Give paint to "Joe the Painter" or to Michaelangelo, and you will get two different results.  People often come to me and state that fillers "did nothing".  My answer is, let me do it.  
My hearty recommendation to you is fillers, done by someone who knows what they are doing.  Not someone who is doing a half-hearted job, in hopes of you paying them lots more money for a facelift, or someone who took a weekend course on fillers.  You want a long lasting hyaluronic acid filler.  There are several out there.  My personal choice is Juvederm Ultra Plus XC.  There are others.
Good luck to you!

Darryl J. Blinski, MD · Answer

Based on your post photos, a minimally surgical attempt would be the end of laser. That fee would be $2000-$2500. The other option would be an anterior mini facelift when the Endo laser combination fee $5000-$10,000. Best of virtual consult with for better understanding.

Mats Hagstrom, MD (license on probation) · Answer

Premature lines around the mouth are usually related to insufficient skeleton structure in the lower, 1/3 of the face. The lines develop as age creates a loss of elasticity in the skin.
In other words, this happens on people who have a relatively small mandible.
A facelift will not address this.
Fillers may not be sufficient because they don’t address the primary problem.
If anything fillers should be placed around the mandible not in the maxilla. It may still be difficult to correct this problem. 
It’s not an easy or straightforward condition to treat.
I wish I could give you a straightforward answer but fillers in the hands of the right provider is probably the best approach.
Minimize this getting worse by always wearing sunscreen and minimizing excessive facial sun exposure.
You may find other plastic surgeons will see this as a soft tissue issue.
While it may be to some degree I believe the primary or fundamental cause is skeletal.
Best,
Mats Hagstrom MD

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