Sculptra or filler? (Photo)

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. If you're looking to address smile lines without the puffy look associated with fillers, there are several options to consider. For smile lines, a small amount of Botox can sometimes help relax the muscles around the area, but it sounds like you've experienced limited success with this. In addition to Botox, you might consider treatments like SkinPen (microneedling), which can improve skin texture and stimulate collagen production, helping to soften the appearance of smile lines over time. Combining microneedling with your existing tretinoin regimen can enhance results, as tretinoin promotes skin renewal and can further improve overall skin quality. Another option could be chemical peels or laser treatments, which can help with texture and firmness without adding volume. Since you prefer to avoid a puffy appearance, these methods might align better with your aesthetic goals. I hope this helps and best of luck!

Thank you for your detailed question and the photo. Based on what you’ve shared and shown — visible volume loss and fine creasing around the midface when smiling, this appears to be dynamic volume depletion and tissue laxity, which is common in thin, athletic individuals in their 30s, especially those with low body fat and strong facial muscle activity.

Why Botox Isn’t Enough
Botox works by relaxing muscles to reduce wrinkles caused by movement. However, the smile lines and creasing you’re showing are more related to volume loss and skin elasticity, not muscle overactivity. So Botox alone won’t be effective in this case — especially when you're already treating forehead and crow’s feet.

Sculptra vs. Filler vs. SkinPen
Here’s a breakdown of the best options:

1. Sculptra (Poly-L-Lactic Acid)
Ideal for thin, athletic faces who want gradual, natural volume restoration without the “puffy” look.

Stimulates collagen production over time, improving skin texture and volume subtly.

Best for those who are patient with results (it takes 1–3 months to fully show) and want something that ages gracefully.

Works well in temples, midface/cheeks, and nasolabial areas.

2. Hyaluronic Acid Fillers (e.g., Volbella, Belotero)
If used, you’ll want a very soft, low-density filler in precise amounts.

Can provide immediate correction, but carries a higher risk of looking unnatural if not placed properly, especially in thin skin.

Requires maintenance every 6–12 months.

3. SkinPen (Microneedling)
Great for fine lines, texture, and early creasing, but won’t replace lost volume.

Works best in conjunction with collagen-stimulating treatments like Sculptra.

Minimal downtime and effective for skin tone and smoothness, not lifting.

Recommendations
Given your:

Thin facial structure

Avoidance of a puffy look

Desire for natural results

Commitment to skin care and prevention

→ Sculptra would be the most appropriate treatment to rebuild subtle collagen and support skin structure without altering your natural expression or fullness.

You can also complement Sculptra with SkinPen treatments for enhanced skin texture and firmness, particularly around dynamic areas like the smile lines.

Hi, since you are an avid gym go’er, and are 30 years old, I would recommend starting with microneedling. It has just came out in published studies to increase collagen production dramatically with a series of treatments. With that being said, if your skin is feeling thin and crepey, Sculptra would be an option. If it is your smile lines that bother you, start with microneedling.

Thank you for your thoughtful question. I’m glad that you are thinking about regenerative options especially in your 30s when you will respond very well!
This area will definitely respond well to Skin Pen with PRP or exosomes. I would add a daily high dose collagen supplement such as Whole Body Collagen from Designs for Health. You want to wear high quality sunscreen every single day! Also protect your skin with antioxidants!
This area can also be treated well with different laser treatment options both ablative and non ablative depending on your down time commitment.
Good luck on your aesthetic journey!
This above is for entertainment purposes only and not medical advice.

The absolutely best way to add more volume to a thin face is by means of fat grafting. As long as fat grafting is done by an expert in fat grafting techniques, Plastic Surgeon, the result should be extremely natural and practically permanent. At the same time if you really have no fat available for fat grafting, then using Sculptra would be the next best step.
I hope this helps and good luck from Leonard Grossman, M. D. organic Plastic Surgery in New York city.