Do I need Sculptra, filler or microneedling? Have quite a bit of dimpling around the mouth area. (photos)

Question

I seem to have quite a bit of dimpling around the mouth area. In the past I have had Sculptra on the right side of my jawline to help but wasn’t sure if I needed that again, or filler? I also wasn’t sure if I could benefit from microneedling or RF microneedling in addition.

Anna Chacon, MD, FAAD · Answer

From your photos, the dimpling around the mouth appears to be caused by a combination of volume loss, skin thinning, and dynamic muscle movement, which is very common as collagen naturally decreases with age. Because several factors are contributing, there usually isn't a single treatment that addresses everything.

If the area has lost support, small amounts of hyaluronic acid filler can help soften the creases and improve the transition around the mouth. Filler tends to work best when placed strategically to restore support rather than directly filling every dimple.

Sculptra is another excellent option, particularly if you've responded well to it in the past. Unlike filler, Sculptra gradually stimulates your own collagen production over several months, making it a good choice for more generalized facial volume loss and improving skin quality. It won't provide immediate correction, but the results can be very natural and long-lasting.

For the skin texture itself, RF microneedling is often more effective than traditional microneedling. The addition of radiofrequency energy reaches deeper into the skin, stimulating collagen remodeling and helping improve mild skin laxity and fine textural irregularities. Standard microneedling also promotes collagen production but typically provides more modest improvement when laxity is part of the problem.

In many patients with concerns similar to yours, the most satisfying results come from combining treatments rather than relying on just one. Restoring facial support with Sculptra or conservative filler while improving skin quality with RF microneedling often produces a more balanced and natural-looking outcome than any single procedure alone.

Based on your photos, I don't think you appear to need a large amount of filler. A conservative approach focused on rebuilding collagen and providing subtle structural support would likely maintain your natural facial contours while softening the dimpling around the mouth. The goal should be to refresh the area rather than completely erase every line, as that typically leads to the most natural and long-lasting result.

Nelson Lee Novick, MD · Answer

I gave up using Sculptra quite a few years ago once more robust HA fillers came on the scene. Years ago the advantage of Sculptra had been that it lasted longer than the ordinary Restylane or plain Juvederm that were available at the time. The disadvantage was that Sculptra was expensive, required about three treatment sessions to see a response, and it has  had the very serious disadvantage that if there were any adverse reactions, there was no enzyme to dissolve it. Once longer-lasting, more robust HA fillers were approved, which did have the advantage of being relatively easily dissolvable, I could no longer justify the use of Sculptra. In experienced hands, the use of robust HA fillers can restore facial volume, improve under-eye hollows and tear troughs, diminish smile lines and marionette lines and straighten and define jowly jawlines. And all of this can be accomplished in about 30 minutes and typically engenders little to no significant downtime. Microneedling is best reserved for very treating very superficial, surface color and texture irregularities. It is not for facial contouring. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Leonard Grossman, MD · Answer

You don’t need fillers. I would consider Fat grafting. An expert such as myself performs fat grafting, the results should be natural and practically permanent. The procedure of fat grafting makes her the individual look at least 15 to 20 years younger and exactly like themselves when they were that much younger. I hope good luck from New York City plastic surgery.

Anna Avaliani, MD · Answer

Your lower face doesn't have enough of support, hence you are bothered by the dimpling and lines. Your mid face/cheek area also needs support to make the under eye area better.Your treatment plan will include Sculptra and RF Microneedling in the same session . You need 4 vials of sculptra 2 in cheeks and 2 around mouth /chin area. RF microneedling will improve the malar rounds on your cheeks and tighten the skin as well. Depending on your provider comfort level, they can be done together or separate. In our practice we often combine both treatments at the same time. Sculptra sessions are usually 1 month apart and please include neck in RF microneedling as well to look balanced .
Have a beautiful day!

Do I need Sculptra, filler or microneedling? Have quite a bit of dimpling around the mouth area. (photos)

Answers (4)

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