What causes the heaviness around my mouth/beneath my lower lip? How can I fix it? (Photo)

Question

I have noticed this darker area of heaviness and shadowing developing around my mouth and especially beneath my lower lip. What could be causing it? Is there any way to address it? I’m in my late 20s and have very minimal aging on the rest of my face.

A.J. Amadi, MD · Answer

Hello!

My name is Holly Frandsen and I'm an aesthetic Injector at Amadi Aesthetics Plastic Surgery. What I am seeing can be caused by a few different factors. One can be collagen and elastin loss that happens as we age, causing our skin to loss elasticity. Another could be caused from weight loss/volume loss. We see this in a lot of patients who have lost a significant amount of weight, causing the skin to feel heavier since it doesn't have the support that it used to have. Lasty this can also be caused be the mentalis pulling upward and outward because of it being over-reactive. You could consider putting a few units of Botox/Dysport in this area to relax it.

Nelson Lee Novick, MD · Answer

In my experience, this kind of issue relates either to a slight loss of support by the lower lip directly above or a slightly increased downward pull by the chin muscle located below.  To evaluate the first possibility, I would suggest that a trial "treatment" with either an injection of salt solution or diluted anesthetic solution  (i.e a temporary test solution) be injected into the region of the mental crease (the furrow that horizontally separates the lower lip and the upper chin) in order to see if that improves the overall appearance. If so, then a robust HA volumizing filler can be injected for actual treatment in that same location.
If this test does not achieve the desired results, then the possibility of the downward pull of the chin muscles can be addressed with  the use of microdroplets of Botox to relax the pull. 
You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist injection expert. Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

Based on your photo and what you’re describing, this is a very common concern—especially in patients in their 20s who otherwise have minimal signs of aging.

The “heaviness” or shadowing beneath the lower lip is usually not true aging, but a combination of subtle structural and skin-related factors:

1. Natural anatomy and early volume imbalance
The area just below the lower lip (the labiomental region) is naturally concave. Even a small loss of support in the chin or lower lip—or relatively strong mentalis muscle activity—can create a shadow that reads as heaviness or darkness on camera and in certain lighting.

2. Muscle activity (mentalis overactivity)
If the mentalis muscle is strong or overactive, it can pull the lower lip inward and downward, exaggerating that crease and creating a “pouty but heavy” look beneath the lip. This can happen even in younger patients.

3. Early skin changes, not aging
In your late 20s, this is often more about skin translucency and light reflection rather than sagging. Thin skin + subtle dehydration + mild pigment variation can make shadows look more pronounced.

4. Mild perioral hyperpigmentation or vascular shadowing
The darker tone you’re noticing may be due to pigmentation, underlying blood vessels, or simply the way light hits that recessed area—not something dangerous or abnormal.

How this can be addressed (without overdoing it)

The goal is softening the shadow, not adding bulk.

Subtle neuromodulator to the mentalis
This can relax downward pull and smooth the area beneath the lip, often making it look lighter and more balanced.

Very conservative structural support
When appropriate, minimal support to the chin or lower lip can reduce the hollow without making the area look “filled” or unnatural.

Skin-focused treatments
Improving hydration, barrier strength, and pigment balance can significantly reduce the appearance of darkness:

Topical brighteners

Barrier-repair moisturizers

Sun protection (this area darkens easily with UV exposure)

Avoid overfilling the nasolabial or marionette areas
Overcorrection nearby can actually worsen this specific shadow by creating contrast.

What you’re seeing is very early and very treatable, and it’s not a sign that your face is aging faster than it should. With thoughtful, conservative care, this area can be softened while keeping your natural look completely intact.

What causes the heaviness around my mouth/beneath my lower lip? How can I fix it? (Photo)

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