Cleft chin removal and other facial treatment options (lipo, fat grafting, lift)? (photo)

Based on what you’ve described, here’s how I would approach your concerns: 1. Chin Cleft & Mentalis Muscle
You're absolutely right in suspecting that a strong mentalis muscle can influence both the appearance and behavior of fillers. Surgical modification or release of the mentalis muscle may help soften the cleft and improve chin contour — especially if filler alone has been giving you a tight, unnatural result.
Additionally, removal of migrated filler (particularly if placed deep or over bone) may be beneficial to eliminate excess roundness before any fat grafting is done.
2. Fat Transfer vs Filler
A fat transfer can be an excellent alternative in your case. It offers long-term soft volume without the migration risks of HA fillers. Many patients prefer fat for areas like the chin and cheeks due to its natural texture and integration — especially when aging changes are involved. 3. Chin/Neck Liposuction
For submental fullness, chin/neck liposuction can refine your jawline beautifully — and it pairs well with both mentalis work and fat transfer. This combination often provides a more elegant and balanced lower face contour.
4. Midface Concerns: Cheeks & Brows
Your interest in cheek fat grafting or a ponytail facelift/brow lift is also well-founded. At 33, subtle changes in the mid and upper face can become noticeable, especially with volume loss or early laxity. Depending on your anatomy and goals, either approach (fat transfer alone or a light surgical lift) may be appropriate.