Smile lines, age 46, after weight loss (photo)

Question

I have lost over 3 stone in weight since January and I am nearly 46x I have had some cheek filler as I feel my face is sagging. I have a good of skin near the corners of my mouth. What area heeds treating to address this? Thank you

Shahnoos Mahdavi, MD · Answer

Thank you so much for the pictures and congratulation on your weight loss achievement.although local volume loss will respond well to dermal fillers but for over all saggy skin at your age by the result of weight loss, Sculptra injection will be naturally help to resume your elasticity by collagen stimulation. most of the time I combine the 2 treatments for the best outcome.

Nick Slenkovich, MD · Answer

Hello! I’m Lauren, the aesthetic provider here at Colorado Plastic Surgery Center.  Smile lines can become more noticeable after weight loss and with age.  Fillers can help by restoring lost volume and lifting the area, softening those lines for a more refreshed look. Since you've already had cheek filler, adding a bit of filler directly to the smile lines or around the marionette lines help support and smooth the lower face.

Athanasios Christopoulos, MD · Answer

Congratulations on your weight loss. Weight loss improves body shape but also creates sagging (or skin laxity) on the body, particularly on the face. The problem you are referring to is due to this sagging.

Specifically, marionette lines and nasolabial folds, if mild, can be corrected with hyaluronic acid or generally with some type of filler material. However, if they are deep, a combination of procedures is needed. A large part of the improvement comes from a facelift, which can be combined with some type of filling, which could be with hyaluronic acid or fat (fat grafting).

Combined treatments yield better results. Correction solely with injectables is never highly effective if the wrinkles are deep. I am generally not in favor of overall facial filling to achieve a lift. I agree with the localized use of hyaluronic acid directly on the wrinkles but not with generalized facial filling, which can cause distortion without any particular reason.

Therefore, I maintain that the combined treatment of facelift + filler is the most effective.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos and story, and congratulations on your impressive weight loss. I know how much dedication and effort that takes.

What you’re noticing around the corners of your mouth, often referred to as "smile lines" or marionette lines, is very common after significant weight loss. When the face loses volume, especially in the midface and cheeks, the skin can naturally appear looser, and folds in this area become more noticeable.

In your case, while cheek filler was a good step, additional support may be helpful in a few areas:
Midface and lateral cheek support: Enhancing volume here can lift and soften the downward pull around the mouth.
Nasolabial folds and marionette lines: Carefully placed filler in these lines themselves can reduce their depth.
Jawline and chin definition: Subtle contouring here can balance sagging and restore a more youthful profile.

Skin quality treatments: Options such as biostimulators (like Sculptra or Radiesse) or collagen-boosting therapies can improve skin laxity and elasticity over time.

The overall goal is not just to fill the lines directly but to restore the underlying structure that has shifted with age and weight loss. This combination usually gives the most natural and long-lasting improvement.

Camille Cash, MD · Answer

Congratulations on your weight loss!  You will likely have the best result from a combination of treatments.  You have both volume loss and skin laxity contributing to the look that concerns you.  Fillers can help with replacing that volume.  You can also consider Morpheus8.  This treatment uses RF technology combined with microneedling to improve overall skin tone and texture.  I've included a video that I hope you find helpful.

Smile lines, age 46, after weight loss (photo)

Answers (5)

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