(28) Harsh shadows around mouth, makes me appear deflated. Botox, Filler or something else? (Photos)

Question

Pictures provided, I havent even entered my 30s yet, but I have these harsh shadows around my mouth corners and nasal folds that make me look deflated in most lighting situations (unless front facing). It’s ruining my self-esteem because I cant stand looking at it. Note: I put on a ton of moisturizer so you can see the shadows more dramatic.

Nelson Lee Novick, MD · Answer

Relax. The kinds of folds and shadowing that are seen in the photos are very common complaints. The ones around the nose are called smile lines and those at the corners of the mouth marionette lines. Both can be addressed with the use of HA fillers. In the hands of an experienced, board certified cosmetic dermatologist filler injector expert, treatment of both regions in the same session, if so desired, should take no more than about twenty minutes and yield immediate results and engender little to no signficant post-treatment downtime.So, again, relax, and best of luck.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos and describing your concerns so clearly. I completely understand how frustrating it can feel when shadows around the mouth make you appear deflated, especially when they affect your confidence. Even at a younger age, some people naturally develop subtle volume loss in the mid-face and around the mouth, which can create these shadowed areas. Factors like genetics, facial structure, and even slight soft tissue changes can contribute, so it’s not uncommon and doesn’t reflect anything “wrong” with your skin or lifestyle.

For your situation:

Dermal fillers are usually the first-line approach for softening these shadows. Placing filler strategically in the cheeks, nasolabial folds, and corners of the mouth can lift and support the skin, reducing the shadow effect and restoring a more youthful contour.

Botox can sometimes help if there’s a strong downward pull from certain muscles around the mouth (like the depressor anguli oris), but fillers are generally more effective for volume-related shadows.

Skincare alone (even heavy moisturizers) won’t change the underlying contour, though keeping the skin hydrated can improve how shadows appear in softer light.

In short, the main contributor to what you’re seeing is volume loss or structural shadowing, not age alone. A carefully placed filler approach is likely the most effective, and in some cases a small, subtle Botox adjustment can enhance the result.

It’s understandable to feel self-conscious about this, and these treatments can be tailored to keep results natural and harmonious with your face.

(28) Harsh shadows around mouth, makes me appear deflated. Botox, Filler or something else? (Photos)

Answers (2)

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