What should I do about these awful smile lines? (Photo)

Hi @mmv220. Thank you for sharing your photos. I recommend a combination treatment of dermal fillers and Morpheus 8. Morpheus 8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting.

Best of luck,

Dr. Nima

These are dynamic smile lines.  They will never disappear, but you could have them softened with filler.
Accept them as part of your features, they give you a great smile.....

First off, your lines aren't "awful".  I see a happy, smiley person.  That said, if they are really bothering you, they could easily be softened with fillers.  I would recommend one of the hyaluronic acid fillers (ie Restylane or Juvederm) first, since these are safe and easy to reverse if you did not like the results. I like the new Restylane Defyne, which is specifically designed for this very issue.  Good luck!! 

I recommend fillers for the lines themselves but also lifting around the mouth and cheeks to build underlying anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments, J Plasma and peels to get the most conservative natural look. Please see a facial sculpting expert. Best, Dr. Emer

The best way to treat smile lines are with injectable fillers.  I would recommend something that has a little more swelling associated with it, like Juvederm Ultra Plus XC.  They are dynamic in that they only happen when you smile, which makes them harder to fully treat. Fillers can make them softer though. Good luck!

There are a number of options to help with facial lines. Liquid
Facelift uses advanced techniques to gently lift, soften lines, and contour
facial features without surgery and little downtime. Fillers such as Juvederm,
Volbella, Voluma, Radiesse, Sculptra, and even your own fat can lift your skin
and recontour your face restoring a more youthful appearance. Lips that thin
with aging can be made plumper and more kissable, and fine lines around the
lips be reduced.
Topical creams and non-ablative laser
treatments can also help rejuvenate your skin and help improve  fine
lines.
Thermage is a non-invasive (no incision!) treatment that can
tighten skin, renew facial contours, and stimulate your body to make healthier
collagen—the building block that provides structure to your skin. The procedure
uses radiofrequency technology called ThermaCool that has been clinically
proven to tighten and gently lift skin to smooth out wrinkles and renew facial
contours. Fast and easy, Thermage requires no downtime from normal activities.
However, Thermage can have variable results if not performed by an experienced
doctor. It's important, of course, to make sure
you see a board certified plastic surgeon because results can be variable
depending on who is performing the procedure.  

You have dynamic wrinkles which show up with movement of facial muscles and they are a bit hard to fill. However, hyaluronic fillers like Juvaderm ultra plus XC or restylane lift , should help a lot.

This is a common concern in women your age and can be addressed successfully
once the cause(s) of smile line accentuation is determined. So here’s what is
going on.  It sounds like the hollow
below your cheek and near the mouth corners is a favorite area for skin to
gather when you smile. A smile is a beautiful thing, but many patients tell me this
can be nuisance. In lean individuals, the smile lines can be due to volume loss
throughout the face (thin face, fat loss) that allows skin to drape toward the
mouth and collect in “parentheses” with smile activation. In older individuals
or facial skin that has suffered collagen and elasticity damage (thin skin,
wrinkles), loss of skin integrity or thickness can accentuate the “corduroy” lines
appearing below the cheeks, even before smiling. Now here are some options.  For the thin face or loss of fat padding, strategic
volume correction using structural filler such as hyaluronic acid or calcium
hydroxyl apatite can improve the drape of the skin and prevent so much of it
from collecting near the mouth. Typically in someone your age only one or two
syringes is necessary. To improve the integrity of thin or aging skin, a skin stimulator
such as PLLA applied in multiple sessions (2-4) a month apart can provide
correction with several months that lasts for a few years. If you have
experienced a significant amount of sun exposure or UV damage from tanning bed
sessions you may have elasticity problems that should be addressed. In this
case, your Doctor may choose a collagen induction method that employs thermal
energy, such as fractional Radiofrequency, to address your skin laxity. Again,
serial treatments 4-6 weeks apart can provide noticeable results months after the
treatments are completed that can last years with regular maintenance. As with most
non-surgical cosmetic corrections, an agreed maintenance plan with your Doctor is
important to enjoy the results over time.     

Based on the photo, you are a good candidate for treatment with dermal fillers. I love the newer flexible gel hyaluronic acid based fillers, Restylane Refyne and Restylane Defyne, for treating laugh lines. See an experienced injector for an in person consultation and to come up with an appropriate treatment plan.

Thank you for your question. It is hard to commend with only one picture. However, smile lines can be improved and soften with dermal fillers injections. Results are natural looking and they can last up to a year. For more superficial lines, microneedling with PRP and/or laser resurfacing are great options. I recommend seeing an expert in your area for an in-person consultation and treatment plan. All the best, Dr. Michon