27 year old male with skin folds around mouth and mid cheek area - Surgery or filler?

Question

Idk why i have this problem but I want to know what recommended procedure i should do to get rid of these sagging folds j have on my mid cheek area and also around my mouth. I look aged so much and no idea from what.

Nelson Lee Novick, MD · Answer

Relax. You issue is a very common one in and typically easily remediable in the hands of an experienced, board certified cosmetic dermatologist filler injector expert. At least from the photos provided, there is clear volume deficit in the cheeks, which is not only responsible for flattened cheeks, but secondarily for the deepening smile folds and even the folds around the mouth. In the hands of an expert, a robust HA Volumizing filler injected appropriately in the cheeks to preserve a masculine appearance, as well secondarily improving the smile folds and very likely the folds around the mouth, as well. Treatment usually takes about ten minutes to perform with immediate results and often little to no significant downtime. Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

At 27, I would first reassure you that having visible folds around the nose, mouth, or mid-cheek does not necessarily mean that your face is aging prematurely. Facial anatomy varies tremendously from person to person, and some people naturally have more prominent nasolabial folds or cheek creases even when they are quite young.

The important part is figuring out why the folds are prominent before deciding between filler and surgery.

Why can this happen at 27?

The appearance of these folds can be influenced by your natural bone structure, cheek-fat distribution, facial expressions, skin thickness, genetics, and the way your mid-cheek tissues move when you smile. A recessed or less-projecting midface, for example, can make the area around the mouth appear more folded even without significant skin laxity.

If the folds are much more noticeable when you smile and become relatively subtle when your face is relaxed, that is often a normal dynamic feature rather than true "sagging."

Would filler help?

Potentially, yes. Filler is generally much more reasonable to consider than surgery at age 27 if the concern is primarily a lack of volume or a structural transition in the cheek/midface.

However, I would not automatically fill the folds themselves. Sometimes placing a lot of filler directly into the nasolabial or mouth-area folds can make the face look heavy or puffy rather than younger.

A more natural approach can be to assess the mid-cheek first. If there is a genuine volume deficiency, a small amount of strategically placed hyaluronic acid filler in the cheek/midface may provide support and soften the transition toward the nasolabial fold. Dermal fillers are commonly used to restore facial volume and soften facial creases, including nasolabial folds.

The key at your age would be conservative correction, not trying to completely erase every fold.

What about surgery?

I would be very hesitant to recommend a facelift simply because you have prominent folds at 27. Surgery is designed to address actual tissue descent and laxity, and it would be unusual to jump directly to that without establishing that significant structural laxity is truly present.

A midface lift can address cheek descent and prominent nasolabial folds in appropriately selected patients, but it is generally considered when there is actual midface descent or laxity rather than simply because someone has naturally deep facial folds.

Even surgical correction of nasolabial folds is not completely straightforward; recent reviews note that there isn't one surgical technique that reliably produces optimal long-term correction for everyone.

One thing I would avoid

I would be cautious about trying to "fill everything" simply because you feel that your face looks older. At 27, the goal should be restoring balance rather than adding a lot of volume.

If your face is naturally lean, adding excessive filler to the cheeks or around the mouth can actually make you look fuller or less natural. Likewise, aggressive treatment of the muscles around the mouth can potentially alter your smile.

So, based on your age and description, I would not start with surgery. I would first determine whether what you're seeing is primarily anatomy, cheek volume distribution, dynamic movement, or genuine tissue descent. If there is a correctable structural volume deficiency, very conservative filler may be appropriate. If there is little true volume deficiency, you may actually be better off leaving the folds alone rather than trying to completely erase a feature that is part of your natural facial anatomy.

And most importantly, having these folds at 27 does not automatically mean that your face is aging too quickly. Sometimes what looks like "sagging" in a photograph is simply the way your facial structures naturally fold and move.

27 year old male with skin folds around mouth and mid cheek area - Surgery or filler?

Answers (2)

More Dermal Fillers Questions

In my 50's and ready to address under eye concerns - what procedure would be the most beneficial? (Photos)

Should I get a second opinion before filler? Linear Scleroderma (En Coup De Sabre) Concerns (Photos)

Deeper malar lines after cheek filler dissolved. Residual filler or my actual anatomy/true baseline? (Photos)

What can be done for hollow ring around the eyes (under eyes and outer corners)? (Photos)

Can fillers create a good jawline from the front? (Photos)

Is my chin discoloration related to infection or late onset inflammation -1.5 year after chin filler? (Photos)

WE SEND PRETTY
EMAILS