Which Treatment is Best for Deep Laugh Lines with Loss of Collagen?

I have lost some weight and my face is much thinner but now I have what I have been told is loss of collagen in my cheek area which is causing folds/lines/creases that I did not have before. Is there any treatment (besides a facelift...I am in my thirties!) that would help fill these lines? I also have more lines around my eyes as well and would like to know the best treatment for that area too.

Doctor Answers 8

Treatment of laugh lines

Laugh lines are treated differently depending on the area of concern. Laugh lines around the eyes or crow's feet area are usually best treated with neuromodulators like Botox/Dysport/Xeomin. Around the mouth or lower cheeks, the issue becomes more complex. The muscles in this area generally pull at the corner of the mouth to cause the smile, but also cause the wrinkling as a result. Any weakening of these muscles (like with Botox) will decrease the laugh lines, but will also affect the smile, and can look odd. For this reason, I generally do not recommend Botox in this area.

If these lines are present even at rest (without smiling), fillers may be helpful. Also, resurfacing procedures like peels or lasers may be helpful to improve the quality of the skin and reduce fine lines and wrinkles. While a facelift may help with some of these lines at rest, it usually will not eliminate lines that are caused by smiling.

A consultation with a board-certified physician specializing in facial aesthetics is always recommended in order to obtain an individualized treatment plan. 


Frisco Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Hyaluronic Acid Fillers for Wrinkles and Laugh Lines

Hyaluronic acid is a natural sugar found in our bodies. However the actual injections are bioengineered and not derived from animal sources. Examples of hyaluronic acid fillers include Juvederm and Restylane. The molecules are able to integrate rather well with the existing collagen structures beneath your skin. And they are able to hold a significant amount of water. Your skin not only gains the volume it needs for a younger look, it also becomes well hydrated as well. 

Collagen loss can also be addressed quite effectively with cosmetic lasers like Fraxel Dual. Fraxel Dual uses longer wavelengths to deliberately apply heat to the dermal layer. Your skin perceives this as an injury and creates healthy new collagen as a result. This laser system is also safe for the eye area.

You should consult with a board certified dermatologist to determine if a single solution or a combination of treatments would be best for you.

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 32 reviews

Treatment for smile lines

Lines that occur when you smile are nomal and should be acceptable . Lines that are present when you are at rest and are in the smile line location will often be best treated with small amounts of fillers such as Restylane or Juvederm.  In addition, for lines at rest a fractionated laser or full laser resurfacing will help as well.  An IPL will give little results for these kinds of lines and is not recommended for this type of problem.

Shawn Allen, MD
Boulder Dermatologist
5.0 out of 5 stars 1 review

Injectable Fillers work well to reduce the appearance of smile-lines.

If your lines are present even when you're not smiling, then an Injectable Filler treatment should work well to minimize their appearance. Wrinkles that are present only with smiling are not easily treated. You certainly appear to have sun-damage, so protect yourself from those strong Florida UV rays.

Loss of collagen and elastic tissue in your skin is a result of genetics, aging, sun, and smoking, and this loss can lead to the wrinkling you see.

I hope you find this helpful.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

Treating facial deflation

I agree with both previous posters, Drs. Aldea and Rand. You need filling! I would also recommend the Stem Cell Enhanced fat grafting as the newest adaption to fat grafting. I'm using the Dr. Giampappa technique with quite good success.

From MIAMI

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Treating facial deflation

I agree with Dr. Aldea that you can do much to restore the deflation in your face with volume replacement fillers such as Restylane. Also, you already are showing severe sun damage changes and if you don't do better sun protection your beauty will really drop off when you are 45 and older. Have some IPL done to improve the sun damage and get religious about sun screen!

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Treating Facial Deflation

Loss of facial volume results in the appearance of facial aging. Rather than chasing such facial deflation with attempts to tighten the skin (Facelift, Laser, Peels) or fill the wrinkles (Juvederm, Restylane) a more logical approach would be to restore the lost volume. Fat grafting to the face would be my first choice and Sculptra would be my second choice. Both would fill the face, restore the youthful ogee curves of the face and do away with these folds and wrinkles.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Deep Smile Lines Treatment

Dear cheekysmiles:

I would suggest using a dermal filler like Juvederm Volfit to help soften up this lines.  I hope this information helps.

Praven Chetty, MD
Kelowna Physician
5.0 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.