What is the best treatment for lower face when “pockets” start on sides of mouth? (Photo)

Question

Do I need a lift, volume or injections? I’ve been told to get volume in cheeks, injections in chin and lasers to lift to name a few. I’m just not sure!

Thomas Trevisani, MD · Answer

In order to evaluate accurately in person exam is essential, as well as all views of the face. If you have excess skin in the neck, jowls, cheek area (which it appears you have from a limited photo) - then you are a candidate for facelift/neck lift. In the right hands- patients can expect a very rejuvenating, long lasting result. I suggest that you seek an experienced Board Certified PS for in person exam

Muhsin Yilmaz, MD, FEBOPRAS · Answer

The best treatment depends on what is actually causing the changes in your face. Volume loss, tissue descent and skin quality are different problems, so they do not always respond to the same treatment.
If your main concern is sagging of the cheeks, lower face or jawline, adding more filler may not be the best solution and a facelift or midface lift may provide a more meaningful and natural result. If the main issue is loss of volume, particularly in the cheeks or temples, conservative fat grafting or other volume restoration may be more appropriate. Chin injections can improve structural balance in selected patients, while lasers are generally more helpful for skin quality than for significant lifting.
Based on what you have described, I would recommend a proper facial assessment before adding more injections. Sometimes the best approach is a combination of lifting and conservative volume restoration, rather than trying to correct every concern with filler.

Tanveer Janjua, MD · Answer

These bulges right next to the corners of your mouth are pericommissure bulges and different than regular jowls. These can be very hard to treat. A facelift can definitely help in pulling them back and making them flat however, sometimes you need fillers to camouflage them as well. Start with simple stuff i.e., fillers and then proceed to surgery if not better. RegardsDr. J

Raymond E. Lee, MD · Answer

Thanks for sharing.  It looks like some excess skin laxity has created this fullness outside the mouth. A lower facelift will allow this excess skin be tightened and smooth out this bulging area.  The buccal fat may also be contributing to this fullness and your surgeon would need to examine you to determine if this needs to be addressed.

Philip S. Schoenfeld, MD, FACS · Answer

The bulging that you appreciate around the sides of your mouth is called Jowls and this is part of the normal aging process in all individuals.  Thinner women tend to have more prounced skin jowling but patients with fuller faces are also susceptible to jowling of skin and fat.  The proper solution depends on several factors.  One of which is your weight and the amount of facial fat that you present with.  The other variables will depend upon what your are willing to have done.  Less invasive procedures like filler injections will help.  Laser facial skin tightening will also help. Thread lifting can provide some impressive results in your case with minimal downtime and a well performed minimal incision facelift witill also be part of the conversation.  Combition treatmens using facial filler or fat injections along with some sort of lifting procedure will also look quite nice.

Jeffrey E. Schreiber, MD, FACS · Answer

It appears as though you could do one (or more) of 3 things to help lift the pockets that are forming on the sides of your mouth.  This is also referred to as jowling or descent of the cheek fat pads.  You could do:
1.  Facelift - this is an great way to lift the jowls and rejuvenate the neck and jawline as well.  The results typically last 5-10 years.  The surgery takes about 4 hours with about a week of downtime.
2.  Fillers - Restylane Lyft or Juvederm Ultra are good fillers to camouflage the jowls by filling in the areas around them.  They can also be used as a sort of lift underneath the jowls.  The procedure takes about 30 minutes, but the results only last for about 6 months.
3.  CO2 laser - this laser is great for helping to remove fine lines and wrinkles from the face.  You also see some skin tightening with this laser treatment.  The results last about 1-2 years, but it does involve sedation in the OR with about 1-2 weeks of redness and peeling from the laser.
Moreover, it appears as though a facelift would be you best option.  Pain is minimal and again recovery takes about a week of staying out of the public due to bruising and swelling.
Thank you for your question!
Dr. Schreiber, Baltimore plastic surgeon

Larry Weinstein, MD · Answer

Picking the right procedure for facial rejeuvenation involves expertise in the different procedures. I would need to examine your face and hear what bothers you and determine if I can help you achieve your goals. The Vectra 3 dimensional imaging machine can help us discuss what can and cannot be achieved. See a board certified ASAPS plastic surgeon in consultation. Good luck...

Dilip D. Madnani, MD, FACS · Answer

Based on your limited pictures, a combination approach would be best to consider. Replacing some lost volume with filler is an excellent option and doing something to tighten the skin at the same time, would be ideal. The natural aging process on the face involves both facial volume loss and loss of skin elasticity- majority of the facial treatment options address these conditions. Your filler options vary from injectables such as restylane, juvederm, voluma to facial fat transfer and your skin tightening options vary from nonsurgical to surgical depending on the extent of the laxity. This is an overview of your options and more can be explained at a consultation.

Ronald J. Edelson, MD · Answer

I am not a fan of fillers overall.  You would probably get better improvement with a facelift, depending on your age.  Expect partial improvement but I believe more worthwhile than fillers.

Barry L. Eppley, MD, DMD · Answer

Your pockets by the side of your mouth appear to represent lax skin as evident by our very thin face with little subcutaneous fat. A limited lowe facelift, possible combined with submalar cheek implants, would provide the most assured removal of these pockets and to smooth out the skin from your mouth corners back to your ears.

What is the best treatment for lower face when “pockets” start on sides of mouth? (Photo)

Answers (19)

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