Help with smoothing mid cheek lines. What are my options? (Photo)

A combination approach would give the most improvement. Deep wrinkles and smile lines can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like J Plasma, RF treatments, lasers, microneedling/PRP, salt facials, Cosmelan for skin tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

From the photos that you have provided you have what appears to be prominent orbito malar ligaments.  These ligaments are naturally occurring structures that separate your mid face and eye into compartments.  Dermal filler is very effective to manage these lines.  I think that some filler to the lateral part of your cheeks would also create an attractive shape to your mid face and enhance your eyes.  

I would recommend focusing on your cheeks and undereye area to help you appear less tired. I love using Radiesse to bring shape, lift, and definition to the cheek, as well as HA filler such as Belotero to bring the undereye area into balance with the rest of your face. Always remember that high quality sunscreen and retinols will be your best friends to keep your skin looking young and fresh.

You would likely benefit from conservative filler injected in the upper cheek and extending under the eyes. I would typically inject Restylane or Restylane Lyft with a cannula in this area. Treatment is well tolerated with minimal discomfort and minimal downtime. I would recommend that you see a filler expert for in person evaluation.Regards,Dr. Ort

You are a good candidate for cheek fillers of the upper cheeks to replace your volume loss. Many patients who have "full cheeks" are afraid of filler, but they still would benefit from filling certain areas that will be smoothed with filler without making the cheeks look fatter.