What is This Weird Fat Pocket Around my Mouth Where my Marionette Lines? Do I Need Filler or Fat Grafting? (photo)

Thanks for the photos.  As my other colleagues have suggested, this area can be challenging to correct, and I would caution you about excessive fillers or fat in this area that could place inappropriate volumes where you don't want them.  Your perioral dynamics need to be evaluated with smiling, speech, and other expressions to determine the need for "volume" or "support" in this area.  Volume can be effect to fill areas of lack, while support is needed where gravity is causing the problem.  How can you know which is needed?  You may be able to control for gravity by viewing your problem area in a mirror while lying on your back.  A test injection of saline may be an easy and very temporary way to see if volume will help.

Both fat and filers can be used to fill the marionette lines. There are advantages and disadvantages of both techniques. Fat will last much longer but it is a more difficult procedure for the patient and recovery is a little longer. Fillers can be done with minimal recovery. Consult with a surgeon who uses both approaches.