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.

Hi DJ,  I believe that your perioral area can be addressed with filler, properly done.  You are seeing muscle that is more prominent because of loss of volume in the area.  I would not recommend fat transfer at this time.  It is a tricky area to correct so please make sure that you choose your injecting physician most carefully.  Good luck and be well.   Dr. Persky, Encino,CA

the weird fat pocket is not fat but muscle, it is where all of the muscles of that help move the mouth meet.  It becomes noticeable as you lose the fat around it.  It can be treated by adding volume around it to contour it in to the surrounding areas, either a fat transfer or a hyaluronic acid (restylane/juvederm)  it is pretty hard to get this to contour in perfectly.

I would try something that is reversible like Juvederm not fat! This is a difficult problem st a young age and u need to see an experienced surgeon. 

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.