Best intervention for sagging, sunken area around mouth/chin? (Photos)

Question

What would the best intervention for these divots be? I am 44 years old. I didn’t have this sagging and these divots until the last year. Thank you very much.

Tammy Polit, DO · Answer

As we age and/or with weight loss, we start to lose the soft and beautiful fat later under the facial skin. Over time, the skin will sag, become sunken, or even form harsh lines. The best way to counteract this volume loss is with properly placed filler. Volume loss should be replaced first in the upper face/cheeks and then later in the lower face filling in the lines and sunken areas. In experienced hands, it can also be performed in a natural way so that you look fresher and younger but not like you had any procedures done.Surgical face and neck lifts tend to look OK for about 3-5 years, then the skin will again relax with gravity and the sagging will recur. If the volume loss has not been fixed, the problem will still be there.

Jason Emer, MD · Answer

I would highly recommend getting a formal evaluation with and treatment from a board-certified cosmetic dermatologist and expert in facial sculpting. Technique is the key to a successful lip augmentation with fillers, so you'll want to see someone meticulous. An experienced physician will be able to determine which filler, how much filler, and which technique will give you the subtle result you're looking for. See an expert. Best, Dr. Emer

Dmitriy Schwarzburg, MD · Answer

A variety of options can be used to address the problem you are experiencing including PDO threads. Botox and fillers are also wonderful options when appropriate. Please contact a qualified provider or a board-certified physician with extensive experience in these procedures.

Kathleen Griffin, MD · Answer

Hello 44 year old. I feel you. You wake up one day and suddenly you have aging issues that weren't there last week or a year ago. I see these dimples every week when patients come in for Botox as a new patient and I ask them if anyone has ever given them Botox in their lower face. They usually say "No. I didn't know you could do that." And I say, "Yes. It can make a world of difference, using only 10 Units." You need some where those dimples are to prevent the pulling in of your DAO muscles, and some chin Botox to prevent the pulling in of your mentalis muscle. Then after 2 weeks have an assessment for some volume replacement with a bit of filler so that your lower face will match your beautiful upper face! Good luck.

Nik Rana, MD · Answer

Hi, I reviewed your question and photos. Thank you for sending these in. These divots are a normal part of the aging process and can happen due to elasticity (stretchiness of skin) loss over time. Also, the anatomic variations by which your muscles attach in your face can also make you prone to dimples and divots. My recommendation is the use of a conservative amount of filler to hide the shadows caused by volume loss. You have to be careful in this area to not overfill, as this can cause a "chewing on tobacco" look. I would seek a facial plastic who has intricate knowledge of facial anatomy and understands the appropriate filler for that area. Happy to help anytime! Dr. Rana.

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