Fillers like Juvederm and Restylane are best for the marionette lines. These are hyaluronic acid fillers that can make the smile lines or lines of the mouth look much better. They "fill in" these lines so that the wrinkles and lines are smoother and much less pronounced. Botox is not meant for the marionette lines and would cause your face to droop.
Can Botox Get Rid of Marionette Lines, Mouth and Chin Lines, and Wrinkles?
Doctor Answers (14)
Fillers are meant for the marionette lines
Nonsurgical 3D Vectoring, Volumizing, Filling, & Botox Work To Decrease Sagging, Wrinkling & Improve Facial Contour & Definition
Unfortunately, smiling photographs are not very helpful for tailoring a treatment plan for any individual. In general terms, however, my first choice for most cases of marionette ("Howdy Doody" or "sad") lines would be The Nonsurgical 3D Vectoring Facelift, with particular concentration on the marionette area. This non-invasive procedure, which employs volumizers, such as Radiesse, can be found described in detail elsewhere in the RealSelf Q&A archives.
The Nonsurgical 3D Vectoring Facelift not only softens the marionette lines, but, if necessary, (via appropriate placement of the injectable volumizing materials) can also improve the smile lines on the sides of the nose and the jowls along the jawline as well as give greater, more youthful definition to the cheeks.
For treating the "lipstick bleeding" (aka "smoker's) lines around the mouth, fillers, such as Restylane L or Belotero Balance are quite effective. For dimpled, pebbly chins, chin augmentation, using Radiesse combined with Perlane L (in my Upper East Side practice) and Radiesse plus Restylane SQ (In my Israel office) can be extremely helpful, especially when combined with microdroplets of a neuromodulator, such as Botox, Dysport, or Xeomin for smoothing the chin and providing greater projection and definition.
Naturally, consultation with a board certified aesthetic physician with experience with all current facial rejuvenation techniques and injectable agents is advisable to ensure that the treatment plan that is created is tailored to the specific needs of the individual
Probably not what you want...
for the the mouth, chin and marionette lines botox is not what you really need...the role of botox seems limited to some improvement in the creases radiating from the lips and maybe a little bit at the jawline just to either side of your chin where it may slightly raise the corners of your lip...botox certainly helps calm active movement in the chin and of course reduces wrinkling there...for the rest...you should consider fillers like juvederm as the preferred option...
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Botox for Marionette, Mouth, and Chin Lines and Wrinkles?
Botox placed in this area is an "off label" use. Having said some injectors will place Botox in these areas. Most often, patients may benefit from Botox placed in the DAO muscle. Usually we will use a filler in the areas that you are talking about. Please seek out an experienced and well trained injector.
Botox for not good for marionette lines
Based on your photo, we would not be using any Botox for you. The only time we use Botox for the lower face is when we think it would benefit a patient for smoker's lines. We often use a combination of Restylane and a few units of Botox in the upper lip to get rid of smoker's lines, but it does not appear these are an issue for you.
It does appear that you have lost a little volume in the nasolabial (smile or laugh) lines on the sides of the nose and mouth and that the volume loss continues down below the mouth as you have pointed out (marionette lines). We would most likely use 2 syringes of Restylane to add volume to these areas. Good luck.
Fillers are better for lower facial lines or wrinkles
Rule of thumb, any lines on the lower portion of the face should be filled with fillers such as Restylane, Juvederm, Radiesse, etc. Tiny doses of Botox can be used in those areas as well, but a filler will really give you the look you want. Botox relaxes the muscle, so is much more utilized for the upper portion of the face.
Helps but Fillers Help More
Botox can be injected into the DAO (Depressor Anguli Oris) muscles to augment the response obtained by fillers. The number of units depends on the proclivity of your physician. I prefer 3-4 units. As stated by my colleagues answering this question, fillers are the mainstay of treatment in this area, while they play second fiddle on the upper face.
Botox can also be judiciously into the circumoral lines ( smoker's lines); 1-2 units in four areas (two upper llip and two lower lip). Again, the main effect is from the filler.
You seek someone with experience, however, as drooling ( an effect of poor placement) can definitely be " break up material"
Botox and Fillers
Botox works well by paralyzing the muscle of facial expression like the muscles that cause the lines in the forehead, the glabella (area between the eyebrows) and the lines around the eyes (crowsfeet).
Fillers like restylane and other HA work by filling in the area around the folds and filling in the furrows. These products work well in the nasolabial fold, the marionette and the jowl area.
Hope that helps.
Botox for lower facial lines
Botox is most effective for the forehead and smile lines around the eyes. Botox works by weakening the muscles that cause those lines. For example, it can lessen your ability to scowl or frown. It can also make it when you smile that the crow's feet are less obvious. For the lower face, it can soften a marionette line by weakening the muscles that pull the lip downward. It can do the same for the chin lines. However, generally speaking the actual wrinkles are still there and usually require a filler to correct those areas like hyaluronic acids.
Botox not the best option
I would prefer to use volume enhancing tools vis a vis Radiesse and Juvederm to treat fine lines, volume deficits, and deep creases in the area around the mouth. Botox can be used effectively to the DAO muscle which acts to pull down the corner of the mouth, but must be done with caution due to the potential for interference with oral function.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.