Botox and fillers for marionette lines beginning to show?

I am 44 but have been doing Thermage, Refirme ST, and Microcurrent for several years periodically. I have no wrinkles anywhere now except the very slight beginnings of a depression where marionette lines will form (my mom has them terribly). Will fillers work? i have had fillers migrate to other areas before. How do I know what to inject and who to have inject? I am really worried since I have had filler issues in the past. Could Botox help in minimizing the smile muscle at the corners of my mouth right beneath the bottom of the nasolabial fold? I would love specific advice. Thanks!

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7 answers to “Botox and fillers for marionette...”

A: It might be safer for you to wait

Ronald Shelton, MD

It is always a concern when addressing minimally obvious features as there may not be enough improvement for you to be happy, and more risk in having the product / filler be more visible if your slight marionette depressions were to be filled. Local movement during injection or with your muscle movement during... more

A: Marionette region

Brent Moelleken, MD

Botox may indeed have a place for reducing the activity of the DAO (depressor anguli oris) muscle, the frown muscle of the lower lip. In addition, cleverly placed hyaluronic acid filler in the marionette and lateral lip region can also reduce the appearance of the marionette folds. I would urge patients to... more

A: You may not need any treatment yet.

George J. Beraka, MD

Hi!   Remember, fillers are not meant to be preventive.  It is not clear that you have marionette lines yet. When you do, in New York, we would probably treat you with Restylane injections.  I don't think Botox has a role. See a board certified plastic surgeon or a board certified... more

A: Botox and fillers may both be beneficial for marionette lines.

Otto Joseph Placik, MD

It is possible that Botox into the depressor anguli oris muscle may soften the downturning at the oral commissure and the inferior most extent of the nasolabial fold. Fillers are probably more effective for this area. I would initially employ a hyaluronic filler. Consider Restylane or Juvederm. If you do not... more

A: Yes to both

Mary Lupo, MD

The best way to address your problem is with Botox into the mentalis and DAO, and filler into the marionette and pre-jowl sulcus. Issues with poor results from filler are usually traced back to less experienced (and even unqualified) injectors. I have even given an entire lecture entitled: It is not the... more

A: I like a combination of Botox and fillers for the oral commissure

James F. Boynton, MD

The area you are describing is loosely referred to as the oral commissure that forms the "beginning" for the Marionette line that can start there and "travel" vertically downward on the lateral chin. This can be a very challenging area and I have found that a "combination... more

A: Fillers work well for marionette folds.

Eric M. Joseph, MD

 Dear Smag, If you email / post a picture, I'd be happy to give you specific advice. Injectable fillers are great for filling in all types of folds, especially at the corners of the mouth. The type of filler you choose should be based on the experience and advice provided by your doctor.  Consulting... more

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