Are my marionette lines a result of volume loss in cheeks? (Photo)

I'm only 18, but the corners of my mouth really turn down and it's getting worse as I've gotten older. I also have slight nasolabial folds. Would this be fixed by adding volume to my cheeks, and are my cheeks flat? Or is it from something else? Thanks!

Doctor Answers (5)

Marionette lines are from loss of dental support!

+1
Can we establish any rules for augmenting the  lower third of  the face?In looking at the aging lip, there are two important areas
to observe.
1) One is the shape of the lips themselves, and, i
2)the importance of the support provided to the lower third of the face by dentition,grinding and also 
bone structure.
These are all features which require restoration.
Not only  injection of the lips themselves but also on volumetric
restoration of the lower third of the face. The lips
should be full and well defined. They should be injected
without blunting the edge of the vermilion border of the
lips or unnatural fullness above the lips. A physician must
also focus on the restoration of the ends of the lips, as well
as the building of buttresses at these ends to restore height
to the lower third of the face, correcting the labiomandibular
grooves and oral commissure. Although dermatologic
and esthetic journals deal with substances for
implantation, these journals do not, in themselves, hold
information regarding the proper goal of lip enhancement.
Instead, the answer is found in the dental literature, in
which many articles have addressed the proper height,
size, and location of the lips as produced by dental restoration.

With the patient in the sitting  position, the lips
should be parallel to a line drawn between the pupils of
the eyes. In regard to spatial location, the upper lip should
be 18 to 20 mm from the nose and the lower lip should be
36 to 40 mm from the chin. As the dental support is lost over time the lips move farther from your lips with the visual concept your nose is getting larger. The concept of this loss of dental support is commonly referred to as "Long on the Tooth!


Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Marionette lines at 18 years old

+1
If you have marionette lines at 18 years old, we can blame this on heredity, but chances are, the younger you
correct this feature, the less problem you will have as you age into your 20's, 30's, 40's and beyond.
Hyaluronic Acids such as Juvederm or Restylane can be effectively placed in the corners of the mouth to
create lift.  Additionally, Radiesse can be used with great results.  Also, Botox can be injected into the muscle
which causes the mouth to pull down.  Things to remember, Botox will last about 4 months, Radiesse 7 months
to a year, and Juvederm or Restylane 7 months.  Weigh your options and your pocket book.

Charles A. Wallace, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 2 reviews

Probably not volume loss (yet!)

+1
Hello! You are young for volume loss to be impacting your features. It is more likely a result of your facial bony structure, proportions and muscular attachments. Keep in mind, though, that even babies has a crease at the corner of the nose and corner of the mouth. While volume will continue to decrease in the midface as you age, you are not likely seeing this effect of aging yet. The volume of your cheekbones cannot be assessed with your photos- if you are interested in cheek augmentation, consult with an experienced facial plastic surgeon. Typically, patients are happier with fillers in the cheek area than implants. Good luck!

Catherine Winslow, MD
Indianapolis Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

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Marionette Lines

+1
The only way to assess these lines is from a frontal and 45 degree angled view.  Side views are not helpful.  Some people genetically have decent of the fat pads around the mouth and little soft tissue support of the lower lips with some bony chin recession.  These all work together to give "marionette" lines.  Seek a formal consultation with a cosmetic dermatologist or plastic surgeon.  You may be a little young for filler injections however.  I wish you the best of luck, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
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Marionette lines in an 18yo

+1
Although you technically have marionette lines you have no volume loss in your cheeks and your lines are more consistent with your anatomy than any age related changes.  In case you were considering having a filler placed in your cheeks or your marionette area I would be careful because I don't think that it will turn out nicely.  Too much filler in your folds will puff it out and not look natural.  I think that you are young and pretty and that you should just go with that and not be so tuff on your self.
Best wishes....

Seth Kates, MD
Worcester Dermatologic Surgeon
5.0 out of 5 stars 1 review

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.