36 y/o female with marionette lines at rest. Can this be treated with Botox, filler, or lasers/peels? (Photo)

Thank you for your question. I understand you’re concerned about some smile lines, or marionette lines, around your mouth, and ask if Botox or fillers can improve their appearance.I can provide you with some guidance on this issue. I am a Board-certified cosmetic surgeon, practicing in Manhattan and Long Island for over 20 years, and a Fellowship-trained oculofacial plastic and reconstructive surgeon. Interestingly, oculoplastic or oculofacial plastic surgeons and neurologists were actually the first doctors to use Botox.Moving onto the question of smile lines, we must first understand what causes them. As we get older, volume loss occurs at many levels—particularly when you reach your early to mid-30s. In your teens and 20s, you could smile as you normally would, and your skin would just bounce back. As you get older, the lines caused by smiling or other facial expressions become more etched in and go from being dynamic to static and constantly present. This is caused by a combination of loss of skin collagen, loss of fat under the skin, and loss of elasticity in the skin.In order to address this, a cosmetic filler—usually from the hyaluronic acid family, such as Juvederm or Restylane—can be used. These types of fillers are made of material that’s naturally found in the skin and help fill out or add volume to the superficial levels of the skin.We usually divide the skin, epidermis, dermis and subcutaneous fat layer, and then we place the fillers in the level of the dermis. When it comes to the spectrum of fillers, there are fillers that are softer and last a short time, and there are those that are thicker in consistency and last longer. Often, people will opt to have a thicker and longer-lasting filler placed into their skin, but keep in mind that a thicker filler can also make it look more obvious that you have had fillers done, which is not an ideal look.With the understanding that you’re looking for improvement and not complete erasure of the lines, I would suggest you use a softer filler to soften the lines and create a better overall balance for your face, so your lines are not a focal point when you look in the mirror.In our practice, we do a combination of hyaluronic acid fillers and platelet-rich plasma (PRP). PRP is a concentration derived from your own blood, and its benefits include improved stimulation of collagen production, fibrovascular growth, and blood supply, as well as some wound-healing benefits. The combination of hyaluronic acid fillers and PRP, in my experience, seems to work better because there’s synergy and the concept of a matrix being formed with this combination. Essentially, we’re using PRP or your body’s own natural healing ability to rebuild collagen, while the hyaluronic acid filler provides a sort of scaffold.I recommend you explore this option, as it is certainly worth considering. I hope that was helpful and I wish you the best of luck.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Thank you for your question. Fillers can help soften the appearance of marionette lines, along with different lasers to help tighten the skin. To be sure what is best for you, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment.I hope this helps.

 Thank you for your question. If you had to choose one product or procedure, I would recommend using a dermal filler. If however, you are open to multimodal approach, then I would recommend using an energy-based device such as Ultherapy or Profound to also help create more of a lifted and tighter structure in the face.