Can Botox Get Rid of Marionette Lines, Mouth and Chin Lines, and Wrinkles?

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

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

While Botox is not generally considered the best treatment for lines around the mouth, marionette lines are affected by a specific muscle that pulls down the sides of the lips so Botox can be helpful with expert injection. In addition, these lines are usually caused by volume loss, and are also improved with the use of dermal fillers such as Restylane, Juvederm or Radiesse. An in-person consultation with a board-certified dermatologist would be needed to evaluate your concerns and come up with a custom treatment plan.