Improving Marionette Lines with Lower Facelift?

How much improvement can I expect from a Lower facelift with fairly significant marionette lines?

When I hold my face where approximately I think it will look after surgery, I still see the lines. They become less severe, but somewhat horizontal. How often are some type of fillers needed with the surgery? Thank you.

Doctor Answers 26

Marionette Lines

A lower facelift will address most marionette lines if they are not too deep. Pre-operative evaluation is important in determining whether or not additional filling may be needed. This would include the use of fat grafting or dermal-fat grafting at the time of the facelift. If it is borderline, then I usually error on the side of not doing any grafting and evaluate after surgery. I feel that an "overdone" look is worse than having to use fillers judiciously post operatively. I hope this helps and good luck.

Minneapolis Plastic Surgeon
4.8 out of 5 stars 176 reviews

Marionette lines and a lower face lift

Thanks for the great question -

A lower facelift is designed to address the neck and submental (beneath the chin) excess skin as well as the jowling which can contribute to the marionette lines.

You should see a significant improvement but sometimes there can be some residual lines.

Have a careful conversation with a board certified plastic surgeon about what to expect and how to proceed in a manner that best addresses your concerns.

I hope this helps.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Improving Marionette Lines - surgery, fillers or both

Lower face lifts or mini-lifts re-drape the redundant skin in this region smoothing them out to a degree. The assessment however is key to determining if additional procedures are required: for example: if there is redundant fat in the jowl region this should be reduced (liposuction or direct reduction), if there is pre-jowl ("thumbprint depression between chin and jowl) depression then it would indicate that a filler is probably needed. Fillers  include fat transfer,  Perlane, Jeuvederm, Radiesse, Sculptra, and others to correct the jowl contour problem

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Marionette lines are treated through both tightening and filling

You are very perceptive - with deep marionette lines or folds, a lift alone is inadequate, and can make the remaining marionette fold travel in an unnatural direction.


I find that filling - either with fat or injectible fillers - is a necessary adjunctive treatment for deep marionette folds even with an excellent surgical facelift.

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 203 reviews

Marionette lines

Marionette lines may respond to fillers like Juvederm or Restylane, or more permanently to fat transfers. The lower facelift should help redrape and tighten the skin of the jowl area, and depending on the vector of pull, may help correct the marionette lines well. These procedures are often combined to optimize results. A consultation with a board-certified plastic surgeon can help you in your decision process.

Tim Sayed, MD, MBA, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 17 reviews

Benefits of the Lower Face Lift

A lower facelift, or necklift, is a procedure to improve the neck and jawline, minimize the appearance of the jowls, and treat the marionette lines (the lines below the corners of the mouth). There are many different variations in this surgery regarding incision placement and treatment of the SMAS and skin, depending on the surgeon's training and preferences. In many patients the marionette lines are eliminated through a lower facelift. However in patients with deeper lines or less elasticity of the skin, the marionette lines may persist to some extent. In these cases, fillers such as Radiesse, Juvederm, Restylane, Perlane, or Sculptra may be appropriate. You should seek a consultation with a surgeon experienced in facelift surgery. Ask to see before and after photos and make sure that you like what you see.


Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Define the problem then match the correct procedure.

The current theories of facial aging provide that facial fat melts away in some areas and accumulates in others. The corners of the mouth exemplify a zone where soft tissue "melts" away, leaving a trench, starting from the corner of the mouths and extending inferiorly towards the jaw; the so-called "marionette's lines".

A lower facelift assists in repositioning the mandibular jowls and redefining the neck and jaw. If a surgeon exerts adequate pull on the overlying skin and muscle, much as you do, when simulating the effect of the face-lift, partial improvement of the marionette's lines will result. However, if, as you observe, there is still a line, then a dermal filler, Hyaluronic acid, Radiesse or Evolence will provide structural support and improve the final result.

Prior to proposing any surgery, I ask patients to identify features they dislike and then we discuss "solutions" as well as recovery time, longevity and possible complications. Hope this helps. Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Marionette lines and lower facelift

The marionette lines should be much improved after a lower facelift.  In some cases it may be necessary to either resurface the skin in this area or fill the lines with fillers.  The vast majority of patients will not require any fillers in this area however.

Glynn Bolitho, PhD, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 14 reviews

Marionette lines

The depth of the lines is important.  A lower facelift may alleviate the lines a bit but I would also recommend filler around the lips for this condition.  The procedures can be combined for an optimal result.  Fillers and surgery are performed together when both are appropriate; I have never thought of it in percentile terms.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

Marrionette Lines and Lower Facelift

Marrionette lines improve with traditional lower facelifts to some degree. However, certain facial muscles create these lines and they are not directly corrected by the facelift muscle repair. I advise most of my patients that they will probably need filler to the area approximately once a year to get more of a result. Fillers alone, however, cannot solve the entire problem. This problem frustrates patients and doctors alike.  

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

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.