Artefill for Marionette Lines?

I have quite deep marionette lines. They drive me crazy. How many injections would I need and what is the best filler for me?

I was wanting ArteFill but is that the best choice? Actually, after seeing my photo I'd like a head transplant! Please help.

Doctor Answers 2

Artefill for marionette lines

Sometimes, it's not the "obvious" trouble spots that need the most attention. Most of my patients come to me because they have a few noticeable problems like "under-eye bags," "parentheses," or "crow's feet" that they're hoping a specialist can correct. Many times, though, these areas need only minimal help, and I will get much more dramatic results by focusing on restoring volume to the upper face at the same time.

Focusing on Results

Years ago, facial plastic surgeons designed their procedures to "remove" problems like crow's feet. Today, though, better-trained surgeons focus much more on the "big picture" of a patient's face, with the goal of creating harmony and balance between the features and restoring the characteristics of youthful tissues and facial structures.

For me, this means that along with tightening up the surface tissues, I'll often spend some time and attention using injectable fillers or (in a few cases) facial implants to recreate the rounder upper-facial contour that older people lose as their facial fat starts to droop. Here's why:

• Symmetry - For many patients, aging doesn't happen exactly the same on both sides of the face, even if your facial structures themselves are perfectly balanced. Often, facial asymmetry happens partly because the malar (cheek) fat pads don't fall at the same rate on both sides of the face. Surface and muscular adjustments can help with this problem, but injectable fillers can often help create much more even results.

• Restoration - Sometimes, minor facial sagginess at the jaw line results from loose fat, but in more cases the skin simply falls because there's no tissue volume to hold it. Adding upper-facial volume can reverse this problem without the need for additional surgery.

• Tissue quality - For thinner patients especially, certain facial surgeries risk creating a gaunt, pulled look if the patient has lost a lot of fat from their cheek area. Restoring upper-facial fullness at the same time can smooth out wrinkles, but also help the patient look much healthier.

• Emphasis - Much of facial aesthetics is about placing emphasis on the patient's most attractive features. Creating a fuller contour in the upper face can not only de-emphasize lower-facial sagginess, but also highlight the eyes much more effectively than surgery alone would.

Irvine Dermatologic Surgeon
4.7 out of 5 stars 19 reviews

Several filler choices for marionette lines

To fill your marionette lines, you have several choices which all work good. Radiesse ($630/syringe) is probably the most common used and lasts about 1 yr. Artefill ($1250/syringe) lasts the longest at 4-5 yrs but needs a skin test 1 month ahead of time to make sure you are not allergic to the collagen it is mixed in with. Juvederm, Restylane, Perlane ($550/syringe) is fine to use and lasts about 6-9 months. What ever you use you will look good with but expect about 2 syringes injected over 2 sessions and they are very easy to get injected with. Good Luck.

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 42 reviews

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