What is the best way to treat marionette lines on my face ? I am 54. (photos)

Question

How would you treat marionette lines on my face - the most natural and effective way . I am 54 . Thank you

Marc Polacco, MD · Answer

Thank you for your question. This is a very common concern. Typically, a combination of treatments that both lift and volumize works the best. For lifting, a facelift is going to give the most impressive result. For volume, typically filler can be added to help disguise shadowing, and there are a variety available depending on the area treated. I hope this helps, and all the best!
-Dr. P

Nima Shemirani, MD · Answer

Hi @atarot! The non-surgical option would be dermal fillers. Restylane Defyne works great! In addition, I recommend Botox into the DAO muscle. The injections stop the DAO muscle pulling down the corners of the mouth. Treatment will cause the corners of the mouth to be slightly lifted, giving the mouth a more relaxed, happy, youthful and pleasing appearance.

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. Marionette lines are typically treated with dermal fillers. Hyaluronic acid (HA) fillers like Juvederm and Restylane will restore volume to the areas beneath the wrinkles, smoothing out deep lines and giving the skin a lift to create a younger-looking appearance. A combination of treatments may be best too. Combining fillers with Botox can create a non-surgical facelift, while lasers and Profound RF (microneedling combined with RF energy) can boost collagen production to help further rejuvenate your skin. To determine the best course of action, I recommend scheduling an in-person consultation with a qualified, experienced injector. Your provider can do a proper evaluation of your skin, recommend the best treatment or combination of treatments, and ensure the best possible results.

Jason Emer, MD · Answer

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting,  and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Waleed Ezzat, MD, FACS · Answer

Thank you for your question. Marionette lines are most easily addressed with filler in the area to soften these lines. Depending on your other facial features, there are more invasive treatments that can be utilized to achieve the natural fact that you’re looking for. I would seek out a board-certified specialist who is well-versed in facial aging techniques and treatments.

Best of luck!

Dr. E

Best of luck!

Dr. E

Nelson Lee Novick, MD · Answer

Fillers work well and have been used for years to successfully treat marionette lines. In this particular case, profile views of the jawline and frontal views of the cheeks would be helpful to determine which kind(s) and where best to inject the filler(s) in order to treat them. If there is volume deficit in the cheeks above, then treating this with a robust HA volumizing filler would not only create a more desirable, oval-shaped face, but would likely improve to some degree the marionette lines, which then can be more directly treated with the appropriate type and amounts of filler. Likewise, if there is significant sagging along the jawline, this, too, can be addressed with a robust filler and would likely secondarily improve the marionette lines, which can then be more directly treated. Direct treatment of the marionette lines, especially with ordinary fillers, such as plain Juvederm or Restylane, would be unlikely to result in satisfactory improvement. You would be wise to consult a board certified, cosmetic dermatologist and be sure to ask to see his/her personal before and after photos before agreeing to proceed. Best of luck.

Camille Cash, MD · Answer

Marionette lines are a result of skin laxity and loss of volume.  There are different options to improve the concern depending on your goals and budget.  A lower face lift is the surgical option which would redrape the skin.  Other options include fillers to add volume.  There are different types of fillers to choose from.  HA fillers are the most common.  Some improvement can be seen immediately and they can be disssolved if desired.  Sculptra is a different type of treatment that helps build collagen and provides longer lasting results, but it can take several treatment sessions for the desired look.  Renuva is yet another option.  This product is designed specifically to address age related fat loss.  It has the benefit of seeing some improvement immediately (like with HA fillers), but over time the product is actually replaced with your own fat to give longer lasting results.

William C. Harris, MD · Answer

Hi,
There are a couple options to treat marionette lines. The non-surgical options are dermal fillers, either hyaluronic acid (eg. Restylane and Juvederm) or PLLA collagen stimulating fillers (eg. Sculptra). Both of these have different advantages/disadvantages, but work well despite the need to repeat them every 9-12 months for most people.
The other option would be a surgical approach. It’s hard to say exactly what would be needed based on your pictures, but since fillers don’t actually lift tissue and just serve to volumize - eventually there becomes a point where a facelift of some sort is the best option to diminish those lines. This also is a longer lasting result for people not interested in maintains fillers regularly.
I hope this helps.

Onir Spiegel, DDS, PhD · Answer

Marinette lines start forming as a result of volume loss throughout the face. So while a quick answer to address the marionette lines would be with fillers, a better answer is a combination of treatments to tighten the skin and restore volume which can only be done with a thorough consultation to look at the temples, malar eminence, NLF and jowles to ensure the results are addressing the whole face and are long lasting. Hope this helps.

Jo Herzog, MD · Answer

Restylane Defyne does an excellent job of filling this area.  There are other fillers that could be used with success. I think that it is the person doing the filling that is most important and you want them to use what they are comfortable with.

What is the best way to treat marionette lines on my face ? I am 54. (photos)

Answers (11)

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