Can Botox be used to lessen severe marionette or nose to mouth lines?I look so miserable but I'm not!! (photos)

Hi Reetz.  There are two classes of injection products.  The first is neurotoxins and that includes Botox, Dysport and Xeomin.  All of these work by relaxing the muscles that cause wrinkles.  Generally speaking, these products are used from the eyes upward.  The outer eye, the forehead and the frown lines between the eyes (generally speaking).
Dermal fillers are used below the eyes and provide volume where it has been lost.  You look to be a good candidate for a lower facelift and liposuction in the neck area.  But if surgery is not in the cards right now then your next best option is dermal fillers to soften the nasolabial folds at the sides of the nose and mouth.  Best of luck.
 

A combination approach will give the most improvement. I recommend fillers for the folds themselves but also lifting around the mouth and cheeks to build underlying anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments, J Plasma and peels to get the most conservative natural look. Please see a facial sculpting expert. Best, Dr. Emer

Thank you for sharing your question and photographs.  Unfortunately Botox offers little treatment to the marionette lines and if you are looking for a non-surgical improvement this would better be obtained with a combination of dermal fillers to address volume loss and tissue sagging in the cheek and back jawline.  I would advocate seeing a series of ASPS board certified plastic surgeons in consultation to discuss.