What is currently the best, most effective procedure to correct marionette lines and nasolabial folds? (Photo)

I would like a surgery or treatment to eliminate the marionette lines and nasolabial folds. What is the current, best, most effective way to do this? I'm open to facelift, cheek implant or augmentation, mid facelift, lower face lift, or fillers / laser. If suggesting surgery, could you please specify where the scars/incisions will be & the exact name of the surgery so I can research it? age 46.

Doctor Answers 29

Treatment for marionette lines and nasolabial folds

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 The most conservative treatment for these areas are placement of temporary fillers to augment both areas. If you have tried and failed those treatments, then consider surgical intervention as the next tap. A full set of facial photographs are required to make any determination about what may be needed due to the fact that the face is a three-dimensional structure. Cheek implants are performed when patients have a flat maxilla and a flat cheek profile to augment the mid face. A lower face and neck lift is performed to lift the jowls, tighten facial and neck muscles, tighten loose facial neck skin, and remove any fatty deposits in the neck. It's also important not to pull face so tight that it changes the corners of the mouth since that will look unnatural. For many examples, please see the video and the link below


Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Marionette lines and nasolabial folds

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Hello Lalajaye,
Thank you for your pictures and question.  As my other colleagues have alluded to, aging is multi-factorial and involve the skin (elasticity), fat (loss and atrophy), muscle (atrophy and loss), and bony chnages.  Because aging affects your face in multiple ways, in order to address your folds, we need to address each layer.  What makes the nasolabial folds and marionette region difficult to treat with one modality is it can look unnatural.  Thus, from your pictures, I would recommend a facelift, necklift, fat transfer or filler to the nasolabial folds and marionette lines, and possibly cheek implants.  There are surgical procedures that can eliminate the folds, but those incisions are rarely performed over the folds and creases just because of the location.  Best of luck to you!

Elbert T. Cheng, MD
San Jose Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Facial aging and correcting the nasolabial folds and marionette lines

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Great question.  With aging several things happen including:
  • skin elasticity diminishes
  • soft tissue droops down more from ligament laxity
  • volume loss occurs
Often, there is a combination of factors that result in aging effects.  Proper correction of the issues you have listed is often best done by a combination of face lift, neck lift, and fat transfer.  The incision for a face lift and neck lift are near and inside the ear and often along the side burn hair follicles.

I would seek consultation with several board certified plastic surgeons in your community and look at their before and after photos as well as discuss your goals and options with them.

I hope this helps.

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

What is currently the best, most effective procedure to correct marionette lines and nasolabial folds?

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In my experience, you would benefit from a midface lift to help place your cheeks in their natural, more youthful position. This along with a SMAS facelift will help naturally reduce the marionette lines as well as the nasal labial folds without creating a pulled or unnatural look. This procedure tightens both the skin and the superficial muscle layer underneath. Your photo also reveals some flattening of your cheekbones, this can be improved with the midface but would also likely benefit from cheek augmentation to help enhance your features. I perform my mid face lift through incisions inside the mouth along the top of the gum line and small incisions behind the hairline in the temporal scalp. Typically incisions for a SMAS facelift will begin right along your hairline in the sideburn area. It will then continue in front of your ear and travel behind your tragus and down the front and around your earlobe. The incision will continue behind the back of your ear in the crease. This allows your surgeon to have access to your midface, lower face, and neck during the procedure. The scars are well hidden in the hair and around the ears. I hope this helps in determining if this procedure is right for you.

P. Craig Hobar, MD
Dallas Plastic Surgeon
4.8 out of 5 stars 24 reviews

Ultimate BEST way to correct the #marionettes and #nasolabial folds? #facelift #fatgrafting #fillers

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Your question is a common one asked by my patients too.

Best way is to address the many components, with a facelift and an extension into the temporal area (so a low and mid-face facelift), high-SMAS lift, and fat grafting to both NLF and the marionettes lines.  I would need to see your forehead entirely to see if the composite facelift would not be indicated (adding the browlift to the procedure).

You may also still need a smaller amount of HA fillers such as restylane and juvederm over time to maintain the results.

Hope this helps!

Best regards,

Dr. Marc DuPere, Toronto Aesthetic Plastic Surgeon

Marc DuPéré, MD
Toronto Plastic Surgeon
4.8 out of 5 stars 71 reviews

NLF and ML treatment

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In my opinion:
Nonsurgical: soft tissue filler such as Radiesse/Juvederm Ultra/Restylane Lyft can get you 6-12 months duration but needs to be repeated.
Surgical: Facelift with microautologous fat grafting (using your own fat and injecting small parcels of fat directly into those lines).  Lift the lower 2/3 of the face and fill the "valley" with your own fat.  Potential long term duration of fat survival.  You look like you have some fat under the chin and we can use the fat from there as well in addition to obtaining more from the belly area.
Thank you for the pictures.  They do look like deep lines and we can soften significantly but difficult to completely make them disappear.

Johnny Mao, MD, FACS
Orange Facial Plastic Surgeon
4.9 out of 5 stars 59 reviews

Procedure to correct marionette lines/nasolabial folds?

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Thank you for your question and photos. The short answer is that almost any facelift technique with SMAS
suspension will improve both areas. The SMAS is a deeper layer of connective tissue which has much
greater strength to support the lift, as compared to the skin alone. Your photo also shows a somewhat
flattened malar (cheekbone) area which can occur with normal aging and/or weight loss. This area would
benefit from added volume, either in the form of an implant, fat graft or filler. After your facelift, laser
treatments can improve the tone/texture of your facial skin. However, both lasers and fillers work best as
adjuncts to, and not replacements for, a good surgical lift. I hope that this information is helpful.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 20 reviews

Most effective procedure to correct marionette lines and nasolabial folds?

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 Hi, I have performed facelifts for over 30 years.  From the photos your cheeks are very flat anteriorly (in the front) and there is excess skin as evidenced by nasolabial folds and "jowls".  These combine to create a rectangular shaped face.  Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces. Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.  I shape the cheeks, chin and jaw line with every facelift procedure.

 If you have "jowls" this represents sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op
I combine whatever facial shaping that's necessary with every facelift procedure. When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

The best choices for marrionette lines and nasolabial folds

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Dear lalajaye,
Likely the combination of volume replacement and tightening will have the greatest impact. It is reasonable to start with dermal fillers and then consider surgery if you did not get the results you are looking for. Face (and I almost always also do the neck) lifting in young patients can seem aggressive, but I have been thrilled with the results and longevity. Volume replacement in the cheeks, NL creases and lower marrionettes with fat transfer at the time of the facelift is a nice adjunct, and then you can use fillers later closer to your mouth since these products are well suited for this area.
Best of luck to you!

Stacey Folk, MD
Denver Plastic Surgeon
4.8 out of 5 stars 25 reviews

Marionette Lines around my mouth: What can be done?

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I think dermal fillers would be a good place to start.  I like Radiesse or Restylane for his area.  Radiesse can last between 12-24 months and the Restylane close to a year.  Further improvement of your jowls, jawline, and the marionette lines could be gained from a lower facelift.  Lower facelift incision vary by the surgeon, so you would want to talk to them.  In general, they are placed just in front of the ear and sometimes extend up into the hair and behind the ear.  Best regards.

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 17 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.