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

You're going to get plenty of answers that may differ about this. Certainly, from your pictures, the mainstay of your treatment will be a lower face and neck lift. There are various forms of this procedure, involving different approaches, but in my opinion, this can either be with a SMAS plication or a deep plane facelift, as both address the deeper structures which are the foundation of support.I would make certain this involved an incision behind your chin to address your neck muscles with a platysma plasty, and potential liposuction there. A nice complement to these procedures is fat grafting to help restore lost volume. All of the above will help with your nasolabial folds. However, the marionette lines will only be slightly improved by the facelift. These are notoriously difficult to treat. In my experience, once I have slightly softened them with a judicious facelift, usually adding fat or filler in this area generously can really help blunt them. The most powerful maneuver in this area is called a corner lip lift, which directly removed skin in the area and will elevate what has fallen. However, this must be done in expert hands as if the area is overdone or the scarring is poor, it can distort the corners of the mouth. Done well, it can really improve this difficult area. So,1-lower face/neck lift with SMAS plication2-platysma plasty and neck liposuction3-facial fat injections, with a focus on the marionette linesand potentially, 4- lip lift and corner-lip liftI hope this helps.Best of luck!Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

I generally advise against
undergoing facelift surgery specifically to treat marionette lines. The results
can be unpredictable, and facelift surgery is actually better suited to
treating the jawline. I often recommend trying injectable fillers first,
evaluating your results, and moving on to surgical rejuvenation if necessary.
It's always best to start small and work your way up, rather than risk
overdoing it. In any case, see a board-certified plastic surgeon for the best
chance at getting the results you want. Best of luck!

Thank you for your question.
Marionette lines and nasolabial folds can be treated in various ways. Beginning with less invasive treatments,
dermal fillers would be a great first step for these areas. Facelift surgery is more highly recommended
for facial laxity, specifically for excess skin and sag in the jowls and
neck. Your next best step is to seek a
consultation with a board certified plastic surgeon. I wish you the best of luck.

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

The development of a marionette line is passive in that is generated by the dissent of soft tissue not facial expression. Nasolabial fold is generated by facial expression and will reemerge in time after a facelift because of the active function in the area. When they do occur fillers do a nice job of solving the problem.

Hello,Given your significant mid face volume loss, I would actually opt for a combined malar/submalar implant. I would also overdraft with fat in the mid face, nasolabial fold, and marionette lines. Finally, I would perform a face and neck lift to redrape lower face, jawline, and neck.Best of luck!

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.

It's a good question. The most conservative way to start is by using filler within the marionette lines and nasolabial folds. Also, filler can be placed in the cheek area (malar area), and can also improve the appearance of the nasolabial folds. If you like the results from filler, then it's a good way to improve the appearance of these areas without having surgery.Surgical treatment involves a face and neck lift. It's important to understand that even with surgery the marionette lines are difficult to treat completely. A face and neck lift uses incisions in front of, and behind, the ear to re-elevate the soft tissues of the face and contour the neck. Fat grafting can be used to restore areas of volume loss. Fat is commonly placed in the cheekbone area, nasolabial fold, and marionette line.You will get the most helpful information by visiting a surgeon who performs filler and cosmetic surgery of the face and neck. They will be able to answer all of your questions and help you decide how best to proceed.

Fillers can be used as a temporary fix but will not correct the excess skin in your face and neck. To rejuvenate these areas you would need a face/neck lift to remove the excess skin. See a very experienced facelift surgeon to evaluate your face and neck. 

In facial rejuvenation there are many options to achieving your goal. I normally like to place it is good better and best depending on how long the treatment is going to last and how effective it's going to be. Using volume to fix the problem is a temporary one however will work especially if combined with a laser treatments, however I think you will be happiest with the surgical neck and facelift that will last up to 10 years and will completely combats the problems that you have described