Marionette lines -- what can be done?

In my case, the lines are like shzdiws, or hollows, volume loss -- not creases or folds -- but still quite apparent. I've tried Juvederm injections several times but the filler seems to migrate away from the hollow. Maybe not enough? Or is there a better choice? I'm a 55 yr old woman, lost 40-50 lbs 11 yrs ago.

Doctor Answers 10

Marionette Lines

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If you have already tried filler without success, you may want to consider a surgical option such as a lower face lift.  Sometimes after weight loss and with aging changes, a filler is just not enough to restore the youthful look to the lower face.  I would consult with a facial plastic surgeon to discuss your options.

Marionette Lines and Treatment

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It may be that the best solution to treating these marionette lines is to add a filler like Voluma to the mid-face.  Voluma can volumize the face and lessen the marionette lines by bringing up the cheeks and diminishing these lines.  This would be the most effective solution. Best, Dr. Green

Marionette lines -- what can be done?

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Hi, non smiling photos of your face from the front and side would help in the evaluation.  At 55 years of age, marionette lines are likely caused by loose facial skin called "jowls".  If you are only interested in softening the marionette lines, aa dermal filler remains the best option.

If you have "jowls" this is sagging facial tissues and an indication for some form of a facelift, not Cheek Augmentation.   I have performed many Cheek Augmentations over the past 30 years and the notion that Cheek Implants or dermal fillers to the cheeks, by themselves, will lift tissues is an urban myth.  Filler to the cheeks or cheek implants will shape the cheeks but alone will not lift up the jowls.  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.  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.

Hope this helps.

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Marionette lines

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The treatment of marionette lines is somewhat challenging.

Unlike nasolabial fold The marionette lines tend not to respond as well to fillers.

Still fillers are the treatment of choice unless someone is having surgical intervention such as a facelift.

fillers are by far more accurate and predictable than more permanent treatments

Sometimes injecting very close to the skin surface can give a better result.

Juvet arm is a good product to use though I personally prefe using Radiesse both in terms of value and duration.

your provider may be top notch though at times it can be a good idea to try a new provider to see if the results are different.


Mats Hagstrom M.D.

Marionette lines

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I use Radiesse or Bellafill for that area, the main thing is to place it in the right place and to use enough of it. Best of luck.

Radiesse for Marionette Lines

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Hi 55. We prefer Radiesse in this area, but regardless of whether the product is Radiesse, Restylane or Juvederm, it should not migrate after placement.  Perhaps seek out another injector.  Good luck.  

See the link below for a good photo of marionette lines using Restylane.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Marionette lines -- what can be done?

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Marionette lines are treated with fillers, ulthera or Thermitight technology. Please schedule with a board-certified dermatologist so you can figure out your options

Jeanine B. Downie, MD
Montclair Dermatologic Surgeon

Marionette lines and chin -- fillers / fat/ sculptra, you may need lifting, chin implants

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I suggest a formal consultation you may need a more robust filler, fat injections or lifting/implants.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 203 reviews

Treating Marionette Lines

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Filling marionette lines is sometimes frustrating but fillers are the treatment of choice. You may want to try another injector or filler. I prefer Radiesse in this location.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Treatment of Mariionette lines

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Marionette lines are a challenge to treat effectively.  A facelift would most likely be the surgical option, if that is something that would interest you.  However, fillers and volumizing product will do nicely and tend to be more predictable... I prefer using using Radiesse  because of it's duration and price point.  Belotero could be considered useful for injecting close to the skin. Both products could be used simultaneously.
I hope this helps. Good luck.

Leslie M. Sims, MD (in memoriam)
Las Vegas Ophthalmologist

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.