Marionette Lines and Shadowing - would Restylane help? (photos)

Question

I recently turned 40 and am becoming increasingly self conscious about marionette lines, and shadowing, particularly on one side. A month ago, I had 1 ml of Restylane injected into marionettes and jaw area, with an additional 1 ml injected into the mid face are, but I barely notice a difference. Would more Restylane help? If so, how much? What else could I do to help correct these? Thanks so much.

Jonathan Kulbersh, MD · Answer

Thank you for posting your question and images. There are many dermal fillers that can treat facial lines and folds, including marionette lines. Everyone reacts differently to dermal fillers, which is why it is critical to work with a board-certified facial plastic surgeon to monitor your results and concerns. If Restylane did not meet your goals, there are other options. RHA dermal fillers include four unique formulations that mimic natural hyaluronic acid in the body. These injections treat dynamic wrinkles without making the skin look and feel stiff. RHA 3 works for moderate marionette lines and deeper wrinkles around the nose and mouth.

I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon and expert injector. They will be able to evaluate your concerns and treatment history, then determine the best course of action to achieve your desired results.

I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon and expert injector. They will be able to evaluate your concerns and treatment history, then determine the best course of action to achieve your desired 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

Edward Buckingham, MD · Answer

As we age the lines and wrinkles cause shadowing which naturally draws the attention of the eye. The goal of filler is to soften the lines and shadowing without causing an unnatural appearance. The type of dermal filler used may have an impact on results, with no one filler being perfect for each location. Also the amount of filler injected does not have to be symmetric per side. If desired, you may benefit from additional dermal filler to help address your concerns. Surgical options include facelift, however the marionette lines benefit the least in the lower face due to our desire not to caused a stretched appearance to the lower face.

Jeffrey Lisiecki, MD · Answer

Tough to say based on just your photos and description. 1mL may not have been enough, or it may not have been injected into the optimal place to address your oral commissures and marionette region. More filler could help, though personally I wouldn't use Restylane in that area for a number of reasons. Another good option is fat grafting to this region and anywhere else you need volume restoration.

Camille Cash, MD · Answer

There are a few options for you to consider.  More filler is one option.  More product may give more support to the tissues to minimize these folds.  Another option is Sculptra.  This is a different type of treatment that stimulates collagen production and gives longer lasting results.  You can also look into Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  I've included a video I hope you find helpful.

Darryl J. Blinski, MD · Answer

Great series of posted photos. Three issues: #1. Under treated in amounts of HA filler use. I would have recommend 2 sessions about 2 weeks apart using a total of 4-6 syringes. #2. Wrong type HA filler. You have lower G' prime HA filler, I would use higher G' filler, like Juvederm Vollure. #3. Maybe a minor anterior facelift wth SMAS plication and filler to lift the peri oral mounds. Best to virtual consult with...

Marionette Lines and Shadowing - would Restylane help? (photos)

Answers (6)

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