How can I best address my marionette lines? 40 years old. Would prefer to avoid major surgery but I’m not wholly opposed (Photo)

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

Hyaluronic acid based fillers such as Restylane Defyne are a great way to soften marionette lines. Fillers could be combined with a skin tightening procedure like Thermage FLX for optimal results. 

Great questions.

Over time, suttle changes occur as we have more birthdays and the what the health of our skin and body is. Now is a great time to have a consultation. Consultation is vital with a Board Certified Plastic Surgeon, Dermatologist, Facial ENT, or Certified Aesthetics Nurse Specialist is essential. During the consultation options would be discussed. Perhaps, there would be a benefit of Voluma XC in midface. By injecting Voluma in your midface, allows to soften your Nasal Labial Folds and possibly with the correct techniques help with jowling (side view). Your Marinette lines would also benefit with Juvederm Ultra Plus XC.  Kybella or Cool Sculpting (3 areas) in the submental area would be beneficial!