What is the best option for marionette lines and fat pockets around the corners of my mouth? (Photo)

Question

This makes me look like I am constantly frowning when my face is at rest. I am 27 years old.

Michael P. Morrissette, DDS, FACS · Answer

With some mid-face descent, a combination of cheek fillers and thread lifting would provide a "lift" without undergoing a surgical procedure. Additional filler in the area beneath the corners of your mouth can also provide improvement for a down-turned smile. A small amount of botox to the depressor muscle also help

Nima Shemirani, MD · Answer

Hi @aehartman! I recommend Morpheus 8.  Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting. In addition, I recommend getting a few units of Botox into the DAO muscle. The injections stop the DAO muscle pulling down the corners of the mouth. Treatment will cause the corners of the mouth to be slightly lifted, giving the mouth a more relaxed, happy, youthful and pleasing appearance. Best of luck, Dr. Nima!

Jason Emer, MD · Answer

I recommend fillers for the lines 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

John Kellum, MD · Answer

The best option would be restyline injected to fill the fat pockets around your mouth.  Restyline can also be used to fill marionette lines.  Botox or Dysport would also be a good option for the lines as well

Lisa Jenks, MD · Answer

Without an in-person examination that allows me to visualize your face at rest as well as when you are animating, it is difficult to give exact recommendations.  However, from the pictures you sent, it appears as though you could benefit from fillers.  We all lose volume in our chin area as we age, which in part contributes to the development of marionette lines and the appearance of fat pockets around the mouth.  I prefer to use fillers such as Juvederm or Vollure in this area, both of which are very natural looking.There are also skin tightening procedures such as Ulthera which stimulate collagen production and muscle tightening that are nice adjuncts to fillers.I recommend that you have a consultation with a physician who specializes in aesthetic medicine.

Eric W. Cerrati, MD · Answer

There are several different ways in which this area can be addressed.  On the more conservative side, a filler injection of Juvederm can camouflage that area and elevate the corners of your mouth.  The next possible treatment is to combine this with a cheek filler, like Voluma, to provide a slight lift to help eliminate that area of concern.  Next, lasers can be incorporated to tighten the skin and stimulate collagen growth.  Given all of the available options, I recommend that you have a consultation with a facial plastic surgeon or dermatologist to discuss all of the options and pick one that is most inline with your goals.

Michelle Ellern, DO · Answer

It looks like you have some skin laxity and loss of volume causing your issue.  It is difficult to give particular recommendations without and in person exam and discussion. However, filler are going to be a part of what you need in order to improve the appearance of the area.  Please find and experienced injecting physician to discuss you issue and what can be done to improve your appearance.  Good luck with your transformation.

Amy Vaughan, MD · Answer

Thanks for your question and the photo. I encourage you to schedule a consultation with a qualified physician. You would be a great candidate for fillers by looking at your photos. The marionette lines and fat pockets are due to volume loss. This can be addressed by having a filler injected into the cheekbone area to give you the "lift" you desire. Voluma is an excellent choice for this area.  Juvederm and Vollure can be used for marionette lines. Schedule a consultation and see what is best for you!

Michael H. Gold, MD · Answer

Thanks for your question and the photos and we always recommend that you consult with a board certified dermatologist or plastic surgeon to learn the best treatment options for you.  From your photos, you do some volume loss in your cheeks and having a filler injected there may improve all that you are looking to improve – fillers such as Juvederm Voluma or Restylane Lyft may be the best for you.  Find the right provider and you will do just fine.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph aehartman. I understand your concern. Fillers are used to restore lost volume in and enhance the appearance of the face.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles. However, I hope the information provided here is useful.The lower face is a common area that we address for rejuvenation. Specific concerns include nasolabial folds (the wrinkles that go from the sides of the nose to the corners of the mouth), marionette lines (the wrinkles that continue from the corners of the mouth to the jawline), the jowls, jawline definition, and the double chin. In order to address these concerns, it is important to understand the causes of them.
Over time there are structural changes in the face that occur with age. The bony structures in the mid-face move downward and the fat pads get smaller. At the same time the levels of collagen, the protein that provides a firm and youthful appearance, decrease. Together these lead to the appearance of the aforementioned signs of aging. Additionally, the double chin is caused by age, weight gain and genetics.
  To address these concerns a number of treatments options can be used and I find that a combination approach works best. Fillers such as Voluma can be placed in the upper cheek to restore lost volume in the mid-face. This will pull up on the lower face, providing a lift to address all of these concerns. Additionally, it also serves to restore the youthful apple of the cheek, which is also lost with age. We assess the results of Voluma two weeks after a treatment once the swelling has subsided. At that point, more product can be used if further enhancement is desired. Alternatively, a filler such as Vollure can be placed directly into the nasolabial folds and marionette lines. To stimulate collagen, I recommend fractional CO2 laser resurfacing for my patients. This treatment works by generating thousands of microscopic holes in the skin and generating heat, which stimulates the skin to produce its own natural, new, fresh, and healthy collagen. This will tighten the skin and pull the lower face up. Other skin tightening treatments include infrared light, other lasers, radiofrequency, and ultrasound. Botox can also be used in the lower face and neck to relax muscles that pull downward on the lower face. The depressor anguli oris (DAO) is one such muscle in the lower face that can be treated. This muscle pulls down on the corners of the mouth, leading to a sad face appearance. When this muscle is relaxed with Botox the corners of the mouth can be elevated by about one millimeter. The platysma muscle on the neck pulls down on the skin in the lower face. When this muscle is relaxed with Botox it can improve jawline definition.Please consult with a doctor for specific recommendations.  Good luck!

What is the best option for marionette lines and fat pockets around the corners of my mouth? (Photo)

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