Should I Continue with Sculptra or Another Procedure for Marionette Lines and Jowls?

I had a sculptra treatment six weeks ago and now find that my cheeks are filling in they are large and drooping even more than before, It makes my marionette lines and jowls more pronounced. Should I go for a second session of Sculptra or would it be safer to have another procedure done. My biggest problem are the marionette lines and jowls. Would a mini lift be better?

Doctor Answers 5


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It is difficult to assess your concerns without seeing you in person or with a photo.  I would highly recommend that you consult with your physician to see if Sculptra can be placed in other areas to improve your concerns.  

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Sculptra vs. facelift

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Sculptra is an excellent product for generalized volume restoration.  The use of it should be tailored to individual needs however.  If jowl and marionette lines are moderate, filling the area in front of the line (toward the chin) would work well.  Putting it in the lines themselves may make the area fuller and possibly make the jowl more obvious.  Placing Sculptra in the higher cheek area helps with jowl to some degree.  But injecting directly into the jowl would not work well.  

If the jowl and marionette lines are severe, surgical treatment would be most effective.  The fact that fillers did not correct the area may indicate your jowls are significant.  In that case, a full facelift would be more appropriate than a mini one.  Certainly filling the area just in front toward chin direction with fat graft at the same time would correct the marionette lines even more.


Seung K. Kim, MD
San Francisco Plastic Surgeon

Continue Use of Sculptra

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Depending on your age and severity of jowel laxity and marionette lines you could continue with Sculptra treatments but without examining you it would be hard to determine.  You can do some on line research to view  photo galleries on facelift before and after photos.  A quick mini lift is also a good remedy for jowel laxity and marionette line removal once and for all.

Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

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Sculptra As Well As Other Procedures Can Be Used for Marionette Lines

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In this situation, it is very important to clearly define your goals with your doctor.  Without seeing your before and after pictures, I cannot give you specific details about your situation, but I can give treatment options for the jowl and marionette lines.


Generally speaking you can do procedures that will correct the concerns long term (> 5 years) or short term.


Long term options are:

1)  Liposuction of jowls or neck

2)  Necklift or Facelift


A minilift can be combined with liposuction in some cases to help with the jowls, but this would unlikely improve the marionette lines to your satisfaction.  To correct marionette lines surgically, it requires a larger procedure.


Shorter term procedures are:'

1)  Fillers--Restylane, Perlane, etc

2)  Collagen Stimulators--Radiesse or Sculptra


These products can work well to improve marionette lines and camouflage early jowling.  These techniques are very technique dependent.  


If you are currently unhappy with the results of your Sculptra, then I would talk about it with you doctor.  It should be your decision if you wish to continue the treatment.


I hope this helps. 

Sculptra for marionette lines and jowls

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If your primary facial concerns are the presence of marionette lines and jowls, I would suggest a short scar face lift with a filler (radiesse, hyaluronic acid or even fat) to the marionette region to soften the marionettte lines.  Sculptra is most effective when used as a volumizer for the cheeks, temples, brow etc. but not to fill depressions.  The use of sculptra in the marionette region can result in the formation of small nodules that are not visible but can be felt with your finger or tongue. 

Adding volume to the cheeks will give the appearance of a more youth face but will not address the loose skin along the jaw line.  Jowls are best addressed with a surgical procedure.

Hope this helps.  Good luck.

Joseph N. Togba, MD
Oakland Plastic Surgeon

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.