Botox or Juvaderm for Marionette lines? (photos)

As we age, the collagen in our skin
breaks down, which can result in lines, wrinkles and loss of facial volume.
BOTOX® is typically used to treat the upper face to address common issues like
forehead wrinkles or crow’s feet, while JUVÉDERM® can be an effective
injectable treatment to minimize the appearance of your marionette lines. You
may also benefit from having JUVÉDERM VOLUMA® XC added to your cheeks, which
will bring some more volume to your face and help reduce your marionette lines.

For marionette lines, filler is generally a better choice than Botox. Botox works by relaxing muscles that cause wrinkles, while fillers add volume. Marionette lines are caused by volume loss and skin laxity, so fillers usually work well in this area. You may need a combination of fillers to the midface, such as Voluma, and collagen building fillers such as Radiesse for a more comprehensive result. I suggest visiting a board-certified dermatologist for a consultation to come up with a custom treatment plan. 

Marionette lines are caused by soft tissue deflation and descent, loss of bony support in the jaw, and are exacerbated by the action of our "frowning" muscle. The best approach to this area is a combination of filler for the volume changes and a neuromodulator like Botox or Dysport for the "frowning" muscle action. Results are better with that combination and both last longer in combination, which is supported in the literature. I was quite surprised reading this that more physicians did not discuss the combination. To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.Cameron Chesnut#realself500 Physician

Fillers do well for this area around the mouth but botox really will not help revolumize the area .  Best, Dr. Emer.

 Thank you for sharing your questions and posting your photographs. The marionette lines can be treated with any one of several dermal  fillers and sometimes requires a thicker filler layered beneath a thinner filler. Botox does not work particularly well in this area of the face. See an experienced injector for appropriate guidance for your particular issues. Good luck,

Fillers, such as Juvederm, work best for improving marionette lines or folds.  Botox would not really help with this issue.  Ultimately, some sort of lifting procedure such as a facelift or Ultherapy can provide more improvement if needed in the future.  

Thank you for your question and for sharing your photographs. Marionette lines are best treated by camouflaging them with the use of a dermal filler, such as Juvederm.  See a board certified plastic surgeon in consultation.  

Marionette
lines are the result of 2 conflating factors: the deflation of tissue as we age
and the repeated action of our frowning muscles. Because of this, a filler such
as JUVÉDERM and a neuromodulator such as BOTOX can both be helpful. A
board-certified dermatologist or plastic surgeon can help guide you to a
treatment plan during a consultation. Good luck to you!

To treat the Marionette lines (puppet lines / sad lines), one can use botox +/- fillers such as juvederm. In your case, I would start with the filler first and see if there is sufficient improvement, and if not, then add 8-10 units of botox in total. Most importantly, get your treatment by an expert such as a dermatologist to optimize results and minimize any risks.

Thanks for including your photographs. The views are all taken with your head leaning down to show the marionette grooves. Your marionette lines will be less prominent when  looking straight ahead. Botox is effective and may be all you need for less prominent marionette grooves. A good starting point is 10 units of Botox, but you may need more at follow-up. For deeper marionette grooves, a combination of Botox and filler such as Juvederm Ultra or Ultra Plus is ideal.