Botox or Juvaderm for Marionette lines? (photos)

Should I get Juvaderm or will Botox work for my Marionette lines I am 45 and I can not stand my sad face look and how much will I need?

Doctor Answers 30

JUVÉDERM® is often used to treat marionette lines.

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.

Chicago General Surgeon
5.0 out of 5 stars 45 reviews

You May Want to Consider a Combination of Both

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!

Susan M. Stuart, MD
San Diego Dermatologist
3.7 out of 5 stars 3 reviews

For marionette lines, filler is generally a better choice than Botox.

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. 

William Groff, DO
San Diego Dermatologist
4.8 out of 5 stars 46 reviews

Botox or Fillers for Marionette lines

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.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon
4.8 out of 5 stars 50 reviews

Marionette line treatment choices

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. 

Renuka Diwan, MD
Cleveland Dermatologic Surgeon
4.8 out of 5 stars 20 reviews

Marionette lines

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

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 104 reviews

Filler, not Botox for the marionette lines

Thank you for your question and photographs.  Botox is generally best used for the upper face to eliminate unwanted lines of the crows feet, brow and forehead.  Fillers are best used to treat lower facial lines such as the marionette lines.  My preference is Juvederm. Be sure to see an experienced physician such as a plastic surgeon who does their own injections. 

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 38 reviews

Marionette lines and chin -- fillers / fat/ sculptra, you may need lifting, chin implants

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

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 191 reviews

Botox or Juvederm

For marionette lines you need a filler like Juvederm to treat those lines. Botox will not treat that.

Good luck!

Juvederm Ultra Plus for marionette lines

Thank you for your post.

Hyaluronic acid fillers like Juvederm will correct marionette lines quite effectively. Botox has no role for this area. 

Dr Karamanoukian
#RealSelf100 Member

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

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.