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