Dao Botox & filler to help eliminate/soften marionette lines, unsure what else to do? (Photos)

Thank you for your question and for providing photos. Since you haven’t achieved the results you’re looking for with Botox and filler, you may want to consider adding RF microneedling to your treatment plan. This procedure uses a combination of microneedling and gentle radiofrequency heating to boost collagen production and refresh the skin from the inside out. RF microneedling can tighten and contour your skin while smoothing wrinkles for a smoother and more youthful appearance.
I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or expert injector. They will be able to review your treatment history, discuss your concerns and goals with you, and determine the best course of action.

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting, and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

thanks for your question and photos.

Marionette lines are produced when the cheek soft tissue compartments slide from the cheekbone down towards the jawline. This creates heaviness in the nasolabial area, marionette line area and ultimately jowls one day.

When this happens, then trying to push the tissues back up with filler is unlikely to work. Threads are an option, but in my experience tend to be short lived and have limited effectiveness.

There will be a time, although maybe not yet, when surgical lifting is your best option. Sadly, all techniques either surgical or non-surgical have a narrower therapeutic window than is often suggested.

I discuss non-surgical and surgical facial techniques on my YouTube channel Adam goodwin surgery if you might find it interesting.

Hope that helps.

Best wishes, Adam, Goodwin.

From the submitted photos the marionette lines seem faint. You may want to try Morpheus8 to work in conjunction with the filler. These treatments combine microneedling and RF technology to improve overall skin tone and texture. Three sessions are recommended for optimal results.

The area below and lateral (away from mid face) to your mouth is very slightly prominent. Botox into the DAO's and dermal filler to the inside of this area can help. I assume you have already done this. I would now consider placing a very small amount (0.25 cc per side) of Kybella into the prominent area to dissolve the fat so this area now matches the area medial to it. Your injector should be very skilled with Kybella before doing this.