What can be done to further improve the appearance of my marionette lines? 69 y/o (photos)

Direct injection of filler into the marionette lines is seldom enough or even the best first route for treating them. Since the regions both above and below the angles of the mouth are important for support and lift of the corners of the mouth, respectively, it is often best to fan a high G-Prime HA filler in the appropriate locations to restore the necessary lift and support to straighten the angle of the mouth. Direct injection of filler into the lines themselves, as you have found out the hard way, is seldom sufficient to get the job done and sometimes even accentuates the marionette folds, rather than improving them. You would be wise to make sure that you are consulting a board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.

To further improve the appearance of marionette lines after using Teoxane RHA 3 and RHA 1 with minimal improvement, consider the following options:

Additional Filler Injections: Increasing the volume of hyaluronic acid fillers or using a different type of filler, such as calcium hydroxylapatite (e.g., Radiesse) or poly-L-lactic acid (e.g., Sculptra), might provide better results. These fillers can offer more substantial support and longer-lasting effects.

Combination Therapy: Combining fillers with other treatments like chemical peels or laser resurfacing can enhance overall facial rejuvenation by addressing skin texture and tone.

Surgical Options: For more pronounced marionette lines, surgical procedures such as a facelift or subnasal lip lift might be necessary to achieve significant improvement.

Re-evaluation of Injection Technique: Ensure that the filler is placed correctly to address the shadows and folds effectively. Using a cannula instead of a needle can sometimes provide better distribution and reduce the risk of complications.

Follow-Up and Maintenance: Regular follow-up appointments with a healthcare professional are crucial to assess the need for additional treatments or adjustments in the treatment plan.

Given your current treatment with Teoxane RHA 3 and RHA 1, it might be beneficial to discuss these options with a dermatologist or plastic surgeon to determine the best approach for your specific case.

You may want to explore FaceTite. The minimally invasive procedure uses RF technology to tighten skin and sculpt the lower face and jaw. It is performed in the office and requires no general anesthesia. Visit with a provider near you or my website to learn more.

I would start by giving you a small amount of Kybella to the area on the outside of your marionette lines to dissolve the extra fat in this area. This is inexpensive (About $250 per visit), will require 2-3 visits 6 weeks apart and permanently reduces this, but it takes a few months to get full results. In a few months when the marionette Lines are much smaller, I would then place a small amount of a dermal filler on the inside of the marionette. You will then need a a small amount of dermal filler about once a year to keep it looking great. Make sure your injector knows how and is experienced in injecting Kybella in this area.