Is a Facelift the Only Answer for Marionette Lines and Jowls?

A lower face lift with either a chin implant or fat injections and perhaps precise jowl liposuction are a reasonable and relatively low risk approach to managing jowls and marionette lines. Your other options are fillers. I generally am not impressed by the results of skin tightening lasers and believe they achieve only a subtle change.

A facelift should include lifting the skin of the face and neck, as well as tightening the underlying muscle (platysma) in the neck and the fascia (SMAS) in the cheek. The surgeon should also "sculpt" the excess fat deposits in the cheek, neck, and jowls.
In my practice, I have also added the malar or mid-face lift, done throw the lower lid incision. This will also "lift' the marionette lines that you are talking about. Put your index finger on your cheekbone, and lift in a line from the corner of your mouth to the lateral corner of your eyelid. Look in the mirror and see what that does!
On the other hand, judicial use of fillers (Juvederm XC, Vollure) to fill the marionette lines, Botox to decrease the vertical lines from the corner of the mouth to the chin, and suction removal or the jowls and neck will treat your complaints and locally take care of your problems. Good luck! 

How to best treat facial lines without surgery. - Great Question.  Obviously, after an examination by an experienced plastic surgeon - many patients can be treated with a "filler" to plump or fill up the depression.  It really depends how much loose skin one is treating and how deep the lines are.  Some "wrinkles" are treated by botox or dysport - like crows feet along your lateral eyes.The folds you are asking about do really well with fillers.

It's hard to be 66 and not have jowls!  The only effective treatment is a well-done facelift, not a skin-only lift or minilift.  This way those bags of fat can be lifted back into the face and not hang down over your jawline.  At the same time, the crease in front of the jowl can be treated with a filler.  The best filler is your own fat, so it is very common for me to perform fat injection the same time I do a facelift.  I have attached a link in case you want to look at some before-and-after photos.  Fear of surgery is normal and common.  The only antidote is being well prepared and going to a surgeon you trust.  The fewer surprises, the less nervous you will be.

This is a great question!
While a facelift is likely to get you the greatest amount of change/results, it is not necessarily the best option for every patient. Some other options to consider include fillers or fat transfer to fill the hollow areas of the face. You could also consider a resrufacing procedure such as laser resurfacing, chemical peel, or dermabrasion which may help address finer lines of the face.
Hope this helps!Kyle Kimura, MD

Thank you for sharing your concerns! Marionette lines and pockets of fat along the jawline are common as we age due to a natural loss of skin elasticity and volume. If you're hesitant about a surgical facelift, non-surgical options like dermal fillers can effectively soften marionette lines by restoring volume and smoothing the area. Neuromodulators may also help reduce muscle pull, which contributes to the downward appearance. Additionally, treatments like Sculptra biostimulators or skin-tightening devices (e.g., radiofrequency or ultrasound) can stimulate collagen production for a more youthful look. To address jawline fat pockets, non-invasive options such as injectable fat reducers or energy-based contouring treatments might be ideal. A consultation with a trusted provider will help you explore the best personalized solution for your goals.

Hi there!
Thank you for your question. By repositioning the tissues with a facelift, you should see a great improvement in your jowls and marionette lines. Based on your description, I would also recommend redistributing some of the volume in your face with micro-liposuction of the pockets a long your jaw line and grafting fat into the areas where volume loss has occurred such as the marionette lines. That being said, you never want to completely erase the lines on your face at age 66 and look unnatural. A good facelift will soften them and restore a more youthful appearance while still looking like yourself.
Hope this helps!

Hello,

A facelift is the gold standard for treating jowls and for jawline and neck restoration. Other modalities including fillers, Ultherapy, Radiofrequency and thread lifts can help modestly improve this region when there is a mild degree of aging. At age 66 most individuals would best be served with a facelift and possible fat grafting to restore youthful facial contours. Advanced techniques with SMAS flaps and finesse accessory procedures with lasers and fat grafting can help create beautiful, natural looking, lasting results.

Warm regards,
Dr. Pedy Ganchi
Village Plastic Surgery

Although facelift surgery does not always get rid of marionette lines, reducing the fullness of the  jowls  improves the  contour of the area.  A combination of facelift and fat transfer can often correct both problems. The alternative would be facelift and injectable filler to the marionette lines. Unfortunately, using only injectable filler in the presence of  more significant jowls,  can produce a slightly heavy appearance around the chin. Threads or other nonsurgical techniques are also more limited in terms of the degree of improvement they can deliver for this type of problem.

Absolutely Not!  A facelift is a wonderful way to gain substantial long lasting improvement in ridding your face of Jowls and Marionette lines.  However, for those patients uninterested in undergoing surgery there are many non surgical and minimally invasive options to treat this area.  We offer a Non Surgical Facelift for patients in your shoes.  This is a combination of non surgical treatments, customized to your individual needs, that will address your problem areas. 

An in-person consultation would be best, but it really sounds like you would benefit from a facelift.  The marionette lines, and jowls will be improved. There are adjunctive procedures such as lasers that can be used as well. I typically perform my facelifts under local anesthesia and sedation.