Besides filler what is the best way to address marionette lines without doing plastic surgery?

Besides filler, there are some non-surgical skin tightening devices that could improve marionette lines.  Fractora is a radio frequency treatment using micro needles that could be done over the marionette area.  Tightening the lower face and along the jawline could also produce some improvement to the marionette area.  There are a variety of radio frequency devices, including FaceTite, that could be used for this purpose.  Laser resurfacing of the face and chemical peels would be other possible treatments that could improve marionette lines.  

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

Hi @Serenity29! Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting.

An excellent alternative to fillers and surgery for marionette lines is the Profound treatment. This device is a state of the art breakthrough in aesthetic services. The Profound procedure involves a radiofrequency injectable injury that stimulates collagen, hyaluronic acid, and elastin. These three factors are the building blocks to youthful and healthy skin. This treatment is less painful and invasive than surgery with manageable downtime. 

Fat transfer to the side cheeks and on either side of the chin can give you a nice lift and softening of the lines that can last for many years. Also, an easy quick fix is using absorbable threads to give a temporary lift.