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.  

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.

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. 

Great question!
Neuromodulator (i.e. Botox, Dysport, etc.) into the DAO muscle is a relatively inexpensive, non-surgical, and temporary alternative to improve marionette lines.  You might consult with a board-certified expert injector to see if this would be sufficient for you prior to trying a surgical alternative.  
Best of luck!

It is often helpful to inject low dose Botox to the sides of the mouth (targeting the DAO muscle) to lift the corners of the mouth.  I recommend that you see an expert injector for an in person evaluation.Regards,Dr. Ort

Marionette lines can be treated with Botox, fillers and your own fat. I generally do not recommend any skin tightening or radio frequency devices in the face because they invariably result in the loss of fat which will make your marionette lines appear much worse 6 months post treatment. The same opinion I hold for the use of Ulthera in the face. I hope this helps and good luck from New York City