Which Filler for Marionette Lines and is One Syringe Sufficient? Can a Nurse Inject?

  I find that Juvederm and Restylane are more alike than they are dissimilar and both will work well for the Marionette lines you show.  Personally, I do not delegate filler injections to my R.N. and although many R.N.s will do a fine job, my patients prefer me to do this for them and it is a service that I am happy to provide.  After viewing your photos, it looks like you may benefit  more from 2 syringes of these fillers than trying to get by with just one.   In such cases, I usually advise my patients to consider Radiesse which comes in a 1.5 cc size, is wonderful for Marionette Lines, and which probably lasts twice as long as the HA fillers.  It costs less than two syringes of the HA filler and I think it is a better value for the money.  hope that this helps!  

I would suggest Sculptra as it seems you have lost a lot of fat in your cheeks, which is the underlying cause of the smile lines.  I would suggest only letting an MD do your injections, especially if you move to a filler like Sculptra.
 

Your lines at rest and those that are superficial, may be helped with fillers.  They dynamic lines which are increased with animation can only be softened with fillers.  My suggestion would be to start with one syringe and see how you like the result.  It is always easier to add more filler then to try and remove it.  Also, I would suggest starting with an HA like Juvederm or Restylane since these can be melted away with another injection.  Who injects you would have to be based on experience as every plastic surgeon does not do fillers and some injectors treat thousands of patients a year with fillers while others do it a few times a week.  

 

Good Luck.