I am 43 and researching facelifts. My biggest concern is the marionette lines that have formed due to sagging skin/cheeks. When I lift my cheek and the marionette fold goes away, I feel satisfied with this look. When looking at facelift before and afters, I notice that the jowls always look good and pulled back, but sometimes there seems to be no improvement on marionette folds. Why might this be?
Answer: Facelifts generally don’t affect much change in this area You are absolutely correct in noticing that the majority of facelift results don’t really show much improvement in the marionette lines because facelifts generally don’t affect much change in this area. A standard SMAS facelift will significantly improve the neck/jawline and show some improvement in the cheeks and midface depending on different techniques used such as fat grafting, midface lift, or high smas lift. Still, the deeper marionette lines you are referring to are present both because that is the normal insertion of the smile muscles and because there are ligament attachments in this area that are not released during most facelifts. Some Deep plane facelifts and midface lift techniques as well as standard facelift techniques that more aggressively release some of the more “central” ligamentous may better soften these lines, but they will never completely go away as they are part of your natural facial shape and smile/animation. I will treat these lines with a combination of dermal fillers, facial fat grafting and a midface lift, but still tell patients that they will not completely go away with any technique.
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Answer: Facelifts generally don’t affect much change in this area You are absolutely correct in noticing that the majority of facelift results don’t really show much improvement in the marionette lines because facelifts generally don’t affect much change in this area. A standard SMAS facelift will significantly improve the neck/jawline and show some improvement in the cheeks and midface depending on different techniques used such as fat grafting, midface lift, or high smas lift. Still, the deeper marionette lines you are referring to are present both because that is the normal insertion of the smile muscles and because there are ligament attachments in this area that are not released during most facelifts. Some Deep plane facelifts and midface lift techniques as well as standard facelift techniques that more aggressively release some of the more “central” ligamentous may better soften these lines, but they will never completely go away as they are part of your natural facial shape and smile/animation. I will treat these lines with a combination of dermal fillers, facial fat grafting and a midface lift, but still tell patients that they will not completely go away with any technique.
Helpful 2 people found this helpful
March 8, 2023
Answer: Marionette lines Marionette lines are often better treated with filler or fat--not only the pulling or lifting of the deep tissues. I universally add fat during my facelifts to soften these lines and add back volume that has been lost elsewhere.
Helpful 2 people found this helpful
March 8, 2023
Answer: Marionette lines Marionette lines are often better treated with filler or fat--not only the pulling or lifting of the deep tissues. I universally add fat during my facelifts to soften these lines and add back volume that has been lost elsewhere.
Helpful 2 people found this helpful
March 8, 2023
Answer: Sagging Cheek/Marionette Folds Great Question. The answer is that because most facelifts are not addressing the midface (Cheeks). Just as you mentioned. When the cheek volume gets pulled up then it tends to help with the nasolabial folds as well as the marionette lines. The only way to address the midface is to do a really good High-SMAS facelift or a Extended Deep Plane Vertical Vector Facelift. The Deep Plane is more of a novel procedure. It has been around for about 40 years or so, but mostly refined and pioneered in the past 15, so there are few surgeons that can perform this procedure and even fewer that are proficient. In time i believe the Deep plane will become standard of care when it comes to facelifting. When you replace the natural volume back where it belongs, the skin laxity drapes better. Hope This Helps!
Helpful 1 person found this helpful
March 8, 2023
Answer: Sagging Cheek/Marionette Folds Great Question. The answer is that because most facelifts are not addressing the midface (Cheeks). Just as you mentioned. When the cheek volume gets pulled up then it tends to help with the nasolabial folds as well as the marionette lines. The only way to address the midface is to do a really good High-SMAS facelift or a Extended Deep Plane Vertical Vector Facelift. The Deep Plane is more of a novel procedure. It has been around for about 40 years or so, but mostly refined and pioneered in the past 15, so there are few surgeons that can perform this procedure and even fewer that are proficient. In time i believe the Deep plane will become standard of care when it comes to facelifting. When you replace the natural volume back where it belongs, the skin laxity drapes better. Hope This Helps!
Helpful 1 person found this helpful
March 5, 2023
Answer: Facial fold correction... When you are lifting your cheek, you are pulling on the skin to make the fold go away. Facelift surgery does not tighten skin - it tightens the deeper tissue. But the skin will keep it's original tension in a well performed lift so as to not look "windblown." The facial folds can be improved a little bit, but they exist primarily from losing fatty tissue, so either filler a fat transfer is done at the same time as facelift for the best results. Be sure to find a facial specialist for consultation.
Helpful 1 person found this helpful
March 5, 2023
Answer: Facial fold correction... When you are lifting your cheek, you are pulling on the skin to make the fold go away. Facelift surgery does not tighten skin - it tightens the deeper tissue. But the skin will keep it's original tension in a well performed lift so as to not look "windblown." The facial folds can be improved a little bit, but they exist primarily from losing fatty tissue, so either filler a fat transfer is done at the same time as facelift for the best results. Be sure to find a facial specialist for consultation.
Helpful 1 person found this helpful
March 5, 2023
Answer: The marionette line can be corrected with a facelift The marionette line can be completely corrected with advanced facelift techniques and is the preferred approach as the chronic treatment of this area with fillers leads to a wide distorted appearance of the lower face.Specifically, the facelift dissection must be carried across the marionette line and usually the depressor anguli oris (DAO) needs to be released as this muscle causes the downturn of the marionette frown. These are not standard surgical techniques however they are extremely effective and long lasting. I have been performing this approach for the past 7 years and found it to be safe with very high patient satisfaction.
Helpful 1 person found this helpful
March 5, 2023
Answer: The marionette line can be corrected with a facelift The marionette line can be completely corrected with advanced facelift techniques and is the preferred approach as the chronic treatment of this area with fillers leads to a wide distorted appearance of the lower face.Specifically, the facelift dissection must be carried across the marionette line and usually the depressor anguli oris (DAO) needs to be released as this muscle causes the downturn of the marionette frown. These are not standard surgical techniques however they are extremely effective and long lasting. I have been performing this approach for the past 7 years and found it to be safe with very high patient satisfaction.
Helpful 1 person found this helpful
