Why do most before and after photos of facelifts not show improvement of marionette lines?

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.

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.

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.

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!

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.

That is an excellent question with a technical answer. The deeper superficial muscle -fascia layer (SMAS)is much more tightly anchored in the cheek-midface area than in the jowl area and in order to get substantial improvement in that area the deep plane dissection underneath the SMAS needs to be more complete which most facelift techniques do not accomplish. A deep plane facelift approach properly executed should improve the relaxation around the mouth and marionette lines. Fat grafting done at the time of the surgery can also help.

Marionette lines extend from the corner of the mouth down toward the jawline. Nasolabial folds extend from the side of the nostril toward the corner of the mouth. Most facelifts show improvement of the marionette lines but not the nasolabial folds. So I think you're referring to the nasolabial folds, which for the most part, are not helped by the traditional SMAS lift. Although the upper nasolabial fold next to the nostril is not targeted, a deep plane vertical lift is your best chance at helping the nasolabial fold. If you have prominent folds due to heavy cheek sagging, most of the effect of the deep plane lift will be to take the "weight" off the fold rather than effacing the fold flat, which is what you may be doing. It's best to go for a personal consultation to see the expected results and set proper expectations.

Thank you for your question. Generally, facelifting by itself does not improve the marionette lines. Over the years, certain techniques have developed that have improved this area dramatically. These include the deep plane facelifting technique which allows a more central pull associated with the facelift. In addition, fat transfer to the marionette lines as well as liposuction of the jowl area another level of improvement. Combining these techniques together can improve that area dramatically. Best wishes to you.

The so-called marionette lines/folds are far forward from the location of the strong pull/lift that occurs with a facelift. The actual force of the pull is created back by the ear, and diminishes as you move forward to the side of the chin. When someone looks in the mirror and places their fingers in the mid cheek or even front of the cheek to lift from that location, the force of the lift is stronger than what would exist after a facelift, so that look is artificially smooth and not necessarily realistic for a facelift. However, there are some techniques that involve placing internal stitches under skin close to the corner of the mouth to actually lift and support the skin in front of the cheek. Although there is a low risk of possible nerve injury, this might be helpful.

The way you pull your face is not the way the facelift pulls it. A facelift pulls it from further away, around the ears. Marionette lines can be improved but eliminating them completely is very difficult