I have marionette lines that I despise. I want to get rid of them as cost effectively as possible. Restylane alternatives? (phot

Question

I had restalyane filler injected into both both marionette lines last July. Within two days the lines were back. The doctor repeated the procedure 3 times and the same thing happened. What could have happened? At first I thought he didn't use enough, but by the time he was done he had gone through 2 siringes.

Brian Maloney, MD, FACS · Answer

These lines can never be completely removed. It would be very unusual to metabolize or breakdown the hyaluronic acid that fast, but possible. You may want to consider fat transfer combined with a facelift. The fold has two components;the cheek drooping, and the furrow from muscle action.

Nima Shemirani, MD · Answer

Hi @jbustero! Two alternatives would be PDO threads and Morpheus 8. 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. Best of luck, Dr. Nima!

Stephen Giordano, DO · Answer

There are so many options to help this area.  I agree that 2 syringes of filler should have made a big difference if the correct filler was used with an experienced injector.  Keep in mind that just because someone is a plastic surgeon it doesn't mean they have any legitimate skills injecting with fillers.  This is generally not a formal part of residency or fellowship training, and you only get good at it by doing a ton of it!   You can get results from Laser Resurfacing, ThermiTight, Microneedling, MicroneedlingRF, External RF Ultrasound such as ThermiSmooth, Botox, Fillers, etc.  There are many options for you.  Seek someone who has a primary focus on non invasive or minimally invasive methods. You don't need surgery!  Best of luck, Dr. Giordano

Reza Akef, MD · Answer

thanks for your question. A combination of filler injection and PDO thread can improve these lines. thicker filleike Juvederm volift or volure can last longer.

B. Edward O`Dell, MD · Answer

Hi and thanks for your question.  Thanks for the photo also.  Your cheeks look full which gives you a very youthful look but I do see where the marionette lines have not completely gone.  It would be helpful if you had a picture before treatment for comparison.  Are you a smoker?  HA products do tend to disappear more quickly in smokers.  If not then it may be a matter of filler choice.  The Vollure that has recently been introduced into the Juvederm line is a slightly different HA chloice that may do better on you.  I have used fat transfer to the face with good results in patients that do not hold filler well.  Hope this helps.
Dr. ODell

Jacob Bloom, MD · Answer

Thank you for your question.  I have been finding success with a new long acting filler by Juvederm called Vollure.  This filler last up to 18 months when used in the correct volume.  During an inperson evaluation we would complete a full facial analysis and see if you have other factors contributing to this issue.   Discussion of selective neurotoxin use (Botox) as well as more permenant surgical options would be discussed at that time.   Always seek consultation with an experienced Board Certified Plastic Surgeon so that you can hear ALL of your options .  best of luck.

Richard E. Moore, MD · Answer

Thank you for your question. I would recommend looking for an injector experienced with the placement of PDO NovaThreads to lift the tissue contributing to the marionette lines. NovaThreads are very simple to place with minimal to no downtime and take about as long as filler placement. They typically last around one year. We usually bundle a package of NovaThreads to lift the naso-labial folds, marionette lines and jowls at a cost of around $2000. I hope this was helpful - Dr. Moore.

Harry Glassman, MD · Answer

Actually the most cost effective way for you to diminish your marionette lines is with fillers. However, you will need more than two syringes spread over time to achieve a good result. We have found that some support of the jawline just in front of the jowl area is necessary in many patients in addition to injecting directly into the fold. Furthermore there are more substantial and more long lasting HA fillers than Restylane that can be used in this region.

Shaun Patel, MD · Answer

Thanks for the question. Restylane in a good filler for treating the laugh lines (nasolabial folds and marionette lines) around the mouth. It's hard to tell without evaluating you in person why you may not have had the results you expected. Two syringes of Restylane is an adequate amount of filler for you to see results. I would recommend a second opinion with an experienced injector. The newer flexible gel hyaluronic acid fillers (Restylane Refyne and Defyne) give a very nice correction of the laugh lines.

I have marionette lines that I despise. I want to get rid of them as cost effectively as possible. Restylane alternatives? (phot

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