Neck lines and marionette lines; already tried microneedling, will fillers be a better option? (Photos)

I would recommend fillers for the marionette lines as these seem to work the best and last the longest in those areas. Neck and chest lines are more difficult to treat; some options that might improve them include radio frequency tightening and laser resurfacing procedures. Fillers can be used but it would take a tremendous amount of filler in those areas and they typically do not last long in those areas.

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

I have been performing microneedling for over twenty years, and what I can say is that even professional microneedling is best reserved for treating residual color and texture irregularities of the skin, rather than for treating all, but the most superficial wrinkles, crinkles and crepeyness. However, horizontal necklace lines can be effectively treated via a combination approach that includes the use of microdroplets of Botox (or Dysport or Xeomin) placed along the lines to soften the muscular activity that contributes to their formation, and the subsequent use of a superficial filler, such as Belotero Balance, threaded along the lines to elevate and smooth the etched-in lines that have formed from years of that muscular activity. The results of this combination approach are typically quite gratifying. The latter has been my approach in my NY office for over two decades already. More recently, in my Israel satellite facility, I have added the prior injection of Profhilo, a unique, injectable bioremodeling hyaluronic acid-based product. Finally, the mild marionette lines shown in the photo can be quite easily improved with Restylane Lyft (NY) and Hyabell Deep (Israel). Make sure that you consult with a board certified aesthetic physician and not some medspa or uncertified provider and be certain to ask to see his/her before and after photos of each of the areas you wish to be treated. Best of luck.

Thank you for this question.  The neck is one of the places that can show our true age.  As we age the skin on our neck becomes crepey from sun damage and loss of tone.  The horizontal lines that develop are termed "necklace lines".  These can actually develop at any age.  There are a couple different treatments that you can use to smooth and tone this area.  One can use micro droplets of botox, PRP and micro needling to stimulate collagen, laser rejuvenation is another.  One of my favorite treatments is using a technique with Radiesse.  Using an ultra dilute concentration of Radiesse, I will inject all the lines and place the product subdermally.  This not only creates an immediate correction but it also adds volume and stimulates neocollagenesis.  This treatment provides a dual correction.  Good luck!

Hello and thank you for your question.  One option for you to consider is the use of PDO threads for both volume and lifting.  The process may take you a little longer and you may not have that instant gratification but in the end the results are worth waiting for.  Hope this helps and best of luck from the Art of Ageless Aesthetics

Hello there,
     For necklace lines we typically recommend bundling treatments for the best result. I would recommend topical medical-grade skincare to firm and tighten the skin, as well as to supplement the procedures you are doing in office.  I would recommend Ultherapy for deep tissue collagen stimulation and tightening. I would recommend Halo or Microneedling for more superficial texture and crepiness. I would then recommend filler for any residual necklace lines that still bother you. Hope this helps.
Sarah RN BSN 

I recommend combination of micro Botox/Ha or Sculptra diluted injections/threading in a few sessions about 4-6 weeks apart or sooner if healing occurs quickly. Expect to pay a range from $2,000-$5,000/session. Also these are not a permanent solution, last 6 months to 9 months on average. Very few MDs offer this combination yet but to correct these neck lines takes muliple modalities.

Thank you for your question and also the photos, they are really helpful. I think your best bet for your marionette lines will still be an HA filler like Restylane or Juvederm. The neck bands are an interesting challenge, but they could be improved using microdroplet Botox injections along with injections of hyper diluted Radiesse. One could also use a superficially placed HA like Belotero to help fill these lines. Best of luck to you!

I have found that marionette lines are best treated with fat grafting.It usually takes several treatments to get a good result.Neck lines respond well to nannofat.

Microneedling is most effective for the treatment of fine lines, acne scars, and stimulating collagen to rejuvenate the skin.  Marionette lines result from volume loss and the descent of facial tissues, and are best addressed with hyaluronic acid fillers.  Combination treatment with Radiesse and Ultherapy is an effective treatment for improving neck lines and skin quality on the neck and chest.