What will help get rid of marrionette lines and lift my face ever so slightly, non-surgically? (Photo)

I'm 27, and hate my smile lines; I would like something to either fill them in or, ideally, lift my face like i'm doing with my hand - and also take care of the lines under the eyes. I'm considering thermage, but I want something I won't have to upkeep every few months as I'm still a student. I've also heard that we have collagen supplies, and if I activate them now with thermage or something similar I'll be using up my stores of natural anti-aging supplies - is there any truth to this?

Doctor Answers 20

Midface Volumization is an Ideal Option Here

Hi superficiAlly!

Thanks for your question. I presume the lines you refer to here are you nasolabial (nose-to-lip) lines rather than marionette lines (which go from the edge of your lips down to your jawline). In a young person like yourself a great option for putting tension on these lines is to place a filler into the 'midface' or 'cheek' area. Lines under they eyes can be caused by a number of factors (and can be quite complex), so whether this treatment will help is impossible to say without examining your anatomy. It is likely that another approach would be required to address this.

To answer your question about collagen - we do not have limited 'stores' of collagen. Our body continually breaks down and re-forms collagen, using amino acids (the 'building blocks' of all proteins). Therefore treatments targeted at increasing collagen formation will not 'use up stores', but rather continually build more collagen within the skin.

As always, I recommend consulting with a local, reputable aesthetic practitioner (plastic surgeon, aesthetic dermatologist or aesthetic physician) so that they can perform an examination, make a thorough assessment of your individual anatomy and provide further guidance (including discussion of realistic treatment outcomes) to help you make any treatment decisions.

Hope that helps!

Dr Scott.

Adelaide Physician
5.0 out of 5 stars 6 reviews

Marionette Lines and fillers and Thermage

One of the best combinations to achieve that mid face "lift" is through dermal fillers like Juvederm Voluma or Restylane Lyft combined with Thermage.  Both will increase collagen and restore facial volume.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Fillers For Marionette Lines

You are an excellent candidate for dermal fillers. In addition, you may wish to consider skin resurfacing options such as microdermabrasion, chemical peels, or laser resurfacing. These services would help restore your skin and block out any existing fine lines and wrinkles.

Edward E. Dickerson, IV, MD
Fayetteville Facial Plastic Surgeon
4.7 out of 5 stars 117 reviews

Marionette lines

Marionette lines can be treated with fillers very easily. Another alternative is to have your own fat transferred from a sort of your body to the lines. It tends to last longer if the cells are accepted thrive.

Kevin R. Smith, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 10 reviews

Improving marionette lines and lifting the face

You can non-surgically lift and improve Marionette lines with dermal fillers such as Juvederm or Restylane or Radiesse, or other less studied/used products on the market. Skin tightening lasers may also help to some degree. Best to speak with your dermatologist or plastic surgeon about your best options.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon
4.9 out of 5 stars 49 reviews

Reducing Marionette Lines

Thanks for your question and as others have noted, you have several options, all good, which you can consider and should consider before jumping into the first procedure that someone tells you about. I would recommend a consultation with a board-certified dermatologist or plastic surgeon and learn about the energy-based systems for tightening including Ulthera, including Thermage, but also including the Venus Legacy, the EndyMed 3Deep, and Ellman Pelleve. I would also learn about using fillers in the mid face such as Voluma or Perlane, and then if needed in the tear troughs where we use Restylane, Belotero, and Juvederm. All will work, all work well in combination given by very skilled clinicians.

Michael Gold, MD
Nashville Dermatologic Surgeon
4.0 out of 5 stars 18 reviews

Treatments for marionette lines

Classically when one sees improvement from "lifting with their hands" it is because they have some mid-face volume loss. I would encourage you to have a consultation with a board-certified dermatologist or plastic surgeon to assess this, as it is not a decrease in collagen turnover that accounts for the nasolabial fold one sees, but bony remodeling and fat loss that mid face volumization can address. Thermage and Ultherapy do help stimulate new collagen production (Thermage more superficially, Ultherapy deep and superficial) to counteract some of the decrease in collagen turn over we see with age. There is a place for all of these tools, which is why it is important to be evaluated by someone who has a fundamental knowledge of the anatomy of the aging face who can choose the appropriate tool to personalize the treatment plan for the patient. Good luck.

Sabrina Fabi, MD
San Diego Dermatologic Surgeon
5.0 out of 5 stars 83 reviews

Non surgical lifting of the face

Given your photo and your age, I would recommend fillers to help you achieve the look you are going for.  I would suggest Juvederm Voluma to the cheeks and Restylane to your tear trough / under your eyes.  I would use a microcannula when performing these injections to minimize bruising and swelling when having these injections performed.  Skin tightening modalities such as Thermage, Ulthera, and ThermiSmooth can also give a little extra tightening to your skin but will not produce the result you are simulating with your hand. 

Kian Karimi, MD, FACS
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 67 reviews

Liquid Facelift

At your age the best treatment is probably filler injections.  There are many different fillers on the market today and after a complete evaluation your physician can recommend the best ones for you.  Voluma can be used to lift the cheeks and Juvederm or Juvederm UltraPlus can be used to fill the marionette lines.  These fillers are not permanent and the treatments will need to be repeated to maintain the result.

Scott Greenberg, MD
Orlando Plastic Surgeon
3.8 out of 5 stars 16 reviews

Non-surgical facial enhancements - the Liquid Facelift

Dear superficiAlly:

Thanks for providing a photo! It is very helpful.

For the ultimate in non-surgical face enhancements including filling, lifting, smoothening and glowing, consider a"Liquid Face Lift!"

Non-surgical facial contouring is possible with fillers such as Radiesse, a bone mineral for the nose or cheeks, jaw and chin. 

There is also Restylane and Perlane, a jelly-like clear skin filler to fill lines and wrinkles. Juvederm and its longer lasting "cousin" Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial
("parentheses") and marionette folds, the brow ("number 11") lines and fill and lift the cheeks and lateral brow or chin. Voluma is the longest lasting, up to 2 year duration HA filler All the fillers come with numbing anesthetic!.

Scuptra is the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent. 

Botox and Dysport too have been found to reshape the nose, rebalance excessive facial expression and provide a non-surgical brow lift and lip lift as well as reducing wrinkles!

Dr. Obagi's new, second generation Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.

IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.

Pulling on your cheek as you do indicates a desire to LIFT the cheek. Fillers will volumize the cheek making it fuller and as a added benefit provide the illusion of lift. 

I agree with the commentary below. You appear to need filler in the cheeks and just a little fill and lift in the lateral commissures (corners of the mouth) and nasolabial folds. Firming and color eveness would be helpful too.

Please select a well experienced Board Certified Plastic Surgeon to properly evaluate you and offer you the options best for you. 

All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 81 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.