My lower facelift did not totally remove my marionette lines, any suggestions?

Removing the marionette lines completely may require significant tension on the SMAS and lead to abnormal shape at the corner of the mouth.
Visibility of the lines is sometimes made worse by the buccal fat volume and buccal fat reduction can help control the area. A deep plane facelift may also offer a stronger correction.
Treatments using fillers or fat transfer can also help to smooth the area and also to enhance slightly the chin projection for continuity in the contour of the jawline.
I suggest that you discuss your concerns with your surgeon and explored together options for improvement before considering alternatives.

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

A face lift will NEVER EVER affect marionette lines. They have to be filled in and fillers or an implant does the job nicely .

I always counsel my patients that a facelift will not get rid of marionette lines and will only soften them. I would recommend fillers or fat grafting. Best of luck!

Thank you for your picture and questions. It would be helpful to know more about your "lower facelift." Lots of surgeons call everything a "facelift" but the devil is in the details...how long ago, what exactly was done, SMAS work, skin removal, etc. I would start with an evaluation of your current appearance in movement and a review of your previous procedure. Most people on here are going to recommend fillers or injectables or threads, and I think this is continuing to throw small solutions at a more significant problem.

Hope this helps!

Dallas R. Buchanan, MD, FACS
VIVIFY plastic surgery

In patients with heavy jowls, we have seen some residual marionette (labio-mandibular) lines, despite dividing the mandibular ligaments and doing an aggressive fascial tightening along the lower border of the face. In those cases, we have recommended the use of threads as an adjunct to the tightening. Obviously, fillers would be another option.

Your problem is not uncommon. There is only so much pulling, stretching and excising from the rear that can be achieved with any facelift procedure, which accounts for why so often improvement is less than adequate in the most frontal regions of the face, such as with marionette lines. The one photo provided suggests mid-face volume deficit that is contributing to the tear troughs, incipient smile lines, and likely to some degree to the marionette lines. The photo also suggests that volume replacement in the jawline would not only help to diminish the incipient jowls there, but again to some extent the marionette lines. And finally, once the latter have been performed, direct treatment of the marionette line region would likely yield quite gratifying results. You would be wise to consult with a board certified aesthetic physician and make sure to ask to see his/her personal befores and afters before agreeing to proceed. Best of luck..

A facelift often will not eliminate Marionette lines without resorting to distortion of the the corners of your mouth or some unnatural feature. Injectable fillers such as Volbella, work well in this location and can be tailored to your taste. They are simple to do in a clinic setting. Fillers do need to be repeated every 6-12 months, though this is better than having a facelift that looks stretched or unnatural.