Perioral mounds or marionette lines - how can I fix this area? (Photos)

Question

What would it take to remedy these puffy bumps/ lines/sagging in my lower face. I’m not sure if they’re perioral mounds or marionette lines. I already had Botox injections that did nothing for them. If I pull the skin by my jaw (near ear) back, it remedies it-—is it just skin laxity? It seems like there is excess skin-—would a mini lower facelift fix it? If so, is that the only option or is there a skin tightening that would work or mini lipo?

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear skit10010,

Thank you for your question. Based on your photos and your description, this looks more like early lower face laxity and tissue descent than something Botox would improve. So it is not surprising that Botox did not help.

When the area improves by pulling the skin back near the ear, that usually suggests that support and position of the lower face tissues are playing a role. In other words, this is often more of a lifting issue than a volume or muscle issue alone.

A mini lower facelift may help in the right patient, especially if the goal is to improve the jawline and soften the marionette area. Whether it is the best option depends on how much laxity is present and how much correction you want. Skin tightening treatments can sometimes offer mild improvement, but they usually do not create the same result as surgery when there is true tissue descent. Mini liposuction is usually not the answer unless there is a distinct pocket of fat, which does not appear to be the main issue here.

So overall, I would think more in terms of lower face support and repositioning rather than BOTOX® or lipo. An in-person evaluation with a board-certified plastic surgeon would help determine whether you are best suited for a mini facelift, a more formal lower facelift, or a less invasive option.

Warmest regards,

Dr. Stephenson

Ali Riza Öreroglu, MD · Answer

The bumps and marionette lines in your lower face are usually caused by skin laxity and sagging of the lower facial tissues. In my experience, the most effective and long-lasting solution is a mini or full lower facelift. This surgery lifts and tightens the jawline and lower face, significantly improving lines and sagging.
If there is volume loss, I often combine the facelift with fat grafting to achieve a more natural result. Non-surgical options like skin tightening devices or mini liposuction provide only limited improvement and are not permanent solutions.
I also never make a final decision without an in-person physical exam; the best approach is determined after a detailed consultation.

Gary M. Horndeski, MD · Answer

You do not appear to have enough fat to liposuct.  You may benefit from a mini skin only facelift.  However, the scar will be placed is a visible area.

Best Wishes,

Gary Horndeski, M.D.

Perioral mounds or marionette lines - how can I fix this area? (Photos)

Answers (3)

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