How to treat my lower face fat, marionette lines and pre-jowl sulcus? (photo)

Hello and thank you for your great question! At 33, it’s common to start noticing changes like marionette lines, lower face volume loss, and early jowling. Based on the history you have provided, we’d likely want to focus on longer-lasting or regenerative options.

Biostimulators like Sculptra or Radiesse can stimulate collagen production for more structural support and subtle volume improvement that lasts longer than traditional filler.

Thread lifts (especially around the marionette and pre-jowl area) can help reposition tissue and soften early sagging.

Microneedling with RF (like Morpheus8, SylfirmX) can tighten skin and improve texture in the lower face with minimal downtime.

Fat transfer may be an option if you're looking for something permanent and are open to a surgical route.

Best results often come from combining treatments—especially when fillers alone aren’t giving you the longevity or lift you're after.

Best of luck in your journey!
Genie Alexander, RN BSN
for Anna Petropoulos, MD FRCS
Center for Classic Beauty
Boston & Danvers, MA

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Addressing concerns such as lower face fat, marionette lines, and the pre-jowl sulcus can involve a combination of treatments, especially if fillers tend to resolve quickly for you. Here are some options to consider:

Alternative Injectable Treatments:

Sculptra: Unlike traditional fillers, Sculptra works by stimulating collagen production over time, which can provide a more gradual and longer-lasting improvement.
Radiesse: This is a calcium hydroxylapatite-based filler that can provide both immediate and longer-lasting results by stimulating collagen.
Skin Tightening Procedures:

Radiofrequency Treatments: Procedures like Thermage or RF microneedling can help tighten skin and improve the appearance of marionette lines and jowls by stimulating collagen production.
Ultrasound Therapy: Consider trying other ultrasound-based treatments like Ultherapy, which can target deeper layers of the skin for more effective tightening.
Fat Reduction and Contouring:

Kybella: This injectable treatment can help reduce localized fat, particularly in areas like the jowls or under the chin.
CoolSculpting or Liposuction: For more significant fat reduction, these options can remove excess fat and improve facial contours.
Surgical Options:

If non-surgical methods do not achieve the desired results, a consultation with a plastic surgeon for procedures like a mini facelift or neck lift might be appropriate.
Lifestyle and Skincare:

Incorporating a good skincare regimen that includes retinoids, antioxidants, and peptides can support skin health and improve overall texture and elasticity.
Consult with a board-certified dermatologist or plastic surgeon to discuss these options and tailor a treatment plan that suits your specific needs and goals. They can provide a comprehensive evaluation and help determine the best approach considering your history with fillers and desired outcomes.

From the description of your concerns you may want to consider Morpheus8. This treatment combines RF technology with microneedling to improve overall skin tone and texture. Typically three treatment sessions are recommended for optimal results. I've included a video I hope you find helpful.