Can Botox fix this marionette/jowl dimple that appears when I talk & smile? (Photo)

Question

When I talk/speak and to a less extent smile, I get a weird marionette/jowl dimple on one side of my face. What muscle is this? Can Botox fix it? It really bothers me and is annoying. When I see it on video it’s like nails on a chalkboard to my eyes, pls help.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photo. Since the dimple you’re referring to only appears with muscle movements, Botox may be a great option for reducing its appearance by reducing the associated muscle movement. Dermal fillers are also recommended for treating marionette lines, so you may benefit from a combination treatment.

I recommend scheduling an in-person consultation with an experienced expert injector. They will be able to discuss your concern with you and help you decide on the best treatment option.

I recommend scheduling an in-person consultation with an experienced expert injector. They will be able to discuss your concern with you and help you decide on the best treatment option.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photo. Botox injections in conjunction with proper placement of fillers can greatly decrease your marionette lines. Make an appointment with an experienced oculofacial surgeon for detailed evaluation and treatment. Good luck!

Jason Emer, MD · Answer

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

Camille Cash, MD · Answer

You will likely have the best results from a combination of treatments.  Botox can help soften muscle reactions and fillers can improve facial contours.  See an expert injection near you to learn more.

Paul Munsanje, MD · Answer

This line looks like something that would be improved by some strong lifting techniques. If placing both fingers on the corners of your jaw and pulling back gets rid of this line, then this is the case. The ways to do this would be with a surgical lift or a non-surgical option like thread lifting or facial filler lift. 
There are some great techniques using Vycross Juvéderm fillers that are not as good as surgery but can give enough lift to get rid of a line like this. I think you would be talking about 4 to 6 mls with a good injector.
To know if Botox would be helpful stick out your bottom lip like a sad baby and notice if the corners of your mouth pull down more on that side. If they do, then Botox might help.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.

Based on your photo I would guess that the muscle involved is the DAO muscle or the Depressor Anguli Oris muscle.  At this muscle pulls the corner of the mouth down and accentuates marionette lines.  Only a small amount of Botox should be used in this area because there are other perioral muscles that you do not want to weaken.  Typically in my experience with use about 5 International units to treat the DAO muscle

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Either of these may be helpful but you need to consult with an expert injector.  Filler may help as well.

Best of luck!

Can Botox fix this marionette/jowl dimple that appears when I talk & smile? (Photo)

Answers (7)

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