Will Juvederm help my nasolabial folds and marionette lines? (Photo)

I am currently 38 years old, very slim but always had puffy cheeks. Nasolabial folds were always a bit prominent. I recently had one syringe juvederm volbella inserted in nasolabial fold and marionette lines but did not see any difference. Another plastic surgeon told me that I should not use fillers on my marionette line as it will give me more puffy cheeks. Can I use more juvederm for the nasolabial folds and very prominent marionette line (if it is a marionette line after all!)? Thanks!

Doctor Answers 11

Juvederm and Marionette Lines

It appears from your photo that you would benefit from Voluma in the mid-face to help develop that area and decrease the nasolabial area and jowls.  Sculptra would also help a great deal with your facial structure and increase collagen in a long term fashion. Thermage will also help tighten the jowls and  Please consult an expert.  Best, Dr. Green

New York Dermatologist
5.0 out of 5 stars 76 reviews

Nasolabial Folds and Marionette Lines -- Fillers, Fat, Scuptra

Folds can be improved with fillers or fat, Scuptra will build collagen long term.  Marionette lines often needs lasers, skin tightening and face/neck lifting too.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews

What to do about nasolabial folds and marionette lines

 Thank you for sharing your question and posting your photographs. Your nasolabial folds and marionette lines would look better if you increase the volume of the lateral part of your face (outer cheeks and jaw). This would pull the puffy area away from the middle of your face, thereby diminishing the lines that bother you. Additional filler could be injected in the nasolabial fold and marionette lines if needed. Make sure you see an experienced injector.
Good luck,

James R. Gordon, MD, FACS, FAAO
New York Oculoplastic Surgeon
5.0 out of 5 stars 140 reviews


Hi. Thanks for your question. Fillers can be used to add volume and fill hollows in the lower face area. However you have mild jowl formation, and I would be concerned that filling your marionette lines with filler may make your lower face look puffy and too full. You can consider a skin tightening device, such as Ultherapy, to improve the jowls or consider a mini facelift when you are ready. good luck. Best, Dr H 

Sanaz Harirchian, MD
Houston Facial Plastic Surgeon
4.9 out of 5 stars 19 reviews

Try Radiesse

I use lots of Juvederm in my practice, but when it comes to lifting and filling in larger amounts my go-to product is Radiesse blended down with lidocaine. It makes it much smoother. It's important not to ignore lifting the cheekbones with filler at the same time as well as filling in the jaw line to camouflage the jowls. Also your expectations should not be an elimination of the folds and jowls but an improvement. Consider complimenting the filler treatment with Ultherapy. Best of luck. 

T.G. Khan, DO, FACS
Fort Lee Oculoplastic Surgeon
4.5 out of 5 stars 24 reviews

Filler for NL folds

From your photos I would recommend volume to your upper face before I would place filler to your nasolabial and melolabial folds. You have significant volume loss of your cheeks laterally which creates deeper folds and more prominent jowls. You should address the upper face first then address your lower face and you will have much better results. In addition, you are very full in your submental (under your chin) area which can be treated with Kybella. This will remove the fat cells in this area and give you more contour to your jawline and help with your jowls. I would start with Voluma to your cheeks first and then Juvederm to your lower face folds to get a nice result. Please consult a board certified dermatologist or plastic surgeon experienced in fillers. Best wishes.

Kristin Baird, MD
Longmont Dermatologic Surgeon
5.0 out of 5 stars 10 reviews

Will Juvederm help my nasolabial folds and marionette lines?

  Hi, I have performed many facelifts over the past 30 years.  From the attached photos, the cheeks are flat anteriorly (in the front), the chin is weak, there is excess facial and neck fat along with excess facial skin evidenced by jowls (Marrionette lines) and nasolabial folds.  These combine to create a rectangular shaped face.  Using a dermal filler to fill in the nasolabial folds and marrionette lines (next to the jowls) would soften the depth of the folds but not make your face more youthful and naturally beautiful.

  Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation using a dermal filler (I prefer Restylane Lyft) or with cheek implants for a permanent enhancement will create full, round cheeks anteriorly that will feminize the entire face.

  Jowls are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured.  The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane and subperiosteal facelifts) but with these added benefits:

•very small incisions
•minimal tissue dissection = less bruising and swelling = rapid recovery
•can be performed in 90 minutes or less, with or without anesthesia
•no incisions within the hair = no hair loss
•excess fat can be removed
•excess skin removed
•cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
•most patients fly back home to parts all over the world in as little as 3 days post-op

  I tell potential facelift patients to think of creating a more beautiful or handsome face by working on three tissue levels.  The bony structure should be appropriate to make a woman’s face heart shaped and a man’s face chiseled and angular which is described below.  Next the fatty layer should be reduced or shaped allowing the shape to be seen and finally excess SMAS and skin evidenced by the presence of jowls) should be removed from the face and neck. 

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Combination treatment will be best

I do think that a combination approach is your best way forward. The jowls IMO are a little to heavy to volume displace. Treating the lower1/3 of your face and just 'filling' them is not aesthetically ideal. This gives a heavy look.

I would

1. Lift the jowls first- non invasive include Themage, Venus Freeze, etc.
2. Surgical or mini s face lift
3. The address volume and jowls with fillers. 

All the best
Dr Davin Lim
Laser and aesthetic dermatologist
Brisbane, Australia. 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 75 reviews

Would Juvederm be helpful?

Hi Westlorna, Juvederm can be very helpful in softening lines or creases in the face such as the nasolabial fold or the marionette lines. From the pictures that you have provided, you have very deep marionette lines. I would consider options such as fat transfer and very conservative lipocontouring of the jowl in order to soften this part of your face.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Deep marionette lines

You have  very deep marionette lines.  To fill these in would take a lot of filler, and may make the area look even heavier.  Your cheeks appear flat, so adding volume there should help decrease both the marionette lines and the NLF.  See an experienced injector to get the filler in the correct places to maximize the result. 

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

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