How can I get rid of persistent nasolabial folds and marionette lines? (photos)

You've already tried all conservative measures. You do have jowls and marionette lines. You are a candidate for a facelift. Perhaps for this lesser degree of jowling, the doctor you saw is not comfortable with getting successful results. You can get successful results from facelift. I would do a deep plane lift so you could get the heaviness off your nasolabial folds onto your submalar area. I suggest you get another opinion.

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

Hello, and thank you for your question. When using filler to treat nasolabial folds, it is helpful to also use a bit of filler in the cheeks to restore volume and lift to that area. Often the combination approach produces better results. That's why I always recommend working with an experienced, skilled injector who has the expertise to ensure the best possible results.

Since you’ve already tried multiple non-surgical procedures and were not satisfied with the results, you may also consider a more aggressive approach. You do appear to have prominent lines and folds and may benefit from a mini facelift. A mini facelift is a minimally-invasive surgical procedure that’s less aggressive than a traditional facelift and can address early signs of aging, such as slight jowl formation and mild to moderate skin laxity.

The best way to determine the best procedure for you would be to schedule an in-person consultation with a reputable board-certified facial plastic surgeon. Your surgeon can properly evaluate your skin quality and facial profile, recommend the best procedure, and ensure the best possible outcome.

You will need about 450 units of hyaluronidase. The volume you do not like is a result of aging hyaluronic acid fillers. These products persist for years and years. However, after about 12 months, these fillers can hold a little extra water and eventually the volume that drifts lower in the face, makes you look older than you are. Removing this excessive, unhelpful filler will take 10 years off your look without surgery.

Since you have tried all the non invasive/minimally invasive options and are not satisfied, I would recommend a mini face/neck lift with SMAS plication+ either HA filler/Scupltra/nano fat grafting to naso labial and marionette lines in a combination or I call "Composite Mini FACE/NECK LIFT". Fees in $10,000-$16,000 ranges, depending on the filler or fat graft option. Best to seek other other boarded surgeons to discuss.