Permanent Solution for Marionette Lines, Drooping Cheeks and Jawline?

I'm 35 and am interested in addressing my mid/lower cheek and jawline/mouth areas for droopiness. I've had a downturned mouth with slight marionette lines my whole life. Now that I'm older, I now have deep under eye hollows and more sagging in the mid-face cheek/jawline areas.

I like the results I see from the liquid face lift photos, but are there any other procedures that would be a more permanent solution such as a mini-lift or cheek lift?

Doctor Answers 23

Marionette lines

You said you had these lines for sometime now, which means they are hereditary.

If you want a LONG TERM solution then consider a face lift even though you are only 35 years. The results now will be better than waiting 10 years when the lines are so deep that it becomes very difficult to repair.

Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Solution for mationette lines, drooping cheeks and jawline.

The mini lift or cheek lift could work but has to be designed for your specific anatomy based on your surgeon's evaluation in conjunction with your own desires. Surgery is a more long-lasting solution, but in many of my patients in your age group of 30-35, the preference tends to be for liquid face lifts or the use of Botox and fillers rather than surgery. Some facial types age more quickly. A consultation with a reputable surgeon could give you better insight into making the decision that's best for you.

Deason Dunagan, MD
Huntsville Plastic Surgeon
4.9 out of 5 stars 12 reviews

Long Lasting Solution for deep under eye hollows, sagging mid-face cheek/jawline areas

Vertical Mid Face Lift.  The procedure will lift the sagging cheek and in the process correct jowling, smooth the nose to corner of mouth (Nasolabial) folds, fill the cheeks and cover the tear trough lines. It will last many years and can be combined with other procedures as well.

Dr. P. Aldea


Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Solution for Marionette Lines, Drooping Cheeks and Jawline?

Thank you for your question. The concerns that you have expressed are the likely combined results of both facial volume loss and sagging - two of the hallmarks of facial aging.

'Liquid face lift' is a misnomer which usually describes facial volume replacement without any true lifting. Volume replacement alone may be effectively employed during the earlier stages of facial aging to improve facial appearance. At more advanced stages of facial aging or for more substantial or longer-lasting results, lifting is considered.

A mid-face lift or cheek lift can help to restore fullness to the midface by vertically repositioning the soft tissue of the cheek to a higher, more youthful position on the cheek bone. At the same time, lower eyelid appearance is often improved as the repositioned cheek tissue is more favorably redraped over the lower orbital rim, minimizing the unfavorable hollow appearance of the lower eye region. Similarly, the nasolabial folds are somewhat effaced as the lower lying cheek tissues are lifted.

A lower facelift is undertaken to improve the appearance of the lower face and neck including improvement in the jowels and marionette lines. If you are interested in learning if these procedures would address your specific concerns, an in-person consultation with an experienced facial surgeon would likely be very helpful. Warm regards.

James M. Pearson, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 129 reviews

Liquid Facelift with Sculptra may be best solution for sagging cheeks, jawlines and marionette lines

As a young 35 years old, you should aim to postpone need for full facelift. Where there is no permanent solution, or rather permanent fillers are not advisable, period, because you want fillers to evolve as you mature and not protrude out when your facial contour changes ever so subtlely. Best long-term solution may be Sculptra, whose longevity may be 2 to 2 and 1/2 years, restoring volume to your upper cheeks, eyebrows, temples, that can provide subtle but effective lift to help you better defy force of gravity.

William Ting, MD
Bay Area Dermatologic Surgeon
4.8 out of 5 stars 12 reviews

Solution to droopy cheeks & marionette lines

Despite the fact that you are only 35 y/o, the "deformities" you describe are easily addressed with a traditional facelift. I perform an extensive SMAS facelift which directly addresses the lower two thirds of the face. Though this procedure is excellent for improving cheek laxity and marionette lines, it may not improve the downturned corners of the mouth. If that does appear to be the case, I will then do a separate lateral corner lip lift to raise these areas. Regarding the hollows under your eyes, I have found that fat injections or even a mid facelift going through the lower eyelids will improve this.

Stephen J. Pincus, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Jaw and mouth area problems

You brought up two key statements than make the answer to this question very easy. First you say there are jawline and mouth problems. Second you said there is sagging in the mid-face. By definition the answer is surgery....certainly if you want a result that will last 5-10 years and look natural. In my opinion, and It is based on thirty years of experience and 4000 face surgeries is that you need a personally tailored pre-auricular facelift that will address all these concerns and do it with a natural look and a result that will last years. I do all this surgery safely, easily and totally comfortably in the office operating room with oral sedation and local anesthesia that provides for the safest experience along with reasonable costs and easy recovery. There is also no compromise to the quality of surgery or result by this approach. .

Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
4.6 out of 5 stars 11 reviews

Facelift vs fat graft

It is not easy to give you an educated answer without all the facts. That is important. If it is just a volume issue then fat grafting can be done and there is no scars or incisions. You could also consider a facelift, but a physical exam is best to decide. My best advice is to visit with a board certified plastic surgeon who will truly access your issues and give you an honest opinion vs the opinion you want to hear.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.3 out of 5 stars 34 reviews

Permanent solution for Marionette Lines

  it is rarely appropriate to use the word "permanent" when discussing the world of cosmetic surgery.  This is especially true because no matter what you do or don't do, time marches on and gravitational forces continue to be out play.  Nonetheless, you will have far greater LONG TERM results with surgery than with fillers for the Marionette Lines.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 131 reviews

When to lift and when to fill

The areas of concern would be addressed with two different procedures.  A mid facelift for the cheek sagging and hollowness around the eyes and a regular facelift for the neck, jowls, marionette lines and descending lateral lip.  At 35 it is very young for a facelift and I would recommend trying to temporize the problem with facial fillers, botox, and/or chemical/laser peels.  You can only get a limited number of facelifts in your life before things just start to look strange.  Just ask Joan Rivers.  

Chad K. Wheeler, MD
Spokane Plastic Surgeon
5.0 out of 5 stars 52 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.