37 - Marionette/Nasolabial Lines. What can I do to treat this area besides filler? (Photos)

Question

I’ve developed these out of the blue. They make me look so old. I’m only 37. What could make them go away? I don’t want to do filler.

Ella Fedonenko, MD · Answer

I recommend 3-4 units of Botox on each side to inject into DAO(depressor anguli oris) muscles to minimize the appearance of marionette lines.

Anna Chacon, MD, FAAD · Answer

Hello, and thank you for sharing your concern — I completely understand how frustrating it can feel when facial lines seem to appear suddenly. At 37, these changes can feel premature, but the good news is there are several effective, non-filler options to help soften marionette and nasolabial lines.

These lines typically form due to a combination of factors — volume loss, repeated facial expressions, skin laxity, and even dehydration or sun exposure. Since you prefer to avoid fillers, here are a few alternatives:

Energy-based treatments such as radiofrequency microneedling (like Morpheus8 or Genius RF) or ultrasound therapy (Ultherapy) can stimulate collagen production and gently tighten the skin.

Topical retinoids (like tretinoin or adapalene) and medical-grade skincare with peptides or hyaluronic acid can improve skin texture and firmness over time.

Botox or neuromodulators can sometimes help if the downturn around the mouth is caused by muscle pull rather than volume loss.

Laser resurfacing or chemical peels can improve skin quality, making lines appear softer.

Lifestyle measures like consistent sun protection, maintaining hydration, and adequate sleep can make a meaningful difference in maintaining youthful skin elasticity.

Each of these can be customized based on your skin type, facial anatomy, and how mild or deep your lines are. With a thoughtful approach, it’s absolutely possible to achieve natural, refreshed results without using fillers.

Camille Cash, MD · Answer

There are other treatments you can consider besides filler to address your concerns.  Morpheus8 is a good option.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  Three sessions spaced one month apart are often recommended for optimal results.  I've included a video I hope you find helpful.

Leonard Grossman, MD · Answer

It appears that you may have lost some weight or have been stressed out, had children, and that could be the reason why you see the changes in your face. You also appear to have a bit of flatness in the cheek area, but that most likely is hereditary. By seeing a plastic surgeon or specializes in fat grafting, you can have your face looking almost brand new from some 15 years ago. Make sure to bring photographs of your younger self while having a consultation. I hope this helps and good luck from Leonard Grossman, M.D., organic plastic surgery New York City.

37 - Marionette/Nasolabial Lines. What can I do to treat this area besides filler? (Photos)

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