Best Treatment for Marionette Line and Smile Lines?

Thank you for your question. It is a little hard to say without at physical exam or photos. You may be deep in the nasolabial fold area, (NLF). You may also have some asymmetries. Directly injecting the NLF area is the most common approach. Injections of other areas of the face can also address asymmetries. There are a variety of materials that can be placed there. Please visit an experienced, well trained injector. They will give you a good evaluation and see if you are an appropriate candidate.

Jeffrey J. Roth, M.D.,F.A.C.S.

Board Certified Plastic Surgeon

Las Vegas Plastic Surgery

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

Thank you for your question about which is the best treatment for marionette and smile lines.  There are many different types and brands of injectable fillers. Some are made for increasing volume in a portion of the face which will aid in softening lines in other areas of the face, others are for smoothing or "filling" lines. There are many ways to use fillers in the face to achieve a youthful and natural appearance. To achieve the results you are looking for, see two or more experienced, licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

In the absence of significant skin sag, injectable fillers
are an excellent option for treating smile and marionette lines. When utilizing this approach a large variety
of injectable fillers are currently available. Examples include Restylane, Perlane, Juvederm, Sculptra, Artefill and
Radiesse to name a few. The filler
chosen is dependent on the patient’s anatomic findings, aesthetic goals and the
surgeons comfort level. In the
vast majority of cases, we prefer either Juvederm or Restylane when treating
these lines. Although, there are
differences between these products, they are both associated with excellent
clinical results. Both fillers last
about 6 to 9 months and are associated with high satisfaction rates.If
patients are satisfied with the results of these injections, we occasionally
switch to a longer lasting injectable. In most cases, we prefer Radiesse which can last 2 to 3 years.If
you’re considering injectable fillers for marionette and smile lines,
consultation with a board certified plastic surgeon is appropriate. This surgeon should be able to formulate an
appropriate treatment plan for this problem.

For marionette and smile lines, I like to use Restylane Defyne.  This filler is smooth, not as thick as some and provides a nice appearance for these areas.  Any area with much movement, you want the filler to move with facial expressions.  This way when you smile or frown you don't see the filler.  In the lower face filler may not last as long as the upper face.  The upper face does not have as much movement, therefore the filler will last longer there.  Most filler last around 4-6 months.  Visit a Plastic Surgeon near you for a consult to see what they recommend for you.

Two great Restylane products to use on marionette lines are Restylane Defyne and Refyne. These products are great because they are very elastic and/or stretchy and thus move with your facial expressions, all while giving volume to this area and filling the rhytids. Restylane silk can be nice for marionette lines if the lines are very soft and superficial. Sometimes, a combination of appropriate fillers yield a very nice result. Restylane-L may work nicely for the acne scar. 

 love going fillers as much as I love putting on my make up, because it is an art!
Chances are you need a combo of Botox and fillers. Botox should be placed carefully because it can cause a "joker smile" if you are not a candidate for it! Therefore, I always have patients smile really big to see what the effect of the botox will be on their smile before we even discuss this as an option.
Fillers are great because they support the angles back up! Most people think that they need to put fillers just in the area of the sagging! Not true! There are "vectors" to sagging. IF you find the area of the vector and place fillers there, you create a bigger lift to pull up the parts of the face sagging. Then once you lift from there you also add fillers to the M-lines to enhance them.
You NEVER want to have too much fillers on the lower face- it causes an aged appearance because young faces are like a nice triangle and older faces are an inverted triangle. So, simply put, enhance the upper face can help make a natural restoration to the sagging angles of the mouth.
I always determine which combo of fillers to use based on the consolation: as my patients are talking I watch them animate their faces. The answer comes to me based on their unique anatomy! It really is so satisfying to see their happy faces after!
Best of luck!

I would recommend either Restylane or Juvederm for the nasolabial area and smile lines and acne scar.  Depending on the depth of the line would affect the choice of fillers.  Please consult an expert cosmetic injectors for the best results. Best, Dr. Green

Marionette Lines can be softened utilizing both neuromuscular blockers in association with dermal fillers. The muscle "Depressor Anguli Oris" is easily blocked with Botox or Xeomin decreasing the shadow caused in this area. Dermal fillers can also be utilized decreasing any deficit.

We are very fortunate to have so many wonderful fillers. My suggestion is to let the doctor customize the treatment plan for you.We have lots of fillers but let them decide what is best for your type of wrinkle pattern. Without seeing you it would be difficult to make an opinion. We have Juvederm, Restylane, Perlane, Radiesse,Sculptra and Artefill. I like to customize the plan for the patient and also try to be ecconimical for my patient.

The most important thing is to pick  a physician with a lot of experience in doing these procedures and then trust their opinion.