Best Treatment for Marionette Line and Smile Lines?

I'm interested in using a filler for the marionette lines and for the smile lines on my cheeks to the right/left of my mouth and for one acne scar I have.

Doctor Answers 10


In my opinion Radiesse is a great choice for marionette lines. It is a semi permanent substance that tends to last longer then Restylane. It has also been shown to help rebuild the faces own natural collagen!

Bellevue Facial Plastic Surgeon
4.0 out of 5 stars 69 reviews

Filler for marionette or smile lines

My personal preference is to use a combination of Restylane and Perlane.  Perlane is a thicker product, is injected deeper, and gives more volume.  Restylane is thinner and injected more superficial than Perlane.  They can be used alone or can be used together in a layered fashion.

Edmond A. Zingaro, MD
San Francisco Plastic Surgeon
4.1 out of 5 stars 8 reviews

Marionette Lines.

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.

Kristin J. Tarbet MD, FACS
Bellevue Oculoplastic Surgeon
4.9 out of 5 stars 18 reviews

Use Specialty Dermal Fillers to treat specific areas

With today's advancements in dermal fillers, you should look for a facial plastic surgeon or dermatologist who has experience, as well as who offers a solid range of injectable dermal filler products. The reason is because dermal fillers have become more and more specialized with certain products best suited to treat certain areas. 
For example, Teosyal Global  or Restylane are good for marionette lines, whereas products like Teosyal Ultimate or Voluma might be better suited for the smile lines if they are a result of lost volume in the cheek area, Redensity II is best for under eye hollows. I wouldn't recommend seeing someone who just uses one brand of filler to correct all areas of the face; the product lines have become much more refined now and meeting with a reputable doctor will help you discern which choices are best for you.

Cory Torgerson, MD, PhD, FRCSC
Toronto Facial Plastic Surgeon
4.8 out of 5 stars 131 reviews

Fillers might be a good option... meet with a surgeon.

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.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 193 reviews

Facial Fillers

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.

Esta Kronberg, MD
Houston Dermatologic Surgeon
5.0 out of 5 stars 29 reviews

Facial Fillers Perlane and Restylane May Help Smooth Lines

Marionette and smile lines (or nasolabial folds) are usually deeper creases than are found in the forehead or around the eyes, which means they call for a different type of injectable than the popular Botox or Dysport.

Fillers like Restylane and Perlane work to fill lines and creases in areas that lose volume and suppleness as we get older. Both are made from hyaluronic acid (HA), which is produced naturally by the skin to increase fullness and elasticity. Juvéderm is another filler option that also contains HA and is approved by the FDA to last up to a year. Fillers Sculptra and Radiesse may also be good options based on your needs, too.

No matter which filler you choose, make certain to schedule your appointment with a trained and experienced injector. For example, in the state of Georgia only board certified doctors of medicine, physician assistants, registered nurses, or nurse practitioners under the direction of a physician may administer cosmetic injections in patients.

Ashley R. Curtis, MD
Atlanta Dermatologic Surgeon

Prefer Perlane

I think each of the fillers has its own advantages. For deeper Marionette lines, I prefer Perlane. I find that Perlane gives the most "lift" to this area. I have compared Perlane and Restylane, using my own version of a paired comparison and found that the results on deeper lines is superior with Perlane. This may have to do with the bulkiness of the product.

Interestingly, Juvederm's own promotional material may be responsible for this perception. When Juvederm first came out, their rep showed me photomicrographs of both Resylane/Perlane and Juvderm. Juvederm had much neater, well rounded spheres. They were better spaced and more orderly. In comparison the Restylane photos looked more like the office of an absent-minded professor: everything seemed to be out of order, less well spaced and messy globules. However, in my mind it seems that this may be the reason Perlane/Restylane gives more lift: by having its globules bulkier and thicker. Maybe, a false perception, but a perception nonetheless. 

Restylane can be placed on top of Perlane. This layering effect takes advantage of the Restylane's ability to sit at the top of the dermis, thereby smoothing out the surface.

One other advantage, by the way, is that Restylane/Perlane is less expensive, especially considering Medilcis has not added $25 for Xylocaine ( the anesthetic).


Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
4.7 out of 5 stars 14 reviews

NLF fillers, Radiesse, Perlane, smile line fillers

You have quite a few choices for filling smile (nasolabial fold) and Marrionette lines. Restylane or Juvederm is meant to be placed within the layers of the skin and is best used for more shallow lines and folds. To fill in deeper folds a larger molecule filler like Perlane or Juvederm Ultra Plus would be used. Sculptra could also be used but would require 2 or 3 treatments at 6 weeks apart as this product places crystals within the skin that makes your body create collagen to fill and plump up the area.

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

Treatment for marionette and smile lines

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.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 167 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.