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 13

Combo Treats!

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 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!

Los Angeles Dermatologist


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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!

Philip Young, MD
Bellevue Facial Plastic Surgeon

Filler for marionette or smile lines

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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

Fillers for Marionette Lines

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 recommend a combination treatment of Botox and Juvederm Voluma.

It is always the best option to get a consultation, before you commit to getting anything done. What might be right for you, might not be right for someone else, and vice versa. As an experienced provider of injectable fillers, I can attest that it is a safe and effective treatment when applied by a trained professional. While it takes 2-10 days for the swelling to go down, depending on the area, the results are long-lasting. Most clients need 1-2 syringes for a dramatic effect, but some require more. This depends on the amount of product you need to achieve your desired look. Any facial enhancement requires a great deal of precision and skill and can really alter the balance of your face when done poorly. 

Justin Harper, MD
Columbus Physician
5.0 out of 5 stars 24 reviews

Marionette Lines and Best Treatment

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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.

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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.

Use Specialty Dermal Fillers to treat specific areas

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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
4.7 out of 5 stars 170 reviews

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

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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.

Facial Fillers

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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
4.9 out of 5 stars 28 reviews

Facial Fillers Perlane and Restylane May Help Smooth Lines

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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.

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.