Marionette veins: what procedure would pull up the blossoming jowls? (Photos)

The superficial veins can be treated with some light therapy - IPL/ Laser.
Filling your midface/ cheek may give you a lift of the jowls  -with something like Voluma.
Filling the marionette lines may make the jowls heavier.
Alternatively skin tightening treatments like Ultherapy, Exilis or other RF treatments may help tightening the jowls.

Hi,Thank you for including photographs. You have a few options available to you. First, you may be able to camouflage the jowls with some fillers around the corner of the mouth and marionette area - this is the least invasive and costly treatment. You also have the option of having Ultherapy or Radio Frequency treatment to stimulate collagen production and skin tightening in the jowl area. These treatments can have some down time and increased cost associated with them but results last longer. There are also resuspension sutures (Silhouette Instalift) that can pull the corners of the mouth up - it may be too early for this based on your pictures. I recommend visiting a qualified facial plastic surgeon who can discuss all these options with you to help achieve your aesthetic goals. Best,Mehdi Sina, MD 

There are easy fixes for the corners of the mouth.  The cheek area can be filled conservatively to lift that area that is starting to sag.

Actually, I think you are a good candidate for dermal filler treatment. I  like Sculptra in patients with age related volume loss. Sculptra is a collagen stimulating filler which is great for volumizing the face. I then treat specific lines, wrinkles and folds using a hyaluronic acid based filler such as Restylane Refyne or Restylane Defyne. You could also consider a RF skin tightening treatment such as Thermage. Combine this with a good at home skincare regimen and you will notice significant improvement. 

Hi dear
I recommend laser and Ultherapy first and then filler. I always start from top, meanig I use filler on bony structures in mid face and then work my wat down and also the is an area that place filler in jaw line where is a indentation and that causes the lift and pull muscle to make it tight.
For veins laser ND-YAG laser 1064, nor IPL
Thank you
Ramtin Massoudi, MD

As you age and form what I call pre-jowls, the solutions that work involve adding a filler to the pre jowl marionette areas as well as tightening skin with UItherapy with the RF being done first if possible and affordable for you. In your case, I do not think you want to change your cheek appearance with Voluma as it requires injections that change your mid face which you do not mention as a concern. If that analysis is true, then in a fair skinned person, just starting to age, suggest  Juvederm to the marionette per jowl area, Vobella over an area of fine wrinkles and vein exposure, approximately 2 weeks after you have had a Ultherapy  treatment to the area for tightening so the Juvederm is not degraded. I do not recommend thread lifting in a thin skinned individual.

The jowls can be lifted with a mid face filler such as Voluma and I would add a small amount of filler to the chin as well, something like Juvederm would be a good choice. Treating the marionette lines will only make the jowls more prominent and you already have a nice cheek and square angle of the jaw, so these products must be used judiciously so that they look natural.  For the facial veins, I would use an NdYag vein laser.  You are very pale so as you age and the dermis decreases, your veins may become more visible.  Avoid the sun and use cosmeceutical skin care.  All the best and thanks for your question.  Alexis Parker MD