Marionette lines at 20 years old? Botox? (photos)

I have lines/wrinkles around my mouth that bother me. I'm only 20 years old, is botox a reasonable option for me considering the wrinkles/my age, etc? Are they too pronounced? What are my options? Thank you!

Doctor Answers 15

Marionette Lines : Botox or Fillers?

Thank you for your question. Botox and Fillers are different. Botox is used to correct frown lines and crows feet by temporarily paralyzing or relaxing the muscle. This is not the treatment you require.Fillers such as Juvederm or Restylane are injectables that will smooth out your skin and wipe away wrinkles. This treatment would be your best option. You would only need a small amount of filler since your lines are not severe. Be sure to consult with a board certified plastic surgeon for best results. Regards,

Marionette Lines at Early Age

Thank you for sharing your question and photos. This area is best treated with fillers rather than Botox. Botox is used to temporarily relax muscle movement while fillers help prop up the skin in areas that have lost volume. Based on the photos you have provided, the lines you are noticing are not severe and would only warrant a small amount of filler to correct. Since you are so young, I would strongly recommend consulting with a an experienced physician who can assess you in person and give you more specific recommendations to achieve the appearance you are looking to achieve.

Kian Karimi, MD, FACS
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews


Thanks for your question. Botox is a temporary neuroparalytic that is used to eliminate wrinkles in the periorbital and forehead area. Its also works well for softening the 11s (corrugated muscle). Fillers are used to add volume to the face and also deal with dipper folds and lines such as the smile lines and marionette lines. In addition filler can be used for filling the tear trough deformity and adding volume to the cheeks and lips. Please consult with your plastic surgeon to review the best options available for you.
Good Luck.

Ali Sadeghi, MD, FACS
New Orleans Plastic Surgeon
4.8 out of 5 stars 20 reviews


If these areas are concerning to you, I would recommend considering fillers in the area such as Restylane or Juvederm.

M. David Cole, MD, FAAD
Newport Beach Dermatologist
5.0 out of 5 stars 3 reviews

Lines at corners of mouth

Thank you for your question and providing pictures. It appears that this area could be improved using fillers instead of Botox. Weight loss can create these lines and fillers do a great job in correcting the loss of volume in that area. I hope this helps. Good luck! 


Thank you for your question in regards to Botox. Botox wouldn't be recommended for your area of concern. Possible fillers, or even a few peels may help soften out the problematic areas. To be sure what is best for you, see two or more 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 144 reviews

Botox Versus Fillers

You have a very common question. However, often times people get confused between Botox and "Fillers."

There are a number of solutions to you concern, however Botox is probably not the best choice. 

I included a brief editorial I wrote on this topic. Take a look and perhaps you'll get some insight. 

Dr James Bonaparte

James Bonaparte, MD, MSc, FRCSC
Ottawa Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Botox to lower face

Thank you for your question.

Botox can be injected into the lower face with caution, but it will not correct the area you are concerned with. I would go to a board certified PS for your injections, so that you do not run into problems. Good luck with your decision.

Francis Johns, MD
Greensburg Plastic Surgeon
4.8 out of 5 stars 53 reviews

Selecting a treatment for marionette lines.

There are so many wonderful treatment options available to improve the appearance of one's face. When choosing one the first priority is safety. The second priority is selecting the correct treatment for the right indication.

Botox and other neuromodulators (Dysport and Xeomin) are great for active muscles that cause wrinkles, particularly around the eyes. Around the mouth, the muscle groups are so complex, it's challenging to get a consistently good outcome. There is even potential to give you a lop-sided or unnatural smile.

Fillers are great for wrinkles or folds that you see at rest, particularly in the nasolabial fold and marionette area. However if there are no wrinkles/folds at rest, then fillers won't help. They may even create too much volume that bunches up when you smile.

I would recommend having a consultation with someone who can explain these differences further. They can also lay out a safe and conservative treatment plan. 

Victor Chung, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Marionette Lines

Botox is a neurotoxin, and placing it in this area may result in unfavorable changes to your smile.  I would suggest a hyaluronic acid filler for the area, and maybe a small amount for the mental crease as well, if necessary.

Jesse E. Smith, MD, FACS
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 21 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.