Here Are my Jowls/marrionette Lines. What Should I Do? and Which First? (photo)

Question

disliking this entire puffy area around my mouth. marrionette lines from corners down are present at rest, front/ side and with smile. my dads bulldog jowls creeping in! at 43, I used to rock 35 nicely until last year. tired of being called M'aame! have had one consult: doc says Botox in corners to soften lines. however, i would like them gone more than the results i have seen in before/after botox photos. she has also says thermage for jowls--opinions here suggest otherwise.

John J. Corey, MD · Answer

I would use a filler like Perlane to soften the jowls and maybe Juvederm or Restalyne for the marionette lines. Sculptra is another option, a longer lasting product that seems to work nicely in jowly area. This product can last 24 plus months in that area.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

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

Sam Speron, MD, FACS · Answer

Hello.  I am not a fan of Botox for your situation.  You are more likely to dislike the resulting facial affect, in my opinion.  Thermage is not likely to be a winner, either.  You should do great with a filler.  Start there.

Ron Shelton, MD · Answer

Your photograph shows some tear trough depression and flattening of the normal rounded inner cheek. You have probably lost ample amounts of fat content in the deep facial planes that has caused you to lose support of the lower cheek. This then falls and creates the small jowls and pushes the inner cheek over the smile crease and over the marionette line. Botox injected in the DAO muscle may help lift the corner of the mouth slightly but if it were to be injected to soften the perioral lines, there could be unwanted side effects of weakening the smile and speech muscles.  

	Lifting can be accomplished with either Thermage or Ultherapy.  Having used both devices on my patients, I have found Ultherapy to be more effective in lifting facial features than Thermage. Neither, however, comes close to the amount of lift a surgery can do but it is ideal for patients such as you who don't have significant jowls. Volumizers and or fillers should be done after the tightening with Ultherapy.

	Different doctors prefer different volumizers such as Sculptra and fillers such as Radiesse, Fat injections, Perlane, Restylane, Juvederm UltraPlus or Juverderm Ultra and Belotero.

	The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs

Toby Mayer, MD · Answer

A mini lift will give you the best result and ultimately be more cost effective than having repeated fillers. See an experienced facelift surgeon for a proper consult.

Martin Jugenburg, MD · Answer

I would recommend seeking out a board certified Plastic Surgeon with extensive experience in facial cosmetic surgery and injectables. In my opinion Botox is not the ideal treatment for your marionette lines and puffy area around your mouth.

Robert W. Sheffield, MD · Answer

Let's remember why these expressions lines appear; first of all, it is part of aging's natural process. We lose elasticity and collagen production, causing a loss of volume and genetics; from what you say, I can tell these lines come from your dad, who already has jowls. I can't entirely agree with Botox for treating this area; I recommend for you is Restylane to restore your volume in the marionette lines and give you a natural refreshed look; there's little to no recovery downtime, and you see immediate results. On the other hand, you can do Ultherapy to tighten the skin and prevent these jowls, giving you the lift you need with long-lasting results.

Robert Applebaum, MD · Answer

My recommendation is to investigate using RadioFrequency energy to tighten skin non surgically. Thermage has a low rate of success in this area and botox will not last very long.

Elizabeth F. Rostan, MD · Answer

I think you are still rocking 35 but a great way to keep it that way is to restore facial volume with fillers - often referred as the liquid face lift (which I really think of as more full face). Your medial cheeks under your eyes (the area immediately above the nasolabial or cheek folds) are flat and the goal of filler would be to restore the natural convex curvature and contour of the cheek. Also as we age, we lose volume in our chin area accenting marionette lines and making a jowl look more prominant and filler here would be a quick and easy fix. Forget a facelift for at least another 10 years - maybe more if you keep up fillers and botox (between brows - I think you will have minimal effect on corner of mouth but it only takes about 5 units total and can't hurt) and maybe add in some skin tightening procedures (think exilis or ultherapy)!

	BTW - we are the same age and I think you are looking great!!

Here Are my Jowls/marrionette Lines. What Should I Do? and Which First? (photo)

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