How can the marionette lines be improved?

Question

Anything that can improve these mario lines? Under chin area? One plastic surgeon said no to filler in that area.

Don W. Griffin, MD · Answer

Based on your single photograph, you have classic signs of facial aging with loss of cheek volume and support causing more prominence of the nasolabial folds and marionette lines. Cheek and jawline filler can provide some lifting effect, but there is a point where filler will not provide enough benefit and directly injecting into the medial cheek and chin area will leave you looking overfilled. The best way to address these signs of aging is with a deep plane facelift and neck lift. This will improve your nasolabial folds, marionette lines, restore volume to your upper cheeks and improve your neck contour.

Hagen Schumacher, PhD, FRCS(Plast), FEBOPRAS · Answer

Hello,
Marionette lines ("labiomandibular lines") result from cheek laxity in combination with fibres between your skin and the deeper muscles and bones ( between "mandibular ligaments" and "oral commissures").
I agree with the other plastic surgeon that fillers are no good for this. The reason is that there is no depression but a loose skin fold. Fillers don't tighten the skin but add extra volume to additional volume from the skin fold and therefore create an abnormally full lower face.
Because the fold results from tissue laxity, the correct treatment is tightening of the skin (and underlying soft tissues). This is essentially a facelift.

Ram Kalus, MD, FACS · Answer

I have successfully treated the marionette depression with fillers. Bit let’s review the anatomy. The marionette “line” is actually a shadow, which is what makes all folds or wrinkles ultimately visible. This is due to gradual laxity above the retaining ligaments that keep the deeper tissue fixed to the bone, while the looser tissue above descends and folds creating a visible shadow. The correct and proper treatment is to tighten the looser tissue. That said, a facelift or energy based skin tightening is more involved than a filler injection, and one has to be cautious about avoiding a puffy look since the problem is not “deficiency” or volume, but rather laxity.

Please consult with an experienced board certified plastic surgeon, facial plastic surgeon, or cosmetic dermatologist who can review with you all of your options. Best of luck to you.

Please consult with an experienced board certified plastic surgeon, facial plastic surgeon, or cosmetic dermatologist who can review with you all of your options. Best of luck to you.

How can the marionette lines be improved?

Answers (3)

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