Marionette & nasolabial at 33, any suggestions? (Photos)

Question

At 33, I am developing some marionettes and worsening nasolabial lines. I am genetically predisposed to these. I am wondering if botox might help the corners of my mouth/to help marionette lines. Would botox help me? Using filler, what should I expect in terms of how much filler would be required to fill these? High cheek area and line. I have concerns with starting filler at this age and needing more and more every year as I age. Thank you!

Thomas Wright, MD · Answer

Yes filler is great for this. Usually I start by lifting your cheeks first and pulling out the chin, which restores natural conture. Then if the fold has not lifted, filler can be injected right into the wrinkle to plump it back up.

Hung William Song, MD · Answer

Hi thank you for asking this question. Many people are concerned about going down the road of temporary fillers which need to be repeated annually to correct these pesky lines. After doing a couple rounds of fillers to make sure they like it, most of my patients choose to have a fat transfer of treatment with Bellafill®. These are more long term solutions that do not need to be constantly repeated. You can always top it off periodically to keep up with aging but you never need to start from scratch each time.

Nima Shemirani, MD · Answer

Hi @auserthings!  I recommend Morpheus 8.  Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting.

Harold J. Kaplan, MD · Answer

Hello Auserthings.  Although you are young, you are a good candidate for filler.  One of the reasons to hold off on surgery is that you cannot do an unlimited number of facelifts, so holding off until your 40's until the first one is a good idea.    When correcting the marionette and nasolabial folds, we do not choose to inject the cheeks first.  We fill the lines first and then create support at the upper cheek.  A good starting point for you would be 2 syringes of Radiesse, Restylane Lyft, Juvederm xc, etc.  A medium grade product that will last 6-12 months.  Best of luck.

Nelson Lee Novick, MD · Answer

Right off the bat, I can tell you that having fillers early on, a process so common these days it is now subsumed by the term "PREjuvenation,"  will not make you need more and more filler as time goes on. The chronological aging process will do that, and getting filler earlier on will simply make you look better  earlier on.  I am not a fan of permanent fillers, such as fat and Bellafil, as permanent fillers may give rise--either immediately or five, ten and even twenty years later--to complications, such as nodules and granulomas, that are very difficult to treat, since there is no way to dissolve the problems away (as can be done with natural fillers such as those based upon hyaluronic acid, a natural sugar-type molecule). In addition, the very fact that non-permanet fillers gradually are metabolized away, allows for future treatments to more naturally conform to the many age-dependent losses in the underlying bone, fat, and muscle compartments  Botox can work for your marionette lines, but its results are so temporary, that I find fillers much more practical and economical for treating this area.  Make sure that you consult with a board certified aesthetic physician and ask to see his/her personal befores and afters before agreeing to proceed.

Jason Emer, MD · Answer

folds need fillers, threads/thermage/morpheus for lifting. if you have a lot of loose skin, early facelift can be needed and hormonal optimization (see link).

at home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules weekly, see linkt) should be started now to prevent further aging.

For facial rejuvenation,  I would suggest a combination approach of 
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Best, Dr. Emer.

Marionette & nasolabial at 33, any suggestions? (Photos)

Answers (6)

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