How much more filler do I need to have amazing cheeks and no marionettes if I'm smiling or not? (Photo)

I had Voluma to cheeks (2 vials each side), Juvederm Plus on nasolabials and marionettes (1vial each side), and Restylane to tear troughs (1 each side). And yet I still appear to have no cheeks and marionettes when not smiling and tear troughs either way, plus laxity in lower cheeks that is beginning to permanently wrinkle from smiling. My injector feels I don't need anything else but obliges what I think I need. Do I need more product (if so what) or a different injector (i.e. Is it her skill?)

Doctor Answers 8

Further filler improvement

I think you could probably get more improvement with some more filler or fat grafting. My best advice would be for you to find a board certified plastic surgeon in your area with a lot of filler expertise and get a second opinion. The key is finding the right cocktail of fillers for your unique anatomy so that you look naturally fuller and more youthful without looking overly plump.


Kouros Azar

Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 33 reviews

More filler?

Hi Ashton12,

In looking at your photos, it's my opinion that you would benefit from a filler like Sculptra in the lower and medial cheek region. You may also see improvement with a touch more filler, like Belotero, in the tear trough region. Please make sure that you are seeing an expert in injectables. Good luck! 

Elizabeth Geddes-Bruce, MD, MS
Austin Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Facial Sculpting Using Fillers Like Voluma, Radiesse, Lyft, Juvederm and Sculptra and Fat

If you are not seeing the results you want with fillers, fat injections or sculptra might do better.  you likely need more lateral anatomical filling to get lift rather than size.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews

Under Correction with Fillers

It appears that you still have a volume deficits of the tear troughs and lower cheek ,marionette lines and pre-jowl sulcus. The tear trough can be improved with Restylane or Belotero, the pre-jowl sulcus may benefit from Voluma ,Lyft ,orJuvederm, nasolabial  and marionette lines from Juvederm or Restylane  and the lower cheek from Sculptra.

Joel E. Kopelman, MD, FACS
Ridgewood Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

Do I need fillers?

Thank you for posting your pictures. Your left cheek seems to have less volume overall. Your injector did a good job on the lateral cheeks but you may benefit form augmenting the medial cheeks and the apex on both sides. Since you already had Voluma, I would consider using the same filler. In a different occasion, you may want to discuss Radiesse which works great in patients like you with more bone remodeling secondary to aging. You could have Radiesse for your marionette lines and also at the pre-jowl sulcus. When it comes to facial fillers and injectables, It is not uncommon to need multiple touch up sessions to reach that final outcome we all want: A beautiful, full, heart shaped, wrinkle free, and symmetric face! 

Jose Rodríguez-Feliz, MD
Miami Plastic Surgeon
5.0 out of 5 stars 20 reviews

Additional Volume With Fillers

It appears you have had a good result from your previous injections.  If you prefer higher and more defined cheeks, you could add more fillers to this area.  In the long term, you may want to consider cheek implants for a long term solution.

Fillers in the marionette will only soften the area.  It is very difficult to elimate the marionette lines with the addition of fillers.  

I hope this helps.  

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

More filler?

I think you still need mid cheek/tear trough filler. Pre jowl sulcus needs some too. Don't expect elimination of the marionettes, just improvements. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

Correcting Facial Wrinkles NYC

Your injector did a very good job in correcting the lines and areas that you described.  I think you could benefit from a bit more filler both in the mid-face and in the lower face.  More product injected into the lower face and placed correctly by the lower jaw should "pull back" your face and give you a better result.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 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.