Would You Recommend Botox for Marionette Folds That Are Starting to Show in Your Early 30s? (photo)

The photograph displayed shows smile crease, or meilolabial (also referred to as nasolabial ) folds, not marionette lines. Marionette lines are the creases that form from the corners of the mouth to the lower outer chin at the jaw.  Botox has been used off-label to soften the smile folds but it can alter the normal anatomy of the mouth too much. The upper lip might not raise up with smiling and it may be hard to speak certain letters and eat correctly. Even brushing ones teeth could be a chore because the upper lip droops. Cheek augmentation or revolumization can help some patients build up the support to minimize their smile crease and fillers are ideal for raising the smile crease. 

As far as your question about lips and fillers, that becomes a personal view but your lips look full and you don't want to look unnatural.

Radiofrequency such as Pelleve or Thermage, and ultrasound with Ultherapy can help tighten, and the latter, lift, the mid cheek to help soften the smile crease.

You need to be seen inperson for an evaluation. Doctors need to see your face in 3-D and see how the contours look with animation.

 

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.

 

Fillers such as radiesse ($630) do great to fill in the marionette grooves and can last up to 1 yr. and look very natural and easy to get. Sincerely,

David Hansen,MD

BOTOX is not right for this area ( it will make you look like you had a stroke).  The best option here is hyaluronic acid filler.  I prefer Restylane and Perlane for this purpose.

Soft tissue filler (e.g. Juvederm, Restylane, Radiesse) is best used for naso-labial folds, whereas Botox works best for upper face/forehead wrinkles

The conversation so far has been interesting with many very different responses. While Botox to the muscles right around the marionette lines can cause problems such as drooling and an asymmetric smile, Botox into the Depressor Anguli Oris ( the injection is near the bottom of the jaw- far away from the lines themselves) will cause the corners of the mouth to lift slightly without worrying about the above mentioned problems. While you could then wait and see how much you like the results from this injection, an additional injection of a filler (Restylane or Radiesse) into the corners of the lips and the marionette lines themselves would likely finish off this problem nicely.

I agree with Dr. Glavey. I would try Botox first for treating the anguli oris muscles, it will probably give you enough improvement. You can always do a filler if it doesn't work well enough for you, but it is significantly cheaper to do Botox. As you age the Marionette lines will likely become deeper and at some point you will have to use a filler, such as Radiesse, to adequately correct.

 

Marionette lines are  the lines that extend down from the nasolabial folds and often represent deflated soft tissues and loose skin. Fillers can sometimes improve this, as can a lower facelift in combination.

 Your photo shows not marionette lines but nasolabial (melolabial) folds. A filler should take care of this nicely. There are many fillers on the market. I would use the one that your physician is most comfortable with.

 If you did have marionette lines, Botox could be used assuming that your physician is experienced. However, a filler would still provide better and more reliable results.

 I have used  a small amount of Botox to weaken the depressor muscles within the Marrionette lines combined with Perlane injections to fill in the folds.  

No, please don't do this. I see more problems with people getting Botox in this area! I have had patients come into my office after being treated with Botox in other offices in this area, and they are drooling, having trouble speaking and eating, etc. It's NOT a good idea, especially for a first time person. Botox paralyzes muscles - it does not fill them in. Seek a board-certified dermatologist or plastic surgeon for an evaluation. Even though I like Radiesse as a product too, I don't recommend you do that as a first time filler patient either. There is no counter product to Radiesse and I only do it on very experienced filler patients. Even though I am a top injector in Las Vegas there are some people who simply won't like any fillers and injecting Radiesse in them doesn't allow any changes except for it to dissipate over time. I'd choose Restylane or Juvederm in this area, and a board-certified injector!