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

Is radiofrequency enough to treat skin tightening at this point? would you recommend fillers on the lips?

Doctor Answers 13

Botox is not for Marionette Lines

In fact, stay away from use of Botox in that area unless your goal is an asymmetric smile, drooling and speech impediment.

Consult a board certified plastic surgeon for appropriate choice of filler or volume restoration.  If a doctor has suggested Botox in that area, the wise choice is not to call his/her office again. 

Morristown Plastic Surgeon
5.0 out of 5 stars 15 reviews

Filler is best used for nasolabial folds

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

Anatoli Freiman, MD
Toronto Dermatologist
5.0 out of 5 stars 4 reviews

Marionette Lines - Botox vs Filler

 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.

William M. Ramsdell, MD
Austin Dermatologic Surgeon
4.7 out of 5 stars 3 reviews

Botox in Marionette Lines is a Bad Idea!

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!

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

Botox is not a treatment to improve marionette lines

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.


Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Botox Could Be Used For Marionette Lines- Filler Too

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.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

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

 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.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Botox first, Radiesse second

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.


Curt Samlaska, MD
Las Vegas Dermatologist
5.0 out of 5 stars 4 reviews

Nasal Labial Folds

Hello, in reviewing your photo I would suggest that you use Radiesse  instead of Botox. I am certain you will get a better correction. Botox will lift the area a little but will not fill the lines from your nose to mouth. 

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 16 reviews

Fillers do great for the marionette grooves.

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

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 42 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.