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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.
