Would a Lower Lift Help with Sagging in the Marionette Area?

Due to 30lb weight loss I have sagging in the marionette line area. Its not too bad but it bothers me that I look sad. I talked to a plastic surgeon about a lower lift. He said this would also help my jaw line. What would this entail. Is the recuperation difficult. I am 48. Would juvederm help to hold off the surgery for awhile? Can it help the neck? I have already had my eyes done and rhinoplasty so surgery isn't new to me.

Doctor Answers 15

Correcting Marionette Lines via Facelift

Facelifts help to some degree with correcting the oral commissure (marionette area) but often the area deepens or sags due to certain muscle action in the area. If the muscle is primarily responsible sometimes small doses of botulinum toxin (Botox and Dysport) can be helpful as can injectable fillers. But remember, fillers fill and Lifts lift. An experienced surgeon can show you how much of your problem can be corrected with each type of treatment.


Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Fillers for Marionette Lines versus a Face Lift

Fillers may soften the appearance of the Marionette lines but will likely need to be repeated on a yearly basis.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 72 reviews

Would a lower lift help with sagging in the marionette area?

It is difficult to provide an accurate recommendation without seeing you in person, however dermal fillers, a pre-jowl implant and lower facelifts are all options to improve the marionette area, and sometimes a coupling of two or more for the best results.  I would share your concerns with your board-certified facial plastic surgeon and together you can map out a plan based on your goals and desires.

Vu Ho, MD
Plano Facial Plastic Surgeon
4.7 out of 5 stars 38 reviews

Facelifting after weight loss

Your story is typical and a lower face lift or min-lift is designed to take care of the Marionette area, jowls and upper neck accentuated by weight loss. You may also need fillers (fillers do not work in the neck area) but I suspect loose skin needs also to be addressed.

The aging process involves 3 things ; downward decent from facial soft tissue laxity, skin surface aging characterized by wrinkles and discoloration, and loss of volume especially in the cheek area. Failure to treat all three may make you more aware of what is not treated: in your case the redundancy in the Marionette area. Your plastic surgeon can explain more.

Lower facelift plus volume

Usually patients with your situation need volume (fat grafting or fillers) that are synergistic to lower face lift to improve the appearance of marionette lines.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.0 out of 5 stars 7 reviews

Filler Facelift Marionette Lines

You may need a combination of both. Don't be fixated on one or the other.  there are a lot of complicated factors that go into these recommendations including the "strength" of the jaw and chin, skin consistency, volume loss, etc. If you feel comfortable with your surgeon then go with their recommendation.  Good luck!

Hannah Vargas, MD
Kansas City Facial Plastic Surgeon
4.7 out of 5 stars 40 reviews

Neck lift and fillers

Ideally you would need a combination treatment of neck lift and fillers. However, dermal fillers can be used around the jowls and marionette lines with good results.

Sandy Sule, MD
Dallas Facial Plastic Surgeon
4.3 out of 5 stars 12 reviews

Face lift

 You can discuss with your surgeon the possibility  for the use of fillers   and Botox to  help the down pull of the corner of you mouth .

Marionette lines and sagging skin

At age 48 you probably have fairly good skin tone, although weight loss will affect that. Consideration for the fillers in the marionette lines can be entertained. The goal of the lower face/neck lift is to tighten up the jowls, but one needs to be very careful as to not stretch taller the wind tunnel of the face to try to pull out all of the marionette lines in that area. Nasolabial folds will not be stretched out with a facelift either.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Sagging in the marionette area

Combination treatment facelift plus filler is best answer for sagging marionette lines. The marionette area sometimes is reasonably simple to treat, but other times is more difficult. A simple answer is to utilize simple, safe and less expensive techniques such as Juvéderm or Restylane for the marionette line area. This can be a potential six to nine month or even one year successful therapy in many instances, but not all. More permanent answer entails Sculptra or lipo injection to the area that can additionally soften the marionette line. These answers are safe and less expensive. Nonetheless a facelift provides an excellent improvement in marionette lines in most instances, but there are some instances where supplemental injection is needed. So at 48 years of age I would suggest trying fillers first and if this doesn’t resolve things to your satisfaction then strongly consider a mini-lift or facelift by an expert surgeon in the area who has done a lot of facelift procedures. And again even then, consider subsequent injections if this is not satisfactory.

David Q. Santos, MD
Bellevue Facial Plastic Surgeon
4.3 out of 5 stars 21 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.