The tear troughs are very delicate, so I only use Belotero or Restylane in that area. I don't use Juvederm because that is the most likely to cause inflammation underneath the eyes. For the Marionette lines, I use fillers that have more "oomph" - like Radiesse, Voluma or Juvederm Ultra Plus. Hope that helps. Go to an experienced injector and make sure you have a good discussion about goals and expectations. Good luck!
I like belotero or restylane silk to the troughs to limit swelling and love restylane lyft, voluma and radiesse to the marionette area. however, any expert injector can make use of multiple products for these areas. Best, Dr. Emer.
For many years, and even today, many injectors have tried to inject tear troughs and marionette lines directly. This is no longer, and for many of us has really never been, the best way to treat these areas. When treated directly, the areas around tear troughs can swell and cause significant problems. When the marionette lines are treated directly, the face is not rejuvenated and returned to its youthful triangular shape but furthers the squareness of age. Modern technique uses a product like Juvederm Voluma to fill the area under the tear trough, thus eliminating it, and to fill the area over the lateral upper cheek, thus elevating the cheek and reducing the marionette lines. ( See PlasticSurgeryToday.com/non-surgical/todays-liquid-lift-wrinkle-and-contour-correction/)
There are multiple fillers available on the market. There are some positive and negatives of each that should be correlated to the individual patient and specific areas being treated. I would strongly suggest speaking with a well versed provider in the multiple modalities and discussing your specific needs.
The answer to your question depends on where you have volume loss. Many times, a skilled dermatologist or plastic surgeon can inject Voluma along the lateral cheek (zygomatic) and provide significant improvement to sagging of your lower eyelids / tear troughs AND your marionette lines. To test this improvement yourself, use two fingers on either side of your cheeks and push back slightly toward your hairline.
For true tear trough deformities, I typically recommend Restylane, Vobella, or Belotero. Of these choices, Belotero does not last as long.
For Marionette lines remaining after replacing structure to the upper two thirds of your face, you will need to improve structure to your chin first and then the marionette lines. For the chin, I typically use Voluma. For the actual marionette lines, consider Volift, Vobella, Juvederm Ultra Plus, or Restylane Lyft for longer lasting results.
Suneel Chilukuri, M.D.
If your marionette lines are very superficial than you can have Belotero in both the lines and the tear trough. However, most marionette lines are deeper, and require a product like Restylane or Juvederm. Best, Dr. Green
Since the marionette area you are concerned about is fairly mobile you need a fill that has more cross-linking so it will hold up better over time. The tear trough area is a good place to use it also because of it's structure.