31 years old and concerned with sagging and bulginess around corners of the mouth. Best treatment for marionette lines? (photo)

you may need a surgical intervention but non invasive options such as threadlifting, thermage, and ultherapy can help in the mean time.  Best, Dr. Emer.

Ultherapy is not a great option for bulging around the corners of the mouth. Fillers may offer you better results.You are a good candidate in general for Ultherapy due to your age as we have more collagen to stimulate the younger we are. Ultherapy may work for preventation for you, so in that regards it is a good option to consider but marionette lines can be better softened with fillers. 

In theory Ultherapy can give you a lift, however in reality a real time consultation is needed to see how much lift is possible. Vector lifting with Ultherapy, Thermage, RF micro needling and other energy devices have their pros and cons, in your case it is important to lift not where the problem is, but where it arises from- hence the need to touch, feel and move. Dr Isobel Walker, Brisbane. Fiori, Australia. 

Thanks for your question. The puffy areas form due to natural sagging of the skin. Ultherapy uses ultrasound to prompt the natural production of collagen which tightens and firms the skin. As a result, the skin is "lifted", reducing the bulges. Using cosmetic fillers around the mouth would only increase the puffiness. However, using Ultherapy in combination with fillers around the cheeks may be the solution to lift the skin and reduce the "bulges". I highly recommend scheduling a consultation, either in person or virtual, with a facial plastic surgeon in order to achieve your desired result.

Dear jadeburgess,
Thank you for your question and for submitting your photos. As we age, the SMAS layer of the face, which envelopes the face, tends to loos elasticity and droop with age.  Nasolabial folds, marionette lines and jowls are are manifestation of this.  While rhytidectomy, or facelift, is the most effective treatment to correct these deformities, many would argue that is a bit premature at age 31. I  recommend Ulthera to my patients in their 30s - 40s who are starting to see these changes.  While the results take time to become apparent, the results will not be as dramatic as those seen in a facelift (or your modified image).  In general, fillers camouflage these changes and you are absolutely right, that they can cause the perioral region to appear puffy.
Best regards,
David Kahng, MD