Can Botox be used to prevent marionette lines?

Botox really is not best for treatment or prevention of marionette lines. These lines are generally unrelated to movement. The more common cause is that the tissue on the side of a relatively more fixed facial “ligament”  becomes lax and starts to buckle against that fixed area. Not everyone has the same anatomy here in terms of what happens as they age which is why marionette lines are so recognized as a hereditary feature. 
 Fillers such as those made of hyaluronic acid can be helpful in this area to some degree, particularly in mild to moderate cases. In more severe cases, a facelift as needed to improve the appearance of this area. 

Thank you for your question!  Yes, Botox is a wonderful treatment to help prevent the progression of fines lines and wrinkles within the face.  Botox and other neuromodulators are purified proteins that relax the muscles of the face when they are injected.  As these muscles relax, the overlying skin will also relax and wrinkles will smooth.The marionette lines (lines around and under the corners of the mouth) can be treated with Botox by injecting the depressor anguli oris muscle.  This will help to turn the corners of the mouth upward.  In addition, the marionette lines also respond very well to hyaluronic acid filler injection.  Both treatments are very effective at helping improving this area of the face. I would consult with a board certified injector for a full evaluation to see what is the best treatment. I hope that this helps!-David Gilpin

Botox excels at treating crow's feet, glabellar and forehead lines. It does not address skin volume issues and facial folds due to cheek migration during facial aging. Facial fillers like Voluma can address this issue.

No, I don't recommend Botox for this, but filler can be used to improve marionette lines. It takes 1-2 weeks for final results. Hope this helps.

Dear SFlove,Thank you for your question. Marionette lines are caused by a variety of factors, including the muscles around the mouth. In experienced hands, these muscles can be targeted and inactivated to improve the appearance and/or prevent marionette lines. Keep in mind, however, that Botox does not address all the causes it is just one of many treatment modalities. Hope this helps.Nirmal R. Nathan, M.D.Certified, American Board of Plastic SurgeryMember, American Society of Plastic Surgeons

No, Botox wouldn't be used for this. I suggest seeing a cosmetic dermatologist to get you on a long term plan with microneedling/prp, Viva, Cosmelan, J Plasma, peels, sculptra, Botox, fillers, facials and skin care. Best, Dr. Emer.

Botox placed in small doses in to the DOA muscle can help prevent over use of the muscle that causes downturn of the corners of the mouth.  Doses are usually small 2-3 units, this is a great place for Botox and often over looked by inexperienced injectors.  Marionette lines are caused by DOA but also dropping of the tissues in the upper face.  It’s imprtant to think of collagen stimulation as well as Botox to slow the aging process.  Best of luck!

Hi and thank you for your question.  Botox can be used to treat the DAO muscle, which is the muscle that pulls down the corners of your mouth. So this can help prevent marionette lines.
Dermal fillers can also be injected into marionette lines to help soften their appearance.

Wishing you all the best,

Stay absolutely safe and well,
Dr. Murray from Absolute Cosmetic Medicine

Thank you for your question SFLove. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.While Botox is most commonly used in the upper face, it can also be used in various areas in the lower face. Botox can be placed in the depressor anguli oris (DAO) muscle to elevate downturned corners of the mouth which sometimes produce a sad face appearance. In this area 2-4 units are used per side.Other areas in the lower face where Botox can be used are as follows: The nasalis muscle on the bridge of the nose is responsible for the bunny lines that are sometimes seen there when one frowns or smiles. Usually 2-4 units of Botox are used per side for this area. Botox can be placed in the orbicularis oris muscle around the lips to provide a pout to the lips and reduce the appearance of vertical lines around the lips sometimes called smoker’s lines (although they are seen in people who do not smoke as well). In this area 2-4 units are used above the upper lip and 2 units are used on the lower lip. Botox can be placed in the mentalis muscle on the chin to address a cobblestone appearance or dimpling on the chin. In this area 2-8 units of Botox are used. Botox can be placed in the masseter muscle in the lower face to contour the lower face and address pain associated with TMJ. In this area 20-40 units of Botox are used per side. Botox can be placed in the levator labii superioris alequae nasii (LLSAN) muscle located just beside the nose on either side to address what is called the gummy smile. The gummy smile is seen in some people whose upper lip elevates so high when they smile that the upper gums are seen in addition to their upper teeth. In this area 2-4 units are used per side. Botox can be placed in a vestigial muscle (seen in some people) called the depressor septi nasii to prevent the tip of the nose from moving downward when smiling. Here only 1-2 units is required. Botox can be placed just under the jawline in what is called the Nefertiti lift to relax the platysma muscle which pulls down on the lower face, thereby improving jawline definition. When placed lower in the neck Botox can address vertical neck bands. Approximately 10 units are used below each jaw and in each band.Correction of marionette lines lines is more commonly achieved using fillers such as Voluma and Vollure. One of the reasons for formation of nasolabial foldds and marionette lines is volume loss in the mid-face. Placing Voluma in the upper cheeks will pull up on the lower face and improve the appearance of these folds. A small amount of Vollure can be placed directly in these folds as well.Botox and fillers are two dermal (skin-related) products are both very popular for their anti-aging features. Unlike Botox, which relaxes muscles to smoothen out wrinkles associated with facial expression, fillers restore lost volume in various areas of the face and body. Common fillers include the Juvederm family (Juvederm Ultra, Juvederm Ultra Plus, Voluma, Vollure, and Volbella), the Restylane family (Restylane, Restylane Lyft, Restylane Silk, Restylane Refyne, and Restylane Defyne), Belotero, Radiesse, Sculptra, and Bellafill. With age changes occur in the bony structures as well as fat pads, both of which contribute to a youthful appearance. Over time bones move and change shape while fat pads get smaller by losing volume and move downward. Fillers restore such lost volume. Common areas of volume loss include the temples on the sides of the face, the upper cheeks, the tear trough area under the eyes, the nasolabial folds which go from the sides of the nose to the corners of the mouth, the marionette lines which are the continuation of the nasolabial folds to the jawline, the chin, and the jawline. Often times combining fillers with Botox treatments yields superior results.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids as described above. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.Please consult with a doctor for specific recommendations. Good luck!

Botox can be injected in the depressor anguli oris muscle to help keep the corners of your mouth from turning down.  If it is not relaxed, this muscle will pull down the corners of the mouth and aid in the development of marionette lines.  Also, injecting fillers in the upper cheeks, pre-auricular area can help alleviate the appearance of the marionettes.  Hope this helps.