Age 30, would lower facelift help or fat transfer help lines? (Photos)

Question

Hello, i am 30 years old and for the last year i have noticed deeper marionette lines. I am very self conscious about this,i and feel i cannot smile incase they look worse. I feel it makes me look much older. I have tried filler in cheek and on marionette lines and pdo threads but no change. I am thinking would a lower facelift help or maybe a fat transfer?

Nelson Lee Novick, MD · Answer

Experience and expertise are critical factors for achieving successful filler treatment outcomes. The kind of marionette folds exhibited in the photos are rather typical and quite readily respond to the appropriate choice of a robust HA filler, as well as proper injection technique. Ordinary fillers, such as plain Restylane or Juvederm, so often chosen by inexperienced injectors, are unlikely to be particularly effective in an area such as the marionette folds subject as they are to so much movement. Likewise, a novice approach would be to inject the marionette lines directly (an approach that is hardly ever used by experienced injectors), which often can actually even make the folds more prominent.  Threads, which basically just pull the skin and which I gave up using a number of years ago, often don't give optimal or durable results. It would be wise to make sure to consult an experienced, board certified cosmetic dermatologist and best of luck.

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. While a more thorough assessment of your skin is necessary, marionette lines can effectively be treated by dermal fillers. But of course, your results will also depend on the skill and experience of your provider. This is why I strongly recommend only seeking treatments from a reputable injector, particularly one with extensive experience and training. An expert will know the right product to use, how much to use, and where to precisely inject it. During your consultation, your provider can assess your skin, recommend the best treatment, and ensure the best possible results.

Jason Emer, MD · Answer

It's difficult to say without the benefit of a formal evaluation. This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Brian K. Machida, MD, FACS · Answer

It looks like your marionette lines are formed under dynamic muscle action.  It would be good to see under no facial expressions or smiling.  If you've already tried fillers and threads, I wouldn't necessarily recommend fat transfer. A personal evaluation is required to go over what else might be useful.

Arnold Almonte, DO · Answer

Yes, marionette lines deepen as you age. The nonsurgical treatments you described are appropriate treatments, they just don’t last very long. Fat transfer and/or lower facelift are more robust procedures which last longer, although not forever. Seek out a plastic surgeon who specializes in facial rejuvenation for a personal consultation and advice. All the best

Michele A. Shermak, MD · Answer

Hello!
There are fillers that are FDA approved for precisely this application. You can get filler along the jawline to help pull up the skin. You may also get noninvasive treatment to tighten the skin. At your age surgery seems outside what would typically be provided.
I would recommend you meet with a board certified plastic surgeon to discuss your best options. You can find one at plasticsurgery.com.
Best of luck to you!

Darryl J. Blinski, MD · Answer

Maybe a mini FL/NL SMAS with nano fat grafting to NL folds can help. Fees $10,000 ranges. But smiling will ALWAYS cause NL folding because of muscle action.