Age 28, Restylane in my marionette lines or cheek fillers instead? (Photos)

Question

I’m 28, but think I have quite prominent marionette lines - I’ve heard conflicting advice about how to treat theme. I’ve heard that it’s not advised to inject the marionette lines themselves with filler, as I could look puffy, and that I could get 1ml cheek filler (each cheek) to correct this? Would this work? What are the best options?

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  Looking at your photos I think your a great candidate for filler in the marionette lines. Injecting into the cheeks yes can help pull up a bit but won't soften them enough in my opinion.  If injected correctly in the ML you can see some nice soft results that I believe you would be happy with.   I would suggest seeing a Board Certified Plastic Surgeon who has experience with injecting.  Best of luck to you.

Jonathan Landon, MD · Answer

Hello and thank you so much for your question. Based on the 2 images you provided, I would not advise filler to the cheeks unless you're looking to add some plumping to those areas; it seems as though you don't have much in the way of volume loss in the cheeks. Restylane Defyne or Refyne for the marionette lines could be a good option for you. Using as little as 0.25cc per side could help to smooth out the lines while mitigating the risk of the 'puffy' look you are concerned about.

Jason Emer, MD · Answer

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting,  and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Jonathan Kulbersh, MD · Answer

Hello, and thank you for providing photos along with your question. For mild to moderate lines, dermal fillers can be injected to not only smooth these lines but also add volume to the hollowness around the mouth. Direct injection into your marionette lines can reverse the droopy appearance in the corners of your mouth. Cheek fillers, on the other hand, will give an instant lift to your mid-face and may also help address your marionette lines. You may get injections on either region or both.

I recommend scheduling an in-person consultation with a reputable, expert injector who will have the optimal skills, as well as artistry and knowledge of facial aesthetics, harmony, and proportion, to help you achieve the most natural-looking results. During your consultation, your surgeon will evaluate your skin quality, customize a treatment plan tailored to your needs and goals, and ensure the best possible outcome.

James R. Gordon, MD, FACS, FAAO · Answer

Thanks for sharing your questions and photos.  For your specific features, placing fillers directly into the marionette region is appropriate. You would need too much filler in the cheeks to correct the problem. See an experienced oculofacial surgeon for proper guidance. Good luck!

Nelson Lee Novick, MD · Answer

The effect is called the "domino effect," wherein the filler treatment of an appropriate anatomical region not only improves the region itself, but also improves another anatomical region downstream of it. So, yes, lifting the cheek with filler can most certainly improve areas below, such as the smile lines and even the marionette lines. These days only novice injectors jump immediately to directly filling lines and folds, such as the smile lines and maironette lines for precisely the reasons so correctly mentioned in the question. So, make sure to consult with an experienced, board certified dermatologist and ask to see his/her personal before and after photos before agreeing to proceed. Best of luck.

Camille Cash, MD · Answer

From the photos it appears you would benefit from filler in both areas.  You may also consider adding Morpheus8 treatments which use a combination of RF technology and microneedling to improve overall skin tone and texture.

Benjamin Barankin, MD, FRCPC · Answer

Depending on age, and fullness of cheeks, and depth of Marionette lines, I'll either inject just the Marionette lines, or just the cheeks, or both. Likely in your case, I'd do both, but you could also start with 1 area and see if you like it, and 2 weeks later add to the other area if need be. More importantly, make sure to see a highly trained expert skin physician (e.g. dermatologist) for optimal results, the least discomfort & downtime, and optimal safety.

Age 28, Restylane in my marionette lines or cheek fillers instead? (Photos)

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