Smile lines, marionette lines and sagging skin around mouth. How can I treat this?

You’ve already done many of the right treatments — Botox, fillers, microneedling, and Morpheus8 can all help with firmness and lines — but smile lines and marionette folds are often the most stubborn because they result from deeper volume loss and skin laxity, not just surface wrinkles. At 41, the best results often come from combining structural support with skin tightening.

Options to discuss with your provider include biostimulatory fillers (like Sculptra or Radiesse) to gradually restore collagen, radiofrequency or ultrasound-based skin tightening in moderation, or thread lifting for mechanical lift. In some cases, surgical options (mini-lift or lip lift) may offer longer-lasting improvement if non-surgical treatments plateau.

A personalized in-person consultation with a board-certified dermatologist or facial plastic surgeon will help determine the ideal combination based on your anatomy and treatment history.

Hello PNB17 and thank you for your question! The peri-oral area is nearly every patient's most troubling concern, I feel for you! Without seeing photos of you it is difficult to give a proper recommendation, but if you have not yet tried Sculptra or another biostimulator, that might be a good option. These products stimulate the area to produce more collagen and elastin, thus leading to more volume and better, healthier skin in the areas in which they are injected. Adding a bit more volume to the softer areas of your face can also help minimize the appearance of jowling. Also, if the skin appears dry or crepey with lots of little lines, a skin booster such as Skinvive can be a lovely addition to your regimen. This injectable hydrator plumps the area without adding more volume. And finally, if skin laxity is still the issue, you are doing all the right things! Some patients require additional RF-microneedling (such as morpheus) treatments to specific areas- this might be the case for you. The full effects of your Morpheus treatments should be visible about 3 months after you complete your series. Best of luck! I hope this helped! Genie Alexander, RN BSN for Dr. Anna Petropoulos, MD FRCS at Center for Classic Beauty, Danvers & Boston, MA

Hi PNB,
I have found that my patients respond to Profound RF combined with fractional CO2 laser with PRP in the difficult to treat peri-oral marionette area. Feel free to contact our office to schedule an in person or virtual consultation at your convenience. Good luck and be well.
Michael Persky, MD
Encino, CA

It's difficult to give specific recommendations without an evaluation. Based on the treatments you have used with no effect you may need to consider laser or perhaps FaceTite to get improved results. See a board certified plastic surgeon near you to learn more.