I've had fillers done, but my marionette lines are still visible?

Dear s.lin,

It is not uncommon following the deployment of soft tissue
fillers to still have residual aesthetic concerns. The corner of the mouth particularly the
downgoing corners of the mouth called the commissures and the Marionette lines,
those deep furrows below them add a “mouth frown” or sad and droopy appearance
to the face. Soft tissue fillers and the
Marionette lines and at the parasymphyseal region with direct support of
corners of the mouth is usually quite successful. However, when there is still a residual down
turn to the corner of a mouth as you have on the one side, a small amount of
soft tissue filler particularly within the dermis of the corner of the mouth
may be necessary.

In addition, the use of Botox, Dysport or Xiomen which block
the muscle that pulls down the corner of the mouth called the depressor
angularis oris may also be adjunctive and necessary to horizontalize the
commissure. Creating a horizontal corner
of the mouth and improving the Marionette line will improve that sad, “mouth
frown” and droopiness of the face. Over
time and with age even soft tissue fillers may not correct this fully and
suture suspension techniques or thread lifts and even mini lifts of the cheek
may be necessary to reposition the corner of the mouth. Most patients get good success and start with
soft tissue fillers and it sounds like you have almost achieved your aesthetic
goals and at this time, I would seek the advice of your soft tissue filler injector
and see if a small enhancement without looking like “filler face” can be
achieved or if the addition of a product like Botox may be adjunctive and
necessary.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Very rarely are lines or wrinkles exactly the same from one side of the face to the other. What may have been enough for one side, may simply not have been enough for the other. When people still have lines or wrinkles after filler, you simply need more (another syringe) to get complete results. "This
answer has been solicited without seeing this patient and cannot be
held as true medical advice, but only opinion. Seek in-person treatment
with a trained medical professional for appropriate care."