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

Question

So I've gotten my marionette lines filled because the corners of my mouth when I smile go downward. The left corner of my mouth still goes downward, it's less visible now but you still notice it. The right corner of my mouth is fine though. Is there anything I can do without using too much fillers?

Nelson Lee Novick, MD · Answer

After more than three decades of treating marionette lines, dating back to the days of the original Zyderm and Zyplast collagen fillers, it is clear that often simply chasing after the lines (i.e. just filling the folds directly) does not lead to a satisfactory outcome. Not uncommonly, treatment requires more than one approach and sometimes even more than one type of filler in order to produce gratifying results. Depending upon the individual circumstances, the area below and to the inner side of the fold extending below the lower lip toward the chin may need to be augmented with a volumizing filler in order to provide proper "scaffolding" to the corners of the mouth. In addition, the angles themselves may direcly require a filler. And if etched-in lines are present resulting from years of folding the skin while smiling, these may require a filler to elevate and smooth them. Finally, Botox (or Dysport or Xeomin) may be needed for further benefit by softening the downward pull of the DAO muscles in the region. For this reason, it.is advisable to seek treatment by an experienced, board certified aesthetic physician injector.

Martin Jugenburg, MD · Answer

Fillers help to add volume, and fill in lines.  They are not perfect and do not completely erase wrinkles, especially the ones that have been etched into the skin.  In the case of marionette lines, it's a balancing act of adding volume and but not making your face look blown up.

Martie Gidon, MD, FRCPC, FAAD · Answer

Neuromodulators can help prevent a mouth frown where the corners of the mouth droop.  Please consult a cosmetic dermatologist or plastic surgeon who can assess you and discuss possible treatment.  You may not require additional filler.

R. Stephen Mulholland, MD (retired) · Answer

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

F. Victor Rueckl, MD (in memoriam) · Answer

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."

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