Best treatment for marionette lines, chin, and jowls? (Photos)

Question

What treatment would you recommend for my marionette lines, crepe/downturning wrinkle look of chin, and jowls in the same area? I had a mini facelift about seven or eight years ago, but my marionette lines didn't get better with that. I was reading about microneedling/RF. That seems like a decent option. One surgeon said the only thing he would recommend is fillers. But fillers never helped when used. What about face tight or thermi tight? Other thoughts? I hate the downturned look.

Nelson Lee Novick, MD · Answer

First, let me say that the various aesthetic problems here, namely sunken upper cheeks, pronounced smile lines,  jowls along the jawline and marionette lines, are all every day problems seen in any active practice devoted to facial rejuvenation. Secondly, before fillers are simply tossed aside with "never helped," it would be important to investigate which  specific fillers were used, how much of each, and for which areas was each used, as well as the exprience and expertise of the injector performing these injections. If a syringe or two of ordinary Restylane or plain Juvederm was used for the aforementioned problems, the results would be expected to be both unsatisfactory and short-llived. However, if  a sufficiently HA filler were used for the cheeks, and another for the jawline and still a third for marionette lines and each was injected in the proper amounts and with the proper technique for the individual area, I would venture to say that the immediate nonsurgical transformation would elicit an on-the-spot "Wow!" 
As to faddish and relatively expensive, here-today-gone-tomorrow so-called light and energy-based devices, like RF and fraxel lasers, the hard science to support their use lags woefully behind the heavy marketing to promote them. So, "buyer beware!" when it comes to these.  You would be wise to make sure that you consult with an experienced, board certified cosmetic dermatologist.

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. RF microneedling can diminish the appearance of fine lines and wrinkles on the face and neck while reducing the appearance of early jowl formation and lower face sagging.
Through the use of radiofrequency energy and the creation of micro-channels into the dermal tissue, the body increases production of elastin, collagen, and hyaluronic acid to create firmer and smoother skin. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can review your concerns and surgical history to determine the best option for you.

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

Kristin Jackson, MD · Answer

Hi and thanks for your question!Microneedling and radiofrequency would be a great option to tighten the area in your lower face and jowls. Based on your photos, I would recommend treatment of both face and neck for the best results.Please be aware that best results will be obtain with a series of 3 monthly treatments, with best results at 6 months.I would also consider adding to your microneedling a treatment with Sofwave, which uses ultrasound therapy to heat the dermal layers, causing stimulation of both collagen and elastin under the skin, to provide skin lifting.Given that there is heaviness in the lower face, I would not necessarily recommend fillers at this time. While fillers can help to "turn up" the corners of your mouth (which you mentioned you wanted treated), I don't think you would be fully happy if the lower face heaviness is not properly treated.Hope this helps!

Kurt Kuhlman, DO · Answer

I would consider low dose Kybella injections for your marionette lines and jowls. The cost is only about $1000 and the results are mostly permanent. 1.1 ml injected into the fat on the lateral marionette and jowls for 3 -4 visits six weeks apart. Make sure your provider is experienced in these injections.

William Portuese, MD · Answer

The photographs demonstrate a significant pre-gel sulcus just in front of your actual jowls. Consider placement of a pre-jowl implant to augment that area. You also Have significant facial and neck laxity for which a lower face and neck lift procedure can give significant improvement.

Onir Spiegel, DDS, PhD · Answer

Like most things in life, there isn't always a one best answer or one “best treatment”, especially when treating various areas of concern. Morpheus 8 can help improve many aspects of the face and the treatment does tighten the skin considerably. But, Morpheus goes only skin deep, and to treat marionette lines and jowls will require some filler treatment and perhaps Facetite, which is another application of the Morpheus machine, supplying the skin with radiofrequency and heat energy for the ultimate skin tightening. To embark on any treatment, start with a consultation with a doctor you trust to support you through your journey.
Best from Boston, Dr. Onir

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Morning, Sidney! The photos you've shown are very helpful. The downturning of the corners of the mouth is a very common complaint we see in facial plastic surgery. Microneedling RF helps to tone the skin, but the results may be less than you desire. Fillers are often great options, assuming the correct product was placed, but not always. FaceTite helps to reduce the fullness at the jawline and close to the jowls, but you have to be careful being aggressive there due to the location of the marginal mandibular nerve. It really does nothing for improving the support at the corners of the mouth. The gold standard for really improving the marionettes / jowls / jawline is a facelift - particularly a deep-plane approach. Hope that is useful!

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