Threads or filler: what is the best option for eliminating frown and marionette lines? (Photo)

Hello. Great question. If you are ready for surgery, then a facelift is gold standard. If you are only looking for non surgical approach, I will suggest you to try threads first then filler to fill the cheeks afterwards. The reason why you have deep nasolabial fold, marionette lines and jowls is because the soft tissue have descended. The threads can help soften the lines by repositioning your soft tissue to where they used to be. Then after several weeks you can consider adding volume with filler to your cheeks.

Hi @Exuberant5887! I highly recommend Morpheus 8. Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting.

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

Thanks for your question.
Your marionette line can be improved with thread lift. Because you have thin skin and lack of jowl fat, thread lift can help you. even though thread lift can improve your marionette line, additional filler injection may be needed. I also can see deep nasolabial line and this can also be improved with filler injection.

Thanks,

Dr. Choi

Hello Exuberant
The best treatment based on your pictures i a facelift. You can put in fillers but it would take many and the results would be temporary.
hope this helps.
Sincerely,
Michael Kulick MD
San Francisco Ca.

PDO thread facelift allows you to have a more contoured, voluminous, and lifted face as the soft tissues are repositioned and the ensuing collagen production helps with skin rejuvenation. On the other hand, the inner pressure exerted by Voluma on the skin prevents the skin from losing elasticity. So, it is a facial rejuvenation technique also that can smooth out folds and wrinkles, add volume or contour facial features that have lost their fulness due to aging, etc. Consult with your doctor to know the best treatment for you.

For the best possible results, I like to give patients a combination of both. I cannot give an accurate estimate of how much product to use without being able to touch the skin and evaluate its laxity. However, I can say that If fillers are in place first and then threads are applied, it can actually help anchor the threads and lead to tighter, longer-lasting results. Good luck!

Volume restoration with filler such as Voluma in the Y lift technique is the first step. Should get you about 50% improvement. Threads can be done at the same time or as second stage after 1 month of the Y lift. I like Mint and instalift threads used in combination, which should get you to 75% on optimal results. This should last 2-3 years or yearly maintenance for as long as you want.

First, it appears that you have volume loss in the mid face, above the areas you are concerned about. This may been partially genetic due to your underlying bone structure but it occurs with weight loss and in everyone as we age due to loss of collagen, elastin, fat pads and bone resorption. Adding appropriately placed dermal fillers at the malar/midface area would help to give some lift and minimize the NLF's. Some filler in those folds as well as the oral commissures would also be helpful but the combination with PDO threads would give a better result since you would not want to make the lower face too heavy with a lot of filler. Lifting threads and smooth threads may be used in combination together with dermal fillers. Another option would be Sculptra which does work gradually over a few months to stimulate your own collagen but also needs to be done as a series for best results.Be sure to discuss all options with an experienced physician/injector/surgeon. A lower face lift surgery is an option for lifting and tightening but it does not add volume unless fat grafting is also done.

Hi! I agree that you would be a great candidate for a face lift based on your pictures. This would be the best and longest lasting result. With that being said, if you are only committing to non surgical techniques, I love using threads and filler in combination. I find that by first placing threads that lift, I can finesse the results with fillers (often with less fillers needed if used alone and with a more natural result). It is difficult to tell exactly how many threads or fillers you would need. We typically charge for a mid face thread lift or mid face and neck lift and use as many threads as we need to get the best results we possibly can. The results are great with non surgical techniques, but again the gold standard is a facelift. All my best!