My body metabolizes HA very fast and hasn't been effective in treating my marionette lines. Is there any other options?

Although not a closeup and not enough views, careful examination of the photo provided gives evidence of quite a bit of cheek and mid-cheek volume loss. This alone would be expected to give rise to the prominent marionette lines visible in the photo. Moreover, simply filling the marionette line directly with an ordinary filler, say plain Juvederm or Restylane, would not be expected to yield dramatic results, nor would the results be expected to last very long--as is apparently the case here. A much more reasonable approach that takes into consideration our current understanding of the volume loss-related aging process (elucidated within the past fifteen years) that gives rise to deep smile lines and pronounced marionette lines would be the use of volumizing fillers to raise and contour the cheeks and to shape the mid-face. In many cases, this alone would help to secondarily improve the marionette problems sufficiently often without the need to directly treat them, and the results would likely last considerably longer than direct injection into them. Your problem may not really be one of a fast metabolism for the injectable products, but more of an incorrect, novice treatment approach and an inappropriate choice of injectable to get the job done. With a volumzing filler, such as Voluma XC, which I would choose in my NY practice (or Stylage XXL and Princess Volume, which I would opt for in my Israel satellite facility, where a far greater number of regulatory agancy approved volumizing fillers are available), properly used to contour and shape your cheeks and mid-face regions, you would likely experience an immediate "Wow!" reaction following treatment without the need to resorting to expensive, aggressive, and invasive facelift surgery that also typically entails prolonged and signficant downtime. Make sure that you consult with a board certified aesthetic phyisican with experience and expertise in nonsurgical facial rejuvenation with volumizing fillers, and be sure to ask to see his/her personal before and after photos before agreeing to proceed. Best of luck. 

A combination approach will give the most improvement. I recommend fillers for the folds themselves but also lifting around the mouth and cheeks to build underlying anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments, J Plasma and peels to get the most conservative natural look. Please see a facial sculpting expert. Best, Dr. Emer

Thank you for your photo. Filler alone in the lower face adds bulk, this is not the best option for you. You would need multiple syringes of filler to lift the upper face before adding to the lower face. Even with this amount of filler you would not be fully corrected.  I’d consider a consult with a facial plastic surgeon to explore your options.  Best of luck! 

You could definitely consider another treatment option. Profound could be helpful for you. It uses radiofrequency to stimulate your own body's collagen, elastic, and hyaluronic acid. So instead of just masking the lines with filler, it works with your own body to improve skin laxity. You would likely still have some marrionnette lines, but they would be softened. Profound treatment is about a third of the cost as a facelift, and can do about a third of what a face lift can do. A great option for someone who doesn't want to undergo surgery. Best of luck!

Hi Timmason1,One of the reasons why your marionette lines and jowling seem more prominent is because the midface volume has not been addressed. Using Restylane Lyft or Voluma and Sculptra can restore volume instantly and over time. This will lift your cheeks and jowls making the marionette lines less pronounced. Sculptra will take some time to induce collagen growth but results can last upto two years.All the best,Justin Harper, M.D.