Young Patient with Deep Marionette Lines with No Other Wrinkles

I am 45 years old with pronounced marionette lines but with virtually no other wrinkles. I am substantially over-weight and have a thick neck and starting to develop a double chin. Had fillers by very reputable dermatologist with very little results. What is the best type of treatment for me? Will losing weight make these lines better or worse (my mother has the same ones). THX

Doctor Answers 13

Treatment of Marionette lines.

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Marionette lines are a skin creases caused by a fixed line of internal ligamentous attachment to the skin from a deep muscle running down from the corner of the mouth. Bulging of the inner cheek tissues below the corner of the mouth onto this line of resistance exaggerates the depth of the crease. Laxity is the usual cause and is exaggerated by the increased volume of subcutaneous fat from being overweight. In addition the internal, buccal fat pad descends.
Laxity is an early sign of aging, not wrinkles, which appear a few decades later, especially when someone is overweight.
The only proven effective treatment for the laxity you are referring to is to tighten the support layer under the skin called the SMAS layer.
A proper facelift is highly effective here and the result is lasting.
However, after a facelift you must not lose weight as this causes recurrence of the laxity, so you should lose nearly all the weight first. Of course, this then show the real laxity camouflaged by the weight, but the good thing is that this laxity can be taken up with the facelift. The result can be reasonably predicted by pulling your lower cheek almost directly back and up a bit.
The crease itself will diminish as you can see, but once a crease is established it does not disappear completely. However, having the correct shape in this area, with a flatness or slight concavity instead of a bulge is much more positively beneficial, than a mild skin crease.
Skin tightening treatments are so minimal to be a waste of time and money and plumping up the crease, even if it did work, is also minimal.
I stress that I am talking about having a proper, internal support facelift to achieve the result you should have.

Deep Marionette Lines and Face Lift

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Thank you for your question. Losing weight tends to make facial lines worse. If you have had several injections, then you have likely seen how much benefit there is to be had from them. I think that you should focus instead on a good dietary plan which focuses on healthy foods, lower the intake of unhealthy foods, and keep your caloric intake at the about 1500 calories per day with a focus on fresh fruits, vegetables, and whole grains, and good protein sources. Losing weight may not heap good dietary goals and changes, and make loosing weight a priority, then deal with your face when you have met your weight goals. I hope this helps.

Ultherapy for Marionette Lines

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At 45 years of age, your skin is still resilient and capable of non-surgical repair. For that reason, you should consider Ultherapy as opposed to surgery. But first, for best results, it would be wise to lose weight and restore more definition to your face. Then Ultherapy  will work more effectively to lift and tighten. This therapy produces excellent results when treating brow, jaw line, chin and/or neck. Since you only have a problem with marionette lines, this is an area that can be specifically targeted. Furthermore, Ultherapy is especially effective on patients under 50, who still have the capacity to boost collagen production. After treatment, you’ll find the smoothing of the marionette lines will improve for months.

Hal Michael Bass, MD
Miami Plastic Surgeon

Young patient with Marionette Lines

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  I think it is difficult for anyone to answer this question without seeing photos of you.  Certainly, I agree that in your particular case, weight loss should be considered as your first "procedure" before resorting to a lift.  that said, I do not think you are too young to consider a mini lift procedure which will address your individual concerns.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 138 reviews

Will a Facelift help my Marionette lines and Double Chin from being Overwieght

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Thank you for sharing your questions. The biggest focus should be on weight loss. This will help improve the heaviness of the cheeks/jowls and the under chin (submental) fat. All these will see significant improvement, but you may have persistent skin excess. It all depends on the elasticity of your skin. The marionette lines may get better, but there are several factors that will determine this including the strength/prominence of your jaw (mandible) and the structure/contour in the pre jowl sulcus. This is part of your anatomy, and weight loss will not have an effect.  

In the end, both invasive and non-invasive modalities have better and more reliable results after weight loss. Weight loss is a challenge for anyone, so I wish you good luck in your reaching your goals. Involving a weight loss specialist can be a good idea. Take care. 

Robert Brobst, MD
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Each indidvidual's anatomy is unique

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Each indidvidual's anatomy is unique. Deep marionette lines can be a natural part of your anatomy. The two ways I usually address this issue is to consider either fillers for the marionette area, or possibly treatment to the cheek area to help "lift" the marionette lines. Addressing the cheek area can be done with fillers, non-surgical treatments like ultherapy or radio-frequency devices like Exilis, or even surgery. Losing weight can change the marionette lines, but whether they improve or worsen depends again on your overall anatomy.

James Chan, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 58 reviews

Young Patient with Deep Marionette Lines with No Other Wrinkles

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Dear Lola,

Thank you for your question.  As you lose weight, you will de-flate the skin in the face and your skin will be loose and show lines and contour irregularities more.  However, a lighter face is easier to lift and you will have a better result with face lift procedures.  This is also the best thing for your health.  Work with a weight loss specialist to get to your ideal weight, and you will feel better, more active, and healthier.  This needs to be a lifestyle change and not just a diet.

Best Wishes,

Pablo Prichard, MD

Marionette lines

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Thank you for asking about the best treatment of your marionette lines.

  1. Losing weight is best - it will improve your health.
  2. As you lose weight the marionette lines will change - probably not be so deep but with looser skin. Plan on facial lifting when your are at your final weight. 
  3. In the meantime, ask the dermatologist who treated you what kind of filler and how much you had. Changing fillers or having more may give you improvement that helps you feel better while you work on your weight.

Marionette creases

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While losing weight could make the creases look deeper, it might also make them more amenable to filler due to now thinner subcutaneous tissue.  Losing weight is always the best way to start.  Get to your ideal weight.  Then, you should have a evaluation with regards to a facelift and neck lift.  A deep volumizing filler might help too.  This is a complex issue that may not have a simple solution. 

Young Patient with Deep Marionette Lines

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Losing weight can make the marionette lines worse because of loose skin in the lower face.  Depending on how much loose skin you have, you may need to have a mini lift and a Laser Lift with some fat transfer to the marionette lines.  There are videos and before/after pictures on our website.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.