Young Patient with Deep Marionette Lines with No Other Wrinkles

  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.

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

Surgery is not for everyone. In today's day and age, there are many surgical and nonsurgical options to address various concerns one has for their face as they age.
In general, surgery is one of the best ways to address marionette lines. However, skin tightening and all sorts of injectables can definitely help significantly especially for patients that are not interested in surgery. If you're ever interested in surgery, the procedure is much different than what you're probably reading about online. A short scar facelift that addresses the jowls & marionette lines can typically be done under local anesthesia in the office, usually in as little as 20 to 30 minutes. There are usually no drains, recovery is quick and most patients take no narcotics.
I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of facelifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and never be pushed out with just one suggestion. Ultimately there are pros and cons to every procedure whether it's surgery or not surgery. It should always be your choice. I have had 80 year old patients be very happy without having had any surgical procedures.
I hope this helps and wish you all the best in your surgery and event. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

I would definitely include some volumizing procedure (fillers or fat) to correct your midface and lower face deficiency. A midface lift would also be beneficial to correct the nasolabials and Marionettes; since the periorbital deformities can be assessed through the same approach.
In addition, for patients who do not want surgery, fillers in addition to skin tightening procedures (such as needle RF) give good results specially when it comes to younger patients.
Hope this helps,Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey

Based on the history you provided and your age, you could have some skin inelasticity associated with some volume loss.  I would start with volume addition in the form of filler and that should make a big difference.  Marionette folds are hard to improve with just surgery alone.  Many times patients who state they are overweight like you mentioned, don't want to add more volume to their face but many people, when they lose weight, start to show it in their face because they lose support that was holding the skin upwards...start with volume and find a plastic surgeon who specializes in faces.

Each patient's anatomy is unique, so there is no "one size fits all" answer for how to treat marionette lines. In the case of injectable treatments, it's possible that the incorrect product or technique was used, or that simply not enough product was used (which is something I see quite commonly for patients coming from other injectors). That being said, 45 is definitely not too young for a face or neck lifting procedure, but that would depend on the particular patient's anatomy and desired changes.
Be sure to see an expert who specializes in facial aesthetic surgery in order to review all of the surgical and non-surgical options in detail.
All the best,

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.

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.

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.

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.