What is Your Opinion on Marionette Fold Excision?

I have recently had a partial facelift that unfortunately did not correct my marionette folds. I have had filler in the past which also did not adequately reduce/correct these. I am considering having these folds excised. I realize that there is much controversy surrounding this procedure due to the issue of scarring. In my mind I would trade a small likely imperceptible scar for obvious and glaring marionette folds. I would appreciate any input. Thanks so much.

Doctor Answers 24

Marionette Lines or Nasolabial Fold Excision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

   Marionette Lines or Nasolabial Fold Excision can usually be avoided by facial fat grafting and proper facelifting techniques.  Kenneth Hughes, MD Los Angeles, CA

Excision of Marionette lines - not a good idea

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I can think of no worse idea than an excision of marionette lines.  These are caused either by loss of facial volume or skin laxity.  These must be corrected first. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Marionette line treatment

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

if you are looking for a permanent solution to this your best bet wold be a permanent filler such as on the link below.  Surgical excision would result in a scar in a place that may not be so easy to hide.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Marionette Fold Excision scar is too obvious, try fillers, fat and Botox to DAO

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I do not excise the Marionette line of fold. The scar is just too obvious no matter how carefully if is done.

A lower Facelift with Platysmaplasty (neck lift) done properly should help the Marionette Lines. Improvement in Jowls, Jaw Line and Marionette lines is an integral part of a Facelift.

If Marionette Lines reappear after a Facelift there are several ancillary techniques which can help.

Fillers like Juvederm, Restylane, Pearlane and Sculptra can be used to plump the depression.

In addition, Botox or Dysport can be injected into the DAO, the Detrussor Anguli Oris muscle to lessen the downward pull on the corners of the mouth which will lessen the Marionette Line.

Marionette Fold Excision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Well, the issue is how imperceptible the scar will be, something that we cannot predict. We always hope for that, but if you end up not getting a fine thin line, it will be very hard to hide it on a permanent basis.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Marionnette Lines and the Partial Facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The socalled Marionette lines are an integral result of facial aging. Their presense usually indicates that aging has progressed to the point that surgical intervention is necessary. I'm not quite sure what a "partial" facelift is but it must provide a  "partial" result. All facelifts regardless of variety make an attempt to improve both nasolabial and Marionnette lines. Fillers give additional improvement. Resorting to direct excision of these lines is to admit utter defeat in using the standard techniques and in addition to the obvious need for an unhappy scar, there is no guarantee that the fold will be totally gone. There may be indications to use this technique such as in the case of a unilateral facial paralysis,  most accomplished Plastic Surgeons do not believe in leaving scars in such awkward places for cosmetic improvement.

Paul S. Howard, MD, FACS
Hoover Plastic Surgeon

Scarring Risk in Marionette Lines

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Very simple-  in my experience, I would not excise the marionette lines, either directly or with a lateral corner lift lip, due to the risk of scarring.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 145 reviews

Marionette fold excision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Direct excision of marionette fold is probably not the best idea since it will result in a prominent visible scar.  A total and comprehensive face/neck lift should lift the marionette folds quite well.  Any residual marionette lines can be augmented with injectable fillers. In 20 years of private practice, we have never excised marionette folds.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Excision of the marionettes lines or nasolabial folds is a good option for very deep lines. The incision line is usually preferable to the deep fold. This procedure is reserved for patients who are unhappy with results from other procedures.

Facelift - Marionette Fold Excision?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Right - and that's the problem.  A "small likely imperceptible scar" would almost always be a good trade for a "problem" area but it is a huge risk to take in the even that a more significant scar would be problematic.  Which I suspect it would be on that part of your face.

Procedures such as these (excision of facial folds) are more likely to be appropriate for people who are on stage or who are visible mostly from a distance and can wear make-up to cover.  The less likely those are to apply, the less likely I would be to recommend the procedure.

I hope that this helps and good luck,

Dr. E

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.