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What Is the Best Treatment for Marionette Lines?

There are various treatments for marionette lines that depend on the severity of the lines. The term marionette lines is a euphemistic term, because marionettes, like puppets, have these folds that emanate from the corner of the mouth and extend downward where the ligaments attached to the bone most tightly. This creates a fold of tissue that we call the pre-jowl sulcus. 

The first thing that I look for when I see an individual, is what is causing their marionette lines. Is it loss of volume or is it sagging of the tissue? If there’s generalized sagging of tissue, I prescribe some form of lifting, either surgically or with threads. However, if the patient has loss of volume or a relatively isolated line, I like to use filler where we can volumize along the jawline to fill out the area where we’ve got the fold. By doing so we’re really lifting that ligamentous area up. I inject deeply to the bone and then place a little bit superficially to push up he corners of the mouth.

When the corners of the mouth are pulled down, many of my patients refer to that as their resting bitch face and there’s not doubt that a downturned mouth can make us look tired or angry, and can even make you look older. 

How long does filler for marionette lines last?

The length of time that filler lasts in marionette lines depends on how the lifespan of the particular filler used. I tend to get six months at a minimum and often eight or nine months with filler injection.

If you have questions about how to treat the marionette lines and if filler is going to be enough, come see me, call me, or email me. I love seeing patients and would be glad to see you in my office or to chat with you via email. 

About Dr. Jonathan Sykes

Dr. Jonathan Sykes is a world-famous expert plastic surgeon who performs all cosmetic and functional plastic surgery procedures on the face and neck. He is a past president of The American Academy of Facial Plastic and Reconstructive Surgery, and served on their Board of Directors for over 10 years. He is also a Professor Emeritus in Facial Plastic Surgery from UC Davis Medical Center, and the former Director of Facial Plastic Surgery at that institution.

He is known as the expert’s expert, and is often called to consult and advise other plastic surgeons in both Northern California and Beverly Hills. He has a special interest in eyelid and browlift surgery, facial rejuvenation surgery including facelifts, and rhinoplasty. He also has a particular interest in facial feminization surgery. Have questions? Email Dr.Sykes at: [email protected]