My approach for marionette lines differs according to the ageing stage involved.
My preference is to use fillers first: Dermal fillers are gel-like substances that restore lost volume in the face, stimulate collagen production, and attract moisture to the treatment area. This fills in the wrinkles and folds while improving skin texture and flexibility. They work by stiffening the upper part of the lip and adding bulk to the bottom corner to turn it upside down.
They are temporary but usually last around 6-9 months in that area, sometimes longer.
When a patient is young and their chin is fresh, I inject the filler using the MD codes Lp6 to inject deeply on the corner of the mouth to turn it from a downwards position to up.
It can be consolidated, if necessary, with an injection of Botox on the DAO (depressor anguli oris muscle). This is because when this muscle is strong, it has the tendency to bring the mouth down.
The risk of this method is that it can affect the smile in some people. This is temporary and would require re-injection about every 3 months.
When the patient is a little older and starts to show signs of skin laxity and loss in definition of the lower Jaw, working on the cheeks first will uplift both the corner of the mouth as well as contribute to eliminate the sagging cheek.
This will bring a more natural result than just injecting in the corner of the mouth.
For much older patients with real sagging cheeks, threads combined with fillers is the best option. We need to be cautious not to overfill the cheeks with fillers. We want to achieve elegance. If we inflate the cheeks too much, the face will look too heavy!
There is not one way to consider solving marionette lines, it is the reason why a careful analysis of the face is necessary prior to inject to make sure the treatment plan decided is appropriate, to maintain a perfect balance for the entire face.
If you are wondering what would be the best option for you, what are you waiting for? Please call the practice. My assistants will be more than happy to help you book an appointment with me!
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