Any Treatment Suggestions for Deep Marionettes Lines and Jowls?

Dr. Dean Kane Q & A.

Best Alternative to a Facelift for Reducing Deep Marionette Lines and Jowling

CnSZBhKkdNx7Po0Dy-KLPb7XVpMs2h-wkM6mUlD4BiIQ. I have a heart shaped face which is slim. I’m 47 and do not want a facelift. What are my best options to smooth out deep marionette lines and jowling. Had Juverderm late last year and some Voluma added to cheeks to try and lift and plump my mid face a little. Right now my face looks miserable even when I’m not, because the corners of my lips drop downwards. I exercise a lot too. Which treatment would be most economical? Any advice would be greatly appreciated. Thank you!

A. Various options for facelifting, minimally and non-invasive facial enhancements and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need.

​Your question centers over the use of fillers yet your description sounds as though you have a significant amount of skin laxity. Fillers do a wonderful job up to a point but if you can “pinch more than an inch of skin along the jawline in front of the earlobe” I recommend you consider surgery to redrape the underlying soft tissue descent and skin lift with skin excess removal.

​Please consult with a Board Certified, well experienced Plastic Surgeon or ENT Facial Surgeon for your best evaluation and recommendations.

​A patient with significant skin laxity may note some improvement with facial fillers alone but the value is in lifting the tissues and removing the skin excess first and then filling in volume loss thereafter. Don’t forget skin tightening therapies like ZO Obagi Skin Health.

​Both surgical and minimally invasive / non-surgical options are listed below.

Surgical Option for Marionette Lines and Jowls

Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material.

Minimally Invasive Options for Marionette Lines and Jowls

Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift.


The most popular of the fillersRestylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting “cousin”Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial (“parentheses”) and marionette folds, the brow (“number 11”) lines and fill and lift the cheeks and lateral brow or chin. Voluma is the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!

Non-surgical facial contouring is possible with fillers such as Radiesse, a bone mineral for the nose or cheeks, jaw and chin as well.

Sculptra is the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent.

Botox and Dysport too have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles!

Non-invasive Options for Marionette Lines and Jowls

Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed.

Zo Skin Health Programs

Dr. Obagi’s new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.

Learn More:
Zo Skin Health Frequently Asked Questions Answered By Lauri Kane

IPL and Fractionated Lasers

IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.

In Conclusion

Face lift and / or neck lift or any of the other procedures and their combinations should be discussed following a proper examination by a Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he or she is limited in their skills.

​I hope this has helped! All the best!

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