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Treatment options for marionette folds?

Dr. Dean Kane Q & A. shutterstock_18586922 Q. I am 44 years old. I had a facelift 3 years ago to correct my marionette folds. Unfortunately they were not improved after that procedure. I have had filler on several occasions but these do not really improve these folds either. These are not lines – they are actual folds, I’m guessing from volume loss/laxity higher up. I have no other lines to speak of elsewhere on my face so these stand out like a sore thumb. Would a lower facelift specifically help or a vertical facelift ? A. ​The peri-oral lines and folds are the last area of the face where surgery has difficulty correcting. ​Whereas tissue laxity creases horizontally under the breasts and tummy, the “waves” of skin laxity fold at areas of resistance in a slanted or oblique orientation on the face. ​Examples of these are:
  • brow hooding
  • naso-jugal or tear trough folds
  • naso-labial folds
  • marionette folds
  • neck folds.
​A face lift suspends the underlying tissues and redrapes the skin in a upward and outward direction. It is the understanding, experience, skill and talents of your surgeon to be able to lift the jowl in such a direction to assist in re-suspending the descent of the corner of the mouth and cheek tissues to reduce the fold created along the chin / cheek junction or the marionette fold. ​ ​Thereafter, fillers to fill the underlying volume loss. Sculptra to stimulate soft tissue fill and skin firming and retinoids to further rejuvenate the skin are my favorites in this region. ​ ​Please consult with a Board Certified Plastic Surgeon or ENT facial surgeon who are well experienced with these techniques. ​ ​I hope I was helpful. All the best!
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