Causes of Marionette Lines
To compound the problem, as the body ages, its supply of collagen gradually breaks down, which diminishes facial volume and elasticity. This loss of elasticity and volume makes facial wrinkles and folds appear more prominent.
Marionette lines usually appear around age 40, though some people begin to see signs of marionette wrinkles earlier. As frustrating as they may be, marionette lines are a completely normal part of aging.
Surgical facelift/cosmetic surgery
The “gold standard” to fix marionette folds is to have a surgical facelift. This is because surgically pulling the folds back from the mid-face area and above is the best way to fix them.
As Juvéderm® dermal fillers are largely composed of hyaluronic acid - a natural substance responsible for the creation of plump, hydrated skin - facial volume will be restored instantly and results will last for up to 12 months.
As for the cost, it depends how many areas are filled and how many threads are used. The cost is about $200-300 for a pair of laugh lines or marionette lines.
Marionette folds are hard to improve with just surgery alone. Many times patients who state they are overweight like you mentioned, don't want to add more volume to their face but many people, when they lose weight, start to show it in their face because they lose support that was holding the skin upwards...
Using a retinol or retinoid cream can help, too. "Retinol slowly thickens the deeper layers of the skin, while thinning out the superficial layers," says Levine. "This softens fine marionette lines, making the skin look more youthful."
Botox works by relaxing the muscles around the mouth, but it cannot soften the deep folds in the nasolabial area. In this case, a volume-adding injectable like dermal fillers is often the better choice because it can fill the deep wrinkles and smoothen the skin.
If your marionette lines are only just forming and are yet to really make their mark, microneedling is another great option. Also known as collagen induction therapy, microneedling works by creating tiny, controlled pinhole injuries in the skin.
Juvéderm for Marionette Lines? To treat the vertical lines between the mouth and chin to reduce the look of sagging, you're likely to need one syringe per side.
For moderate to severe marionette lines, dermal fillers can be injected into the corner of the jaw. This pulls away, or lateralizes, the fullness around the mouth resulting from fatty atrophy. As a result, the folds around the corners of the mouth are pulled away from the corner of the mouth.
The injections themselves are not painful. We provide numbing cream, numbing injections and skin cooling to minimise any discomfort. Most of our dermal fillers also have anaesthetic mixed in with the filler in order to provide further pain relief.
Depressor Anguli Oris. This is the muscle highlighted in the image. The muscle attaches to the corner of the mouth. Excessive muscle tone will pull the corners of the mouth down, resulting in a sad look and also accentuate the so-called Marionette lines.
Who typically gets marionette lines? Most people will get marionette lines as they age. However, some people may be more prone to developing these lines sooner or have more visible, deeper lines. For example, people who smoke and don't use sun protection may form marionette lines early or have more prominent wrinkles.
What Is the Best Filler for Marionette Lines? In our experience, the most effective filler for treating the marionette line is either Juvéderm Ultra Plus® or Radiesse®, depending on the depth and configuration of the marionette lines.
Fillers are a great option for patients seeking a softer, more youthful look. However, if used improperly or over used, fillers can have negative long term consequences. In fact, patients who do not properly use filler could actually speed up their skin's aging process, resulting in older looking skin.
Botox injections can reduce the movement of the muscles around the mouth which cause marionette lines as well as the muscle that excessively pulls your mouth corner downwards. How does Botox work? Botox temporarily blocks nerve impulses to the injected muscles, reducing activity that causes unwanted wrinkles.
How does the treatment work? Dermal fillers are applied to the marionette lines and the corners of the mouth. This hides the shadow between the 2 areas creating a flatter shape. This smoothens out the marionette lines and reduces the appearance of the jowls.
Marionette lines can be treated with hyaluronic acid. The treatment needs to be repeated approximately every 6-12 months. One of the most common methods of reducing marionette lines is the dermal filler, an injection under the skin. For this purpose, so-called fillers (usually hyaluronic acid) are used.