I have deep marionette grooves on both sides of my mouth. What procedure, would give me the best and longest lasting result for this problem. Thank-you
Marionette lines are also referred to as labial-mandibular grooves. These lines are created by facial soft tissue descent and underlying mandibular bone atrophy – both are age related changes. Fat grafting to this region is effective. Dermal fillers such as Radiesse and Sculptra are also long-lasting and effective.
For the deep marionette lines on the sides of the mouth there are several options. The longest lasting type of “fix” is to have a lower face/jawline lift which will reposition those tissues so that the lines are significantly softened. If you are not interested in surgery there are a variety of “fillers”, which are variations of hyaluronic acid, that can be used to fill in the area and diminish the visibility and prominence of the grooves. Juvederm and Restylane are the two most known of that group but there are multiple others as well including products that are made of substances other than hyaluronic acid. You should know that Juvederm® and Restylane® tend to last about 6 months.
J. Wethe, M. D.
The 2 most important issues contributing to marionette lines are:
1. Volume loss in the area
2. Sagging (loosening) of the cheeks, resulting in tissue draping from above.
Chances are both issues need to be addressed.
The easiest first step would be filler. Injecting a filler in the area will improve the indentation present. You will see an improvement but also see the limits of that procedure. Ultimately, tightening the skin envelope (facelift, etc) will be beneficial to improve the amount of draping (folding).
The important thing to remember is that both volume and lifting are necessary to maximally improve the area. You will still benefit from volume enhancement even after surgery.
–Goesel Anson, MD
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