What is the best filler for beginning marionette lines? I have had three...


What is the best filler for beginning marionette lines? I have had three treatments of Sculptra but still do not have the results I desire.


Sculptra is one of the longest lasting fillers available, lasting up to two years.  However depending on the amount of correction, multiple injections are usually necessary, 2 to 3 is common and some require up to 6 treatments, 4 to 6 weeks apart.  Sculptra increases collagen production but the building process occurs slowly. For a more immediate result, Radiesse is a great filler and usually lasts about a year.


Soft tissue fillers are not a substitute for surgical correction of facial aging.

For Sculptra to start working, it requires multiple sessions and time.

If you are a candidate for fillers then start with Hyaluronic Acid and then graduate in specific areas to Radiesse and Fat transfer.

If you are a candidate for surgery, fillers will not work well.


The Marionette begins to show at the corner of the mouth, and extends down towards the jaw line.  The lower aspect begins to show as the jowl develops behind it.  Fillers work well for the upper Marionette line, but using any type of filler to address the lower Marionette line is an attempt to camouflage the jowl by blunting the transition from the chin to the jowl.  The down side of this is that it will give the jaw a wider appearance.  For a patient who really wants to avoid surgery, this might be an acceptable tradeoff.  The best way to address the jowl and lower Marionette line is a face lift procedure.  I'd recommend you consult with a Board Certified Plastic Surgeon who both uses fillers and performs face lift procedures.  Discuss your goals, and they should be able to tell you if your goals are achievable with fillers, or if you are really requesting the results of a face lift.


For beginning marionette lines, I feel that the use of Juvederm is a good place to start.  For deeper folds or lines, I would consider using Radiesse.


I prefer Juvederm for the temporary correction of marionette lines or fat grafting for a more permanent result.  Botox can also be used to provide a slight lift to the corners of the mouth. This can enhance the results of a filler but not a substitute in most cases.  Depending on the severity of the marionette lines, a surgical procedure to lift the lower face might be the ideal option.

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