How can I get rid of my marionette lines?

I am in my mid-40s and still look fairly young but two decades of smoking have left me with exaggerated marionette lines. It seems to run in the women in my family. I am embarrassed by them as they seem to deepen. I have not yet stopped smoking but I will if nothing else is available to get rid of them outside of the exercises that were suggested to me by some friends. Could Botox be useful in my situation?


F, 47, Florida

Marionette lines are distressing. Believe me, I know.

Yes, botox could help your skin if you’re bothered by wrinkles that developed from smoking or sun exposure. Botox relaxes the muscles beneath your skin. Your skin looks smoother as a result. Although facial exercises may work for some, you’ll need to be patient and persistent to see results. Facial exercise won’t change the skin itself but may help to tone the underlying muscles and approve your appearance. 

Fillers are a fast and minimally-invasive solution to marionette lines if your skin has enough elasticity. Facial fillers work by adding volume beneath the skin. It’s a bit like plumping up a pillow before you pull a lovely silk cover over it. Juvaderm Ultra Plus is sometimes used to plump out marionette lines and folds. Voluma, another facial filler, might be effective and last longer. Facial fillers won’t permanently fix marionette lines, so you’ll need repeat fills to maintain results. 

Facial contouring solutions might work for you. If your skin has lost elasticity over time, Radiesse (for nose and cheeks) or Sculptra can help to recapture youthful facial contours.

Although facial fillers can add value in lifting your skin even if it’s lax, you might also want to check out skin-tightening therapies before using facial fillers. Laser and/or light therapies, skin-tightening products or technologies can make a big difference in smoothing your skin. These options can make you look refreshed and glowing as well!

Getting a facelift from a board-certified plastic surgeon is another option, but it's an invasive one. Don't automatically assume it's the most expensive choice. Facial fillers aren't inexpensive and, depending on how quickly your body metabolizes them, it's possible to spend thousands a year on them.

Hope these ideas work for you. I’ve tried all of them and believe it’s worth it to feel and look younger.

Botox isn't effective with marionette lines, but you may consider filling them in with Restylane, Juvederm or Radiesse. These fillers are more effective because they fill in deep vertical lines, creating a more youthful appearance. You can generally expect the results to last at least six months, and a skilled professional can make it look quite natural. It's also common for these lines to become less noticeable if you gain a little weight. The added facial fat fills in the lines much the same as injected fillers. If you do decide to stop smoking, it may help you pick up a few pounds for natural results.

If you want permanent results, you might consider a facelift. Make sure that you work with a board-certified professional with experience performing facelifts. This is more invasive and comes with a higher risk of complication and a longer recovery time, but you won't have to worry about going back for repeat fillers every year.