Marionette Lines/Jowls: Filler & BOTOX® For Oral Commissures
ALSO KNOWN AS:Oral Commissure Filler, Melomental Folds Filler, Laugh Lines Filler, Smile Lines Filler, Jowls, Jowling, Pre-Jowl, Filler for Jowls, Lower Face Rejuvenation, Lower Face BOTOX, Fillers for Lower Face Sagging
View Marionette Lines/Jowls Treatment in Our Gallery
Mabrie Facial Institute 166 Geary Street Floor 1300 San Francisco, CA 94108 Phone: (415) 445-9513 Text/SMS: (866) 618-9459 Monday–Friday 8 a.m.–5:30 p.m.
As we age, two common concerns that affect the lower face are marionette lines and jowling. Marionette lines are the vertical creases that develop from the corners of the mouth to the jawline, while jowling refers to the excess skin that sags below the jawline. These issues are often caused by factors such as volume loss, bone resorption, fat loss, and changes in skin elasticity.
One effective treatment option for addressing both marionette lines and jowling is the use of filler. At MFI in San Francisco, we strategically place filler to restore lost volume, improve the appearance of these lines, and minimize the sagging skin associated with jowling.
MFI TREATMENT PLANShadows and lines around the mouth, called marionette lines occur with age as we lose fat in our face. We used Juvederm Ultra to soften these signs of aging. THE OUTCOMEThe patient is shown right after her treatment. Read More
ABOUT OUR PATIENT This male patient, in his late 30s, wanted to smooth out those tricky marionette lines and tackling a bit of jowling that had been casting subtle shadows on his face. MFI TREATMENT PLAN A precisely tailored treatment involving the application of hyaluronic acid filler to the targeted areas.Read More
ABOUT OUR PATIENT This patient in her 40s wanted a non-surgical solution for those troublesome shadows around her mouth and jawline. These marionette lines and jowling were prematurely aging her appearance. MFI TREATMENT PLAN Dermal fillers to replenish lost volume! Hyaluronic filler was precisely in... Read More
ABOUT THIS PATIENT Meet our 49-year-old patient who was on a mission to get rid of those marionette lines and jowls. MFI TREATMENT PLAN We brought in hyaluronic filler to save the day. He couldn't be happier – his face is now smooth, defined, and full of symmetry!THE OUTCOME Those marionette lines a... Read More
ABOUT OUR PATIENT This gentleman in his late 50s flew to the Bay Area all the way from Texas for Dr. Mabrie’s lower face rejuvenation treatment. He was bothered by the pouches and creases around the corners of his mouth, and he had sagging skin and jowling due to aging as well as recent weight loss.MFI TREATMENT PLAN Dr... Read More
How To Get Rid of Marionette Lines and Jowling: Your Treatment Options at MFI
At MFI, we understand that it is imperative to evaluate each patient to determine whether marionette lines can be treated individually or if a more comprehensive filler approach is necessary to treat marionette lines and/or jowling. Occasionally BOTOX may be helpful in treating the marionette lines.
Complete Lower Face Rejuvenation Filler Package
Our Injectors understand that treating marionette lines with jowling is about more than filling in the creases. We create real, lasting improvements by layering filler over the course of 2 or more appointments with our signature marionette lines and jowling procedure.
Add Support and Structure to Chin and Jawline
To begin the process of smoothing marionette lines and jowling, our Injectors may first use a thicker filler to add structure and support to adjacent areas such as the chin and jawline. Volume replacement in these areas acts as the foundation for marionette line and jowl filler.
Smooth and Refine
After adding support and definition to the chin and jaw, we conservatively layer fillers, typically from the Restylane® product family, to the marionette lines and jowls to soften them and create an even, shadow-free surface that reflects light.
Before
After
For this woman's comprehensive marionette line and jowling treatment, we used RADIESSE to add structure and support to the chin and jawline, and JUVÉDERM Ultra to the marionette lines and jowls.
Before
After
This patient (who visits us from Texas!) received RADIESSE to add structure and projection to the chin, and Restylane to flatten his jowls and smooth the marionette lines.
Before
After
For this woman's comprehensive marionette line and jowling treatment, we used RADIESSE to add structure and support to the chin and jawline, and JUVÉDERM Ultra to the marionette lines and jowls.
Before
After
This patient (who visits us from Texas!) received RADIESSE to add structure and projection to the chin, and Restylane to flatten his jowls and smooth the marionette lines.
Single Area Marionette Lines Filler Treatment
Occasionally for very minimal marionette lines without jowling, we can address the lines starting with 1 to 2 syringes of filler.
Before
After
We used JUVÉDERM® Ultra® to soften this woman's limited marionette lines. The patient is shown before and immediately after treatment.
Treating Marionette Lines With Lower Face BOTOX
If an overactive anguli oris muscle is contributing to your marionette lines, BOTOX or another neuromodulator can be injected into the depressor muscles on the sides of the mouth to soften lines and elevate the corners of the mouth. This is a very precise application of neuromodulators and is best left to highly experienced injectors.
Before
After
As a part of this woman's Lower Face Rejuvenation, we used a neuromodulator to soften creases and uplift the corners of her mouth.
How Much Does Lower Face Rejuvenation Cost?
Our treatment package for marionette lines and jowling includes 4 syringes of filler. This package is recommended for the complete treatment of marionette lines, jowling, the chin, and the anterior jawline. We also offer limited area treatment priced by the syringe.
At MFI, BOTOX for marionette lines includes up to 20 units. Please visit our dedicated pricing page for the most current information on all procedures.
Once you’re happy with your lower face, you move into the maintenance phase of treatment. From this point on we only need to see you once every 9 to 12 months. During these appointments, we touch up the treated areas, typically only using 1 to 2 syringes.
Qualified borrowers may be eligible for 0% financing for 6 to 12 months through CareCredit and Alphaeon medical financing.
The MFI Advantage
MFI focuses exclusively on injectables, and has set the bar in the art and science of fillers for more than 15 years. Dr. Mabrie, trained as a facial plastic surgeon, has dedicated thousands of hours to carefully selecting and training our talented Injectors in the most innovative, effective, and safe techniques for injectables. There is no other practice in the Bay Area with the level of experience, education, and passion for injectables you'll find at MFI.
Marionette lines and jowling develop with time due to repeated facial expressions, age-related skin changes, and excessive muscle activity. Volume loss in front of these lines creates a sunken appearance and shadows. This volume loss also results in a lack of support to the cheek skin above it, allowing for the cheek fat to descend. In turn, this causes the corners of the mouth to turn downward and creates the marionette lines and jowling. Additionally, the corners of the mouth may be pulled down by hyperactive depressor muscles.
For answers to all your marionette lines questions, read our photo-illustrated blog post.
Repeated Facial Expressions
Every time you frown, smile, or purse your lips, the skin from the corners of your mouth to your chin folds in the same places. Over time, those folds become deepened creases that don’t go away on their own. No topical product can reverse the effect of a lifetime’s worth of facial expressions.
Thinning Skin and Volume Loss
Youthful skin is thicker and more elastic due to plentiful collagen and fat. As we age, we lose collagen, fat, and even bone, resulting in volume loss and skin laxity. When we’re younger, we can make all the facial expressions with none of the expression lines (dynamic wrinkles) due to that skin elasticity. Our older skin lacks the resilience to “bounce back,” and wrinkles like marionette lines and jowling no longer disappear with the expression.
Overactive Muscles
Sometimes an overactive muscle—the depressor anguli oris—pulls down on the corners of the mouth even when your face is at rest. This can exacerbate marionette lines and jowling and create a frowning appearance.
Marionette Lines/Jowling
Consultation and Planning for Your Marionette Lines/Jowling Treatment
Your successful marionette line and jowling treatment experience starts with a thorough consultation with one of our Injectors at our chic, friendly San Francisco office. First, we have an in-depth conversation to get clear on your aesthetic goals and expectations. Next, we take professional-level photographs of your lower face from all angles. We utilize these photos at every visit to identify your concerns and monitor your progress. Using both the photos and the in-person examination, we map out a customized treatment plan tailored to your anatomy and goals.
Your personalized treatment plan may include any or all of the following:
Restoring appropriate chin volume and shape with fillers.
Applying filler to the anterior jawline.
Adding filler to the areas around the marionette lines.
Using neuromodulators to relax a hyperactive mentalis muscle, increasing chin projection and reducing the orange peel appearance.
Treating depressor muscles with BOTOX to improve the positioning and appearance of the corners of the mouth.
Please plan to spend about 3 hours in the office for your first visit, which includes consultation, prep, treatment, pre- and post-treatment photography, aftercare education, and scheduling your next appointment.
Your Marionette Lines/Jowling Results May Look Better After Two ( or More) Treatments
Our preferred approach to marionette line and jowling filler requires a minimum of 2 appointments. This staged approach allows us to create structure, support, and superior, natural-looking results. Too much filler all at once can create obvious results, and it’s better to build and layer until we get it just right.
We wait 1 to 3 months between treatments to allow for swelling to subside before placing the next layer of filler only where it is needed. We evaluate the results of your initial treatment, then build upon that initial foundation. We can now directly place filler in the smaller areas knowing that we have the support in place to keep it there.
For the best experience, follow these tips in advance of your appointment:
A few days before your appointment, restrict blood thinners, such as anti-inflammatories, fish oil, and alcohol. Limiting these will reduce your risk of bruising from marionette line and jowling injections.
DO NOT discontinue prescribed, medically necessary medications.
Eat and drink a normal breakfast or lunch prior to your appointment; low blood sugar can make patients lightheaded during treatment.
Recovery & Aftercare
Immediately after your marionette lines treatment, you may experience swelling, bruising, and tenderness. These are normal side effects and are most apparent 24 to 48 hours after treatment. They can last up to 2 weeks but typically subside within 2 to 5 days. Most patients return to their routine activities the same day.
Swelling
This area may swell more than others, but it peaks within a few days of treatment
This may cause temporary asymmetry, lumps, or bumps
Will gradually resolve to reveal your final results over 4 to 6 weeks
Bruising
Bruising is normal for this area, but this should dissipate within a week.
Redness & Discomfort
Often minimal and lasting just a few days
Your chin may be tender to the touch
Downtime
No downtime required
May return to work immediately after treatment
May resume normal exercise the next day
Because we know you have questions about your recovery process, we created an entire page dedicated to BOTOX and dermal filler aftercare.
Recovery After Marionette Lines/Jowl Treatment
1 Day After Treatment
2 Days After Treatment
3 Days After Treatment
Aftercare Pro Tips
Marionette Lines/Jowling Treatment FAQs
Can marionette lines/jowling be corrected naturally?
Most people think “naturally” means without surgery or a treatment you can perform at home. Some of these “natural” solutions include:
Stick-on patches
Massage
Facial exercises
Expensive serums and creams
Since serums, patches, massage, etc., can’t restore skin quality or lost volume, they can’t provide lasting improvement to marionette lines and jowling.
How long do fillers for lower face sagging last?
Depending on which fillers are used and which areas are treated, your results can last from 6 to 18 months or longer. Dermal fillers are temporary products that require touch-ups to maintain results. We recommend maintenance appointments at 9- to 12-month intervals to keep your results looking fresh. For more in-depth information about the longevity of fillers, visit our page on How to Make Your Results Last.
What’s wrong with just filling my marionette lines with a single injection?
For a few individuals with minimal marionette lines, a single syringe may be enough. But for most people, the marionette lines and jowling go together and need more comprehensive lower face rejuvenation. In these cases, treating a single area in isolation is typically ineffective and can even make the problem look worse. It’s important to understand that the issue you see—marionette lines and jowling—is merely a symptom of volume loss in several supporting areas. Unless you shore up the underlying foundation, adding filler to isolated areas can actually cause unattractive drooping or puddling.
What is the best filler for jowls and marionette lines?
We use several types of injectable fillers for lower face sagging, including hyaluronic acid fillers like JUVÉDERM; Sculptra®, which is a collagen stimulator; and RADIESSE®, which is a calcium hydroxylapatite (CaHA) filler.
The MFI Advantage
MFI focuses exclusively on injectables, and has set the bar in the art and science of fillers for more than 15 years. Dr. Mabrie, trained as a facial plastic surgeon, has dedicated thousands of hours to carefully selecting and training our talented Injectors in the most innovative, effective, and safe techniques for injectables. There is no other practice in the Bay Area with the level of experience, education, and passion for injectables you'll find at MFI.
If you are interested in learning more about getting rid of marionette lines with filler, request a consultation online. Or you can call us at
(415) 445-9513 to schedule your appointment with one of our highly trained specialists. If you’ll be visiting us from outside the area, our Fly in for Your Procedure page was created just for you to help make planning your trip as smooth as possible.
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