Stubborn marionette or “puppet” lines.

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Okay …..who thinks of these names like puppet or marionette anyway!  They are descriptive but not very flattering. These are the lines that run from the corners of the mouth down to the chin.

Many of our patients (but not all) who have these have these had very full, round cheeks when young. Different facial structures age differently clearly.  As this facial type ages, and the cheeks deflate some, the buccal fat pad looks/is larger.  Besides that, there is often a groove between the malar (under eye) fat pad and the buccal fat pad. It might be worth considering non surgical and more surgical possibilities.

Some thoughts:

  • Nonsurgical.  Consider lifting the upper cheek (top of the zygoma) and lift the mid cheek to restore a smooth contour with a high G prime (means stiffer – think framing) filler like Restylane Lyft.   At the same visit soften the nasolabial fold and marionette line with filler – often a different one. This depends on how deep the remaining fold is after lifting.
  • Nonsurgical.  Also consider tightening/lifting  the whole cheek area with deep radiofrequency like Profund or Infini
  • Nonsurgical.  If there is still a prominent buccal fat pad, some experts are using Kybella to shrink the fat pad.  This is an FDA off-label use and experts only please.
  • Surgical.  A facial liposuction expert may be able to help.  Look for an ENT plastic surgeon who does a lot of lipo and works mostly on the face.
  • Surgical.  A facelift may help, as long as the fat pads are addressed at the same time.

As you pointed out, none of us are completely symmetric.  Be sure to point out any asymmetries that you’ve noticed to your doctor also!

Hope this helps,

Dr. Brandith Irwin

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