Will Botox Help Marionette Lines?

Botox treatment in NYC is one of the most popular face and neck rejuvenation procedures in the world. Botox has aesthetic uses that extend beyond the areas it is FDA approved for, and one of the areas it is sometimes injected is in the lower face with hopes of improving the marionette lines.

The marionette lines are down-turned corners of the mouth. Deep lines in this area can project a glum, joyless, or grump appearance. Marionette lines deepen mostly due to loss of volume in the muscles and bones in the face. As the volume in the soft tissue and bone of the face decreases, the skin is less supported and sags and fold on itself causing deep lines.

Botox is not the best treatment for marionette lines because it doesn't address the main cause of the lines. Botox is effective for dynamic wrinkles, wrinkles caused by muscle activity. Marionette lines are caused by a loss of volume in the area, not muscle activity. Better options include procedures such as dermal fillers and Emface, that can restore volume and muscle tone.

As we stated Botox is not the best option for treatment of marionette lines because it does not address the route cause of marionette lines, which is the loss of volume that occurs in the face with age. However, Botox can still provide some improvement in the appearance of marionette lines, when injected carefully by an experienced injector. Botox works in this area when it is precisely injected into a muscle called the depressor anguli oris (DAO) muscle. This muscle is activated when you frown and when you draw the corners of the mouth down. It is also involved in chewing food. When the muscle is injected with Botox it is weakened, allowing the corners of the mouth to elevate more, softening the marionette lines.

Limitations of Botox For Marionette Lines

When Botox is injected into the DAO muscle to improve marionette lines, the results are by necessity, very subtle. If too much Botox is injected in this area, it will effect facial expressions, speaking, and chewing. Because of the very small amount of Botox that is injected the results also tend to have less duration than when Botox is injected in the upper face.

Even when Botox is injected at proper doses in this area, it still always causes some minimal impairment of the mouth. Facial expressions can never look 100% natural with Botox in this area. That is why we prefer other techniques for improving this area. But for patients that still prefer Botox treatment in this area, our expertise and experience will give you the best results possible.

Dynamic vs. Static Wrinkles

Dynamic wrinkles are formed due to muscle movement. Dynamic wrinkles are most commonly seen as the frown lines between the eyebrows (glabellar lines), forehead wrinkles, and crow's feet (periorbital wrinkles) by the sides of the eyes. Dynamic wrinkles are best treated with Botox.

Static wrinkles are lines that are visible at rest. They are either fine lines that results from collagen and elastin loss in the skin or deep folds that result from sagging skin due to loss of facial volume. Marionette lines are examples of deep folds that result from loss of facial volume, and are therefore best treated with improvement in facial structure or highly effective skin tightening.

Emface

Emface is a highly effective treatment for face rejuvenation that uses high intensity focused electrical stimulation (HIFES) to improve muscle tone and lift facial structures, and radiofrequency (RF) energy to build collagen and elastin.

Dermal Fillers

Fillers can be used to add volume where needed to lift and smooth deep folds as well. When fillers are placed in precise locations and deep over the bone the results look completely natural. Dr. Arash Akhavan is an expert in facial fillers that has been selected by the companies that make fillers to be an educator for other physicians.

Skin Tightening

Although the route cause of marionette lines is loss of volume and not loose skin, if the skin is tightened enough improvements in the marionette lines can be seen. This can be achieved with facelift procedures or Ultherapy, the only non-invasive device FDA cleared for lifting and tightening of the face, neck, and décolleté.

Botox For Marionette Lines- Not The Best Choice

Although we can improve the appearance of marionette lines with Botox there are procedures we prefer as they yield more effective and natural results. But if a patient wants to treat the area with Botox due to cost concerns, we are confident that we are the best place to offer this service.

Arash Akhavan, MD, FAAD

Arash Akhavan, MD is founder and owner of The Dermatology and Laser Group, one of the top centers for cosmetic procedures in New York City for over a decade. Arash Akhavan, MD, FAAD is a Board Certified Dermatologist and an Associate Professor at The Mount Sinai School of Medicine. Dr. Akhavan is a Castle Connolly Top Doc, New York Magazine Best Doctor, and Super Doctor featured in The New York Times. Dr. Akhavan is a key opinion leader that has been featured on hundreds of media publications including The New York Times, Allure, Marie Claire, Women’s Health, Cosmopolitan, ABC News, Fox News, Fox 5, NY1, WPIX, and more. He has been featured on nationally syndicated television programs such as The Doctors.

Dr. Akhavan serves as an educator and lecturer for multiple aesthetic device and injectable companies. This allows his office access to newer technologies at an earlier date than other offices, as well as a higher level of expertise in the use of these devices. This, in turn, translates to more effective and safer treatments for our patients.

By Arash Akhavan, MD, FAAD | May 4th, 2023 | Categories: Botox, Face and Neck

Will Botox Help Marionette Lines?

Medically Reviewed by Arash Akhavan, MD, FAAD

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Botox for Marionette Lines

Limitations of Botox For Marionette Lines