Q/A: Fillers or facelift for marionette lines, sagging around mouth, looking sad?

Question: Due to 30lb weight loss I have sagging in the marionette line area. Its not too bad but it bothers me that I look sad. I talked to a plastic surgeon about a lower lift. He said this would also help my jaw line. What would this entail. Is the recuperation difficult. I am 48. Would juvederm help to hold off the surgery for awhile? Can it help the neck? I have already had my eyes done and rhinoplasty so surgery isn't new to me.

Dr. Marotta's response: Both fillers like Juvederm and a facelift can help marionette lines and sagging or looking sad around the corners of the mouth. You would probably get the most improvement in marionette lines doing both because they work by different but complementary mechanisms. A facelift will tighten drooping skin, fat and muscle and fillers can help finish the job by filling in areas of skin with depleted collagen. Fillers will not help the neck at all and only a facelift helps to tighten neck skin. The recuperation from a facelift varies by technique and surgeon. Bruising and swelling usually lasts for a 10-14 day period with most patients returning to work in 10 days.

Q/A: Will I have more wrinkles when fillers like Restylane, Juvederm or Radiesse dissolve?

Long Island Cosmetic Surgeon, Dr. Marotta's response: This is a common question that patients have following filler treatments. The general feeling by most physician's is that fillers don't make the skin or wrinkles worse after they've dissolved. In fact there is some scientific evidence that suggests that the slight skin stretch with fillers may cause collagen production by fibroblasts (collagen producing cells) and make skin/wrinkles better long term. This has yet to be proven. But even barring this effect the skin has a tremendous capacity to expand and contract and any permanent irreversible stretching from fillers is highly unlikely. In my own practice, I think patients are the same if not better after the filler dissolves.

Q/A: Sagging around corners of mouth and jawline, fine lines around the mouth

Question: What should I do about sagging around mouth and jaw?I'm noticing sagging around mouth and jaw, small fine lines around my mouth, and a slight sagging around mouth and jaw.

Dr. Marotta's Response: Sagging around the mouth and jaw occurs as a result of weaking of the facial ligaments and drooping of the cheeks and facial tissues that begins early in the aging process. Smile lines or nasolabial folds that run from the corner of the nose to the corner of the mouth and labiomandibular folds or marionette lines that run from the corner of the mouth toward the mandible can be the result. This can be seen in even as early as the late 20s or early 30s. Fine lines around the mouth, smoker's lines, lipstick lines or now "waterbottle" lines occur as a result of repetitive pursing and loss of collagen and elastin. There are both surgical and non-surgical options for these problems. For the sagging around the mouth and jaw an endoscopic midface (cheek) lift with buccal fat repositioning can help elevate the sagging tissues of the cheek that are pushing on the corner of the mouth and jaw creating the folds. Microfat transfer into the folds helps lessen them even more. For fine lines around the mouth fractional CO2 laser resurfacing, dermabrasion or chemical peel work quite well and offer more lasting improvements. Non-surgical options include fillers like juvederm, restylane, radiesse or perlane to mask the folds around the mouth and jawline and to augment or volumize the cheeks. Botox can be used to elevate the corners of the mouth by injecting the depressor anguli oris muscle. Fine lines around the mouth can be alleviated with Botox and fillers as well.