Marionette Lines And My Jowels Will a Facelift Help?

The Question

It is an unavoidable fact of life that our faces will change as we get older. Sun exposure, smoking, alcohol and drug use, weight gain and loss, good old-fashioned time and gravity all take their toll on the skin, even without any evident injuries or trauma. If we’re lucky to live long enough, it’s inevitable that our faces won’t be as young as they used to be, and it will show. Sometimes, however, it is possible to turn back the clock on skin damage around the face, as with the focus of this week’s Ask Dr. Pane segment. The patient asks, “Will a facelift fix my jowls and marionette lines?”

The Answer

Dr. Pane explains that everyone gets jowls as they age. Jowls are simply a function of the skin along the sides of the neck and the jawline losing their elasticity and sagging, caused by gravity, age and fluctuations in weight. This in turn causes the skin to sag downward. 

Marionette lines are a bit different. These straight lines descend from the corners of the mouth down to the sides of the chin, making the person look a bit like a ventriloquist’s puppet, from which the name is derived. In many cases, they can be treated effectively if caught early by practicing good skincare techniques, such as avoiding sun exposure, limiting alcohol consumption and not smoking, which Dr. Pane observes are practices everyone should be following anyway. 

With regard to jowling the he major question, Dr. Pane says, is not if surgery is indicated, but when. Ultimately, someone showing jowls in their early to mid 30s to late 40s will probably need to consider a facelift later in life. However, if caught early, they can be effectively treated with noninvasive energy therapies such as radio-frequency skin tightening. This can help rejuvenate and restore the skin, pushing back the need for cosmetic surgery by years or even decades in some cases depending on how advanced the condition is and the patient’s relative age and overall health. 

Marionette lines are a symptom of damage to the ligament controlling the corner of the lips. Some patients find fillers such as Botox or fat grafting can help bulk out and reduce the appearance of these areas, at least temporarily. However, while surgical methods to cut the ligament and reduce the lines do exist by recontouring the area around the ligament, they are not commonly done as part of a facelift procedure, although in some cases such procedures can be incorporated into a facelift. The exact methods which will deliver the best results vary from patient to patient and depend on a number of variables such as age, skin type, the reason for the lines and patients’ habits and practices.

A neck and facelift can help eliminate the appearance of jowls and present a more youthful, smoother contour to the face. However, facelifts are generally not considered a permanent cosmetic solution, especially in patients who are prone to jowls and loose skin in that area. For this reason, Dr. Pane is generally hesitant to offer facelifts to younger patients, proceeding from the premise that it is better to work from noninvasive up to surgical intervention rather than start with the “big guns,” so to speak.

Everyone is different, and what may be ideal for one person may be the worst option for someone else. For this reason, in-person clinical evaluation and hands-on analysis of the problem areas and the patient’s overall medical history can provide important clues as to the causes and possibly solutions. Patients should not get “married” to the idea of a single solution, especially a surgical one, without consulting with at least one qualified cosmetic surgeon, and Dr. Pane strongly advocates considering all available options before committing to one solution, especially if the solution is particularly invasive. 

If you have a question concerning cosmetic surgery, Dr. Pane and the staff of ACA are always pleased to take time to discuss and address your concerns and interests. Simply email us through our Contact page; follow us on Instagram, LinkedIn, Twitter and Facebook; or call us at (561) 422-4116. Your question might be selected as the focus of an upcoming Ask Dr. Pane segment, allowing us to help, educate and inform others while giving you the honest answers you need to make wise, informed choices about your cosmetic surgery care. Remember, at ACA we believe the only bad question is the one you don’t ask!