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A two-layered filler approach for difficult wrinkles

Posted: 6:00 a.m. Saturday, April 13, 2013

By Anita Mandal, M.D.
Question: I have deep grooves at my mouth corners that look like “puppet lines.” I have been to several plastic surgeons who have used different fillers, but I only get minimal improvement. Is there any hope without surgery?

Answer: Oftentimes, very deep lines or grooves at the mouth corners are not adequately treated using the traditional approach of injecting a single filler into the area. A double-layer filler method can give significant improvement.

The deeper the line, the more likely that it is due to multiple causes. “Puppet lines” usually result from a combination of the mouth corners sagging downward, wrinkles forming at the mouth corners, and formation of jowls that further deepen the marionette grooves.

In order to effectively address these lines, all aspects of aging in the mouth corner region should be treated. Typically, Restylane or Bellatero work well for the finer mouth corner lines. For the deeper mouth corner grooves, a deeper filler such as Perlane or Radiesse is most effective. Fillers should not only be placed within the lines and grooves, but also injected at the mouth corner to lift the corners.

If additional lifting is needed in the jowl area to further soften the grooves, Ultherapy™ can improve sagging of the lower facial tissues if one wishes to avoid surgery.

Double layering of fillers, in combination with Ultherapy™ to tighten and lift, can be an effective non-surgical approach for the treatment of “puppet lines,” which are often not fully corrected using traditional filler methods.


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