Managing the Marionette Lines – Fillers or Neurotoxins?
Even those among us who aren’t dummies can get confused about when one should use a neurotoxin, (Botox, Dysport and Xeomin) versus fillers, (Radiesse, Juvederm et al) in the nasolabial folds AKA marionette lines. It’s one of the signs of aging that make you look the oldest, even more so than wrinkles. Weirdly, weight gain in the face can help lessen the look of nasolabial folds, calling to mind French actress Catherine Deneuve’s famous quote that “after a certain age, a woman has to choose between her fanny and her face.” Weight distribution differs dramatically from person to person, of course, and if you’re looking to take care of those uninvited vertical meridians, injectables may be right for you. Should you opt for Botox? When would a filler like Restylane or Juvederm do the job? When does a combination of the two make sense? Here’s what you need to know:
In case you’re not well-versed in the realm of neurotoxins, Botox is a drug prepared from the bacterial toxin botulin, used medically to treat certain muscular conditions and cosmetically to remove wrinkles by temporarily paralyzing facial muscles. While Botox can help with some of the vertical upper and lower lip lines, it will not soften very deep folds in that area, according to Dr. Michael Law. It’s best relegated to the upper portion of the face and can even provide a bit of lift to the brows when used on the forehead. Bonus! He says using Botox for marionette lines is an individual placement issue that has more to do with how you hold your face at rest and during expression. A Botox-filler combo platter might be the ticket, specifically if a downward turn on the corners of the mouth is a concern. So while Botox may be a solution for “resting b*tch face,” it will probably not help with nasolabial folds.
As far as fillers go, Restylane is commonly used in the tear trough and cheeks, while Juvederm is typically used for the lower face and lips. Depending on the type of filler you get, the amount injected and where geographically on the face you’re treating, the results will last anywhere from 6 months to a year. Juvederm is a smooth consistency gel made of hyaluronic acid, which naturally occurs in your skin, which helps to add volume and hydration. Restylane is made of a biodegradable, non-animal stabilized hyaluronic acid (NASHA). If you want a longer-lasting solution, Juvederm Ultra Plus and Perlane are thicker and last approximately 6-9 months. Both Restylane and Juvederm are priced by the syringe, about $450-$650. Botox is about $22 per unit, but it may take up to 60 units depending on how much your doctor determines you need. Juvederm Ultra Plus and Perlane runs about $500 to $750 per syringe.
So the main takeaway is that fillers like Juvederm work well for lines that are vertical on the face, whereas Botox tends to be administered to horizontal ones. In certain instances, a Botox-Juvederm cocktail may take the “edge” off of a permanent pouty expression. Now that we’ve demystified when to use Botox versus when to use Juvederm, let us know your experience with either of these in the comments.