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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.

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.

Question: What should I do about 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.

Question from Denmark, Europe: I will try to make it as brief as possible. I got restylane under my eye 4 years ago. 1st time was great. 4th time he injected way too much. Thats now 2 ½ years ago. I still got a huge lump under my skin under right eye. If i try to massage it, it is a very hard lump and about 1-2 cm long beneath the skin. I'm so so tired of this saggy look. I'm only 28 years old. I don't want to see that doctor again. What should i do? Could this be scar tissue? Or what do you think?

Dr. Marotta's response: Restylane can persist for quite a while even years under the eyelids presumably because of lack of significant movement of this area. Good technique is critical to achieving good results in the eyelid region and should only be done by physicians with advanced training and years of experience in injectable filers like Restylane. The good news is that the Restylane can be easily dissolved with an enzyme called hyaluronidase (generic) Vitrase (brand name). Find a doctor who performs this procedure and the lump will be gone. Good luck!

Question: What kind of lift is best to take care of nasolabial problems?

Dr. Marotta's response: The facelift techniques you mentioned have little if any effect on the nasolabial folds. The most effective facelifting technique to improve the nasolabial folds is the endoscopic midface lift. Adding microfat transfer to the nasolabial folds during the endoscopic midface lift provides additional benefit and the best long improvement in the nasolabial folds. Fillers like restylane, juvederm, or perlane can correct nasolabial folds as well, but of course are temporary and don't have the benefits for the other parts of the face that endoscopic midface lifting and fat transfer offer.