Skin Care

Lowe Face Aesthetic Concerns.

Lowe Face Aesthetic Concerns

Some cosmetic issues can be concealed with makeup, while others cannot. Lower face concerns such as Marionette lines and jowls are among the most difficult to conceal, and you may require injectables for the best results. This post will discuss correcting these aesthetic concerns using approved injectables such as fillers and PDO threads.

Marionette lines

Marionette lines are facial creases that develop because of skin aging. The folds appear vertically in almost a straight line between the lips and the chin, causing drooping in the bottom portion of the face. They are named after marionette puppets, which have split mouths to allow puppeteers to use string to move their lower jaw. This is a prevalent aesthetic condition mostly caused by our lower jaw’s constant movement when eating, talking, and smiling.

Jowl Sulcus

The droopiness, on the other hand, is often referred to as Jowls. The quality of the tissues deteriorates with age. Tissues that were previously tight, such as the skin and deeper tissues, becomes thinner and less tight, and it cannot hold themselves and fall down the jawline. Gravity naturally leads these tissues to sink down, resulting in greater fullness at the bottom of the face and less at the top. The pre-jowl sulcus, or dip in front of the jowl, is assumed to be the result of two processes. To begin with, as we age, we lose bone and fat around our jawline. With ageing, bone resorption causes a more noticeable pre-jowl sulcus. Furthermore, a ligament known as the mandibular ligament joins the deeper tissues of the face to the jaw. This ligament emphasizes the distinction between the pre-jowl and jowl areas.

Marionette lines are frequently more visible when paired with Jowls to exaggerate the concern


There are several treatments available for this issue.

Dermal Fillers

If the marionette line appeared alone, without Jowls, then hyaluronic acid dermal fillers were used. Soft-tissue augmentation with Dermal fillers

HA fillers

hyaluronic acid (HA) fillers are a popular cosmetic treatment. HA fillers are a type of filler that is both safe and widely used. There are numerous HA fillers available. The particle size and crosslinking ratio of HA fillers differ. It is recommended to use smaller size HA fillers in the dynamic facial area to achieve a more natural look. These fillers are typically injected into the folds on the lateral side with a blunt cannula or sharp hypodermic needle.

Using a blunt cannula has become the method of choice due to higher safety profile and lower incidence of bruising. This fillers last up to 2 years and can be instantly dissolved if required.


Other type of dermal fillers that are frequently used for correcting marionette lines is Bellafill. This is a long-lasting collagen-based fillers with polymethyl methacrylate (PMMA) beads. According to the FDA, collagen gives instant volume and lift to address a wrinkle or acne scar, while PMMA microspheres stay in place and form a basis that provides structural support to the skin. Bellafill may last up to 10 years, but it cannot be dissolved.

PDO Threads

Jowls would complicate the problem as we should be looking for a mechanical skin tightening treatment such as PDO threads.

Polydioxanone (PDO) threads of different lengths and shapes have been more popular for mid-face lifting and Jawline contouring. Therefore, patients can receive satisfactory results using PDO threads treatment that is a considerably less invasive way. For Mechanical lifting, we usually use cog threads made of PDO material. These treatments have less postoperative downtime and produce good results without incisions or postoperative scars. T The thread is typically carried on an L-type cannula, which allows the practitioner to slide the thread through the hypodermal layer. The procedure is more invasive than HA filler injections, but it is safe and tolerable without anesthetic injection.

After the treatment, most patients experience swelling and discomfort, which subsides after 1-2 weeks. For the first 48 hours, patients are usually advised to sleep on their backs and avoid strenuous exercise.

Bruising is another possible side effect of PDO threads or any other treatment. You can take a few precautions to reduce your chances of bruising, such as avoiding alcohol and aspirin 36 hours before the treatment.


Both HA fillers and PDO threads are biodegradable, which means they are safe for our bodies and will be metabolized over time, resulting in long-lasting but temporary results. In more severe cases, we may use a combination of techniques to achieve satisfactory results.

Treatment results

The following is an example of a female in her fifties who had the PDO thread treatment at Albany Cosmetic and Laser Center in Canada. The images show the patient’s direct before and after with significant improvement.

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