Learn More About
Facial Rejuvenation!


Read "Save Your Face"


“Dear Dr. Seckel, I have developed lines (or folds) that go from the corners of my mouth down to my jaw. I guess it’s just gravity at work, but I have to say I am VERY self-conscious. It’s only in recent years that I started noticing them, and they became more pronounced when I lost some weight. Is there a creme you can recommend to firm this area, or can it only be resolved by surgery? Help! I am getting tired of hiding behind my hands! Thank you,” – Cynthia, Andover, MA

Dear Cynthia,

You can stop hiding, help is available!

The lines you refer to are called Marionette Lines because they resemble the lines on either side of the mouth of a puppet – remember Mr. Bluster on the Howdy Doody puppet show? They are an extension of the Nasal-labial Fold Lines that run from the side of the nose down to the corner of the mouth.

The Marionette Lines and Nasal-labial Fold Lines are skin aging changes and are caused by the fact that with aging the facial skin loses elasticity from years of damage by the ultraviolet rays of the sun and by the fact that the fat beneath the facial skin atrophies or dissolves as we age. As the skin becomes lax, the skin sags or falls downward on the face. When we lose weight, fat dissolves, and the skin becomes more lax.

Our smile muscles, which attach at the corners of our mouth, hold the skin tight at the corner of the mouth. The result is that the skin that is not attached to the muscle at the corner of the mouth, the cheek skin above and below the mouth, falls down in folds, the Marionette lines on the chin, and the Nasal-labial folds above the mouth.

The most definitive treatment for the Marionette Lines and Nasal-labial fold lines is a face-lift. If you use your hands to push or pull the cheeks of your face upward you will see these folds disappear. A face-lift accomplishes the same thing, pulling the lose skin up and then removing it.

However most people do not want to have a face-lift and there are several new non-surgical facial rejuvenation procedures available which can help marionette lines and nasal labial fold lines.

There is no crème that will tighten the skin and remove the Marionette Lines and Nasal-labial Fold lines.

There is a line of products called Fillers, which are very useful to help soften and camouflage Marionette Lines and Nasal-labial fold lines. Fillers such as Collagen, Restylane®, Hylaform®, Radiesse®, Sculptra®, and others are injected by a physician into the skin beneath the deep fold to “plump up” the fold and make it less noticeable.

The fillers, Collagen, Restylane®, Hylaform®, Radiesse®, and Sculptra® camouflage the deep lines, soften them and make them less noticeable. They do not correct the problem – for that you need a face-lift.

For people who do not want a face-lift the fillers like Collagen, Restylane®, Hylaform®, Radiesse®, and Sculptra® are a nice alternative.

Injection of these fillers requires an experienced doctor – I have been a plastic surgeon for 25 years and getting a good result is still very difficult. Consult a board certified Dermatologist or Plastic Surgeon who specializes in Cosmetic Procedures if you want to have a filler. Do not go to a Spa and have this done by a non-physician.

I urge you to read my book “Save Your Face”. In chapter7 I discuss the various fillers, Collagen, Restylane®, Hylaform®, Radiesse®, and Sculptra® in detail. Choosing the right filler for you is a complex procedure, which requires the expertise of a doctor. Different fillers work better in different locations. If you read the book you will be better informed.

Thank you for your excellent question. For further information on facial rejuvenation visit my Boston Plastic Surgery Practice, contact me or read Save Your Face.

Dr Seckel

Boston, Massachusetts

Peabody, Massachusetts