Fixing those ‘puppet lines’


Q: I am a 42-year-old female and have always had bags on my lower eyelids. I saw one doctor recently and she told me that I should have injectable fillers put in to puff out the indented areas around them. Then I saw another doctor and he said that the fat should be removed through an eyelid procedure. These two different opinions have me confused. What do you think?

A: Most under-eye bags consist primarily of fat that has escaped from under the eyeball. Our eyeballs are encased in a bed of fat inside the eye socket bones. This allows the eye to be padded so it can move around inside its encasement without risk of being ruptured. This fat is held back by a ligament that runs from the lower eyelid down to the bone. That supporting ligament weakens with age, allowing the fat to come out from under the eye. Much like an abdominal hernia and protruding bowel, the lower eyelid develops bags of herniated fat. Removal of this fat can be done from inside the eyelid without any external incisions. This would make for a far superior result in your case. Adding more volume around the herniated fat is only going to make your lower eyelids even puffier.

Q: I have “puppet lines” around my mouth that get infected often. Is there a reasonable answer to this problem?

A: What you refer to as puppet lines are technically known as marionette lines. That is the groove area that develops as the face and jowls fall forward with aging against the fixed skin of the chin. They extend downward from the corner of the mouth to the jaw line. There are multiple treatment options for marionette lines, depending upon how severe they are. For mild- to moderate-depth marionette lines, injectable fillers may be a reasonable option, albeit a temporary one. For moderate to deeper marionette lines, injectable fillers are not very effective at effacing them. Options include a jowl lift (mini-facelift), which really treats the cause of the problem, or direct excision of them, which may be a reasonable option in the older patient who does not want to undergo any form of a jowl lift. You can always try injectable fillers first, as they are easy to do in a few minutes in the office setting. An injectable treatment will prove, one way or the other, if that it is an effective approach. Whether that is “reasonable” ultimately comes to whether $500 to $600 is worth the gamble.


Current Morning Briefing Logo

Stay CURRENT with our daily newsletter (M-F) and breaking news alerts delivered to your inbox for free!

Select list(s) to subscribe to

By submitting this form, you are consenting to receive marketing emails from: . You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact