About Smile and Marionette Lines

One of the first changes we see in our face when we start aging are the smile lines or the naso - labial folds. These lines run from the nose to the corners of the mouth. Loss of collagen and bone support, combined with sagging of the cheek tissues, are responsible for the formation of the naso - labial folds. As the fat compartments of the mid-face descent and deflate, the appearance of the fold becomes even deeper.

On the other hand, the marionette lines cruise from the corners of the mouth downward to the jaw line and often times give a sad or bitter look to the face.The prime example for this type of appearance is the German chancellor - Angela Merkel.

Although most people are distressed by the smile lines or naso - labial folds, they are less aging than the marionette lines. A smile line might be present in a young and skinny person, but a marionette line is found only in older persons. This is a reason why marionette lines are more aging than smile lines.

If you ever have to choose between marionette and smile line correction because of budgetary or time constraints, always opt for marionette correction first. Depending on the magnitude of volume loss, one or two syringes of filler might be needed to achieve optimal results in this area. The effect should last for 6 months. After repeated injections, as the collagen is replenished, the treatment may be gradually spread out to every 8-9 months. 

The View From Monaco

In April 2017, I attended the Aesthetic and Anti-aging Medicine World Congress (ICAM) in Monte Carlo, Monaco. It is the largest manifestation of this type in the world, now in its 15th year. For three days, 11,700 attendees listened to...

About Tretinoin

The backbone of every anti aging regimen should include tretinoin or all-trans-retinoic acid,  (brand names Retin-A, Refissa).  Tretinoin is a prescription medication that it is scientifically proven by numerous studies to...

The World Of Aesthetic Medicine

Last month I had the opportunity to attend IMCAS in Paris, one of the largest aesthetic medicine meetings in the world, now in its 18th year. The event was chaired by Dr. Benjamin Ascher (plastic surgeon—France), and there were 6,500...

About The Role Of Anti-Aging Serums

Daily exposure to environmental insults, especially sunlight, leads to formation of reactive oxygen species (ROS) within the skin. ROS are oxidative "bombs", which if not counteracted, will destroy skin components with resultant aging.

About Skin Care Regimens

Many of our clients have asked about what skin care products are the most beneficial. A good skin care regimen should include an antioxidant serum and sunscreen in the morning and Retin-A(tretinoin) along with an exfoliator in the evening. Additional moisturizer may be used as needed. On my face I like using CE ferulic antioxidant serum, Refissa (tretinoin) and retexturing activator (exfoliator).


by Roxana Voica, MD: I often times hear my patients saying: "I always wear sunscreen when I go outside." The truth is that most people are not aware that even when we are indoors, we are exposed to UV A which penetrates through glass.