Marionette Line Correction Using Threads

Marionette lines and jowl ptosis present unique challenges in Asian populations due to distinct anatomical variations. In Asian populations, the modiolus is generally reported to be located in an inferolateral position relative to the oral commissure, with cadaveric studies suggesting an average distance of approximately 11 mm laterally and 9 mm inferiorly, in contrast to its at-level or superior position in Caucasian and African populations, which may predispose to downturned oral commissures and age-related ptosis. This innovation describes a dual-technique approach combining multidirectional barbed threads for deep structural lifting with volumizing monofilament threads for superficial rhytide correction. Barbed threads are anchored at Loré's fascia in the sub-SMAS plane, engaging ptotic jowl tissues through anatomically guided lifting vectors, while perpendicular monofilament insertion is applied for superficial perioral refinement. This combined strategy addresses both deep ptosis and superficial lines while preserving natural facial dynamics and avoiding critical perioral neurovascular structures. The technique offers a minimally invasive solution tailored to Asian facial anatomy.