Marionette Line Correction Using Threads.

Marionette lines and jowl ptosis present unique challenges in Asian populations due to distinct anatomical variations. The modiolus in Asians is positioned approximately 11 mm lateral and 9 mm inferior to the oral commissure, compared to at or above the commissure in Caucasian and African populations, predisposing 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-superficial musculoaponeurotic system plane, engaging ptotic jowl tissues with vectors perpendicular to the marionette line. 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.