Nasolabial Folds and Marionette Lines in the 50s: Why Juvgen and Thread Lifting Were Combined

Hello.

I am Dr. So-hyun Park, Representative Director of Samsung B&S Clinic.

As we enter our 50s, it is rarely just the nasolabial folds that deepen; often, the midface and buccal fat pads sag simultaneously, leading to marionette lines beneath the corners of the mouth and a heavier jawline.

Today, through the case of a female patient in her late 50s troubled by nasolabial folds, sagging jowls, and marionette lines, I will explain the criteria we used to design a treatment plan combining Juvgen and thread lifting.

This case review illustrates the condition and clinical course of a specific patient. Even with identical procedures, outcomes and recovery processes may differ depending on individual skin condition and facial anatomy.

a. In her late 50s, nasolabial folds, sagging buccal fat, and marionette lines were observed concurrently.

b. Juvgen and thread lifting were planned to preserve her naturally rounded face shape and anterior cheek volume.

c. Fine surface creases and mid-to-lower facial sagging were separated and addressed through targeted, distinct approaches.

1. Why We Examined Facial Shape Alongside 50s Nasolabial Folds

The patient was a woman in her late 50s with relatively abundant facial soft tissue and somewhat thick skin.

Her overall facial contour was round, with a moderate amount of volume in both the lateral and anterior cheek areas. Her primary concerns were her nasolabial folds, sagging buccal fat pads, and the marionette lines extending below the corners of her mouth.

However, she did not desire a sharp, significantly slimmed-down face. Her essential requirement was to maintain her naturally rounded facial shape and anterior cheek fullness while tidying up the areas that appeared heavy due to sagging.

Accordingly, rather than merely pulling tissue back aggressively, we established our treatment direction by assessing her current facial structure, skin condition, and the distinctive features she wished to preserve.

2. Considerations in Thread Lifting for Thick Skin and Dense Facial Tissue

While thread lifting is an effective tool to reposition and redirect sagging tissue, it cannot be applied uniformly to every face.

In particular, when a patient presents with thick skin and relatively abundant adipose tissue, the inherent weight of the tissue must be carefully evaluated.

Tensioning the skin with excessive force does not automatically lead to a natural facial contour. In this case as well, we factored in tissue weight to avoid overly diminishing her anterior cheek volume and soft, rounded facial outline.

In thread lifting for patients in their 50s, rather than focusing solely on surface-level skin sagging, it is crucial to holistically evaluate which areas have descended and which areas of volume should be preserved across the entire face.

3. Why Nasolabial Folds, Sagging Jowls, and Marionette Lines Were Evaluated Together

Prior to treatment, not only were the nasolabial folds prominent, but the descent of the buccal fat also caused the lower face to appear wide and heavy.

Marionette lines were clearly visible below the oral commissures.

Although nasolabial folds, jowl sagging, and marionette lines often appear to be separate aesthetic concerns, they are frequently interconnected results of positional shifts in midface and lower face tissues.

Therefore, we compartmentalized the treatment plan: Juvgen was utilized for the superficial creases in the nasolabial zone, while thread lifting was applied to address the structural sagging of the mid- and lower face.

Rather than attempting to address all concerns with a single procedure, it is vital to analyze the distinct causes and anatomical origins of each issue.

4. Midface Sagging Can Accentuate Nasolabial Folds

Even when nasolabial folds appear prominent, the evaluation should never be limited strictly to the fold itself.

When midface tissues descend, hollow shadows form beneath the anterior cheek, while the tissue overlying the fold becomes heavier, making the nasolabial crease appear substantially more pronounced than before.

In such situations, we evaluate not only the crease itself, but also the descending tissue above the fold and beneath the anterior cheekbones.

In this case, rather than flattening the anterior cheek volume, we planned the thread lifting vector to support and reposition the sagging tissue while maintaining her natural fullness.

Post-procedure follow-up photographs demonstrated a refined shift in the focal point of the anterior cheek volume and a restored midfacial contour.

5. Thread Lifting: Tailoring Vectors for the Lower Face and Jawline

Before the procedure, the patient's lower face presented a relatively wide, almost pentagonal contour.

However, because the patient wished to preserve her original rounded face shape, creating an excessively sharp, V-line contour was not our goal.

Instead, thread lifting was carried out with a focus on defining the lower contour around the chin and addressing the sagging around the jowls and mouth corners.

Follow-up assessments after the procedure revealed noticeable refinement in the previously widened lower face and heavy jawline.

Because facial shape, fat distribution, and skin thickness vary by individual, the degree of contour change achieved through thread lifting will naturally differ from person to person.

6. Juvgen for Fine, Superficial Nasolabial Creases

The patient's nasolabial area presented more than just a deep, structural fold.

Fine, crinkling surface creases running along the skin layer were also clearly evident.

While thread lifting was used to adjust the vector and contour of sagging tissues in the mid- and lower face, Juvgen was applied specifically to soften these residual fine surface creases in the nasolabial zone.

Post-procedure progress images showed a visible softening and smoothing of the superficial lines compared to before the procedure.

When examining nasolabial folds, it is essential to distinguish whether one is dealing with deep structural folds, fine dermal lines, or secondary accentuation caused by midface descent.

7. The Link Between Marionette Lines and Sagging Jowls

As midfacial sagging progresses, the buccal fat pad often descends downward.

Inside the face, supporting structural frameworks hold the skin and deeper tissues; when adipose tissue shifts downward, distinct step-offs and height differentials develop between adjacent facial zones.

Through this process, marionette lines can emerge below the corners of the mouth, and buccal fat sagging becomes more prominent. A heavier jawline and visible drooping around the perioral area often follow.

Taking these anatomical changes into account, thread lifting was performed in this case to lift and support the descent of the buccal fat and marionette region.

When addressing nasolabial folds or marionette lines in one's 50s, rather than fixating on a single visible crease, it is crucial to analyze the directional displacement of tissues across both the midface and lower face.

Facial lifting should never be about pulling skin as tightly as possible; instead, it must be planned thoughtfully by accounting for skin thickness, fat distribution, face shape, sagging vectors, and the individual features each patient wishes to maintain.

A more detailed explanation of how nasolabial folds, sagging jowls, and marionette lines in the 50s were evaluated to design this Juvgen and thread lifting plan can be viewed in the original YouTube video below.

For further insights into Dr. So-hyun Park's facial structural analysis and procedural approaches, please visit our official blog.

Frequently Asked Questions

Why consider thread lifting and Juvgen together for nasolabial folds?

Because fold depth and tissue sagging stem from different underlying causes. Structural contour changes caused by mid- and lower-face descent are repositioned with thread lifting, while fine, superficial surface creases are smoothed with Juvgen, addressing each issue at its source.

Does thread lifting always make the face overly sharp or slim?

No. The treatment plan should be tailored to the patient's unique facial structure and aesthetic goals. As demonstrated in this case, thread tension and vectors can be adjusted to preserve natural roundness and anterior cheek volume while only tidying sagging jowls and the jawline.

Can thread lifting still be performed if the skin is thick and facial tissue is heavy?

Yes, but the physical weight of the soft tissue must be carefully accounted for. When there is thicker skin and more adipose tissue, lifting vectors must be calibrated to work with the tissue weight rather than relying on forceful pulling, ensuring natural results.

What causes marionette lines and sagging jowls to appear together?

They are primarily caused by the downward displacement of midface tissues with age. As cutaneous support structures weaken and fat pads slide downward, height differentials form between facial compartments, creating marionette lines below the mouth corners alongside jowl sagging and jawline heaviness.