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Dermal Filler for Jowls and Marionette Folds

Author: Dr Naomi / 28 Oct 2015
Before and after dermal filler marionette lines

Before and after dermal filler marionette lines


Dermal filler is a simple and effective way to treat the marionettes lines. The marionette lines are very ageing on a face. They make the person look sad and negative. Filling marionettes make a person look happier and more positive.

Can you see why they are called marionette lines!

Can you see why they are called marionette lines!


What are marionette lines

Marionette lines are the lines / folds which start at the mouth corners and go downwards ending at the jawline.

AGING OF THE LOWER FACE,

With aging, the bone and soft tissue dissolves in the face, and in women, the skull rotates with the chin moving backwards. These features contribute to loss of structural support which creates the jowl and adjacent to the jowl the marionette.

Dermal filler can fill in the depression of the marionette fold. Some doctors will describe this area as “the bottomless pit” for dermal filler, as such a high dose may be required

TREATMENT OF THE MARIONETTES WITH DERMAL FILLERS

#LINK In addition to  to treatment with dermal filler, the patient should be assessed and treated with muscle relaxing injections in the DAO muscle if required. This is important in some patients who overuse their DAO muscle which pulls down the corner of the mouth. Injecting this with muscle relaxing injections will give a more attractive appearance, with a less downgoing negative appearance to the mouth

Choosing the dose of dermal fillers

The dose required for marionette folds variable. It depends on the anatomy and the desired result. Some patients will be satisfied with 1ml, others will need more get the results that they want.

The doctor will assess the face and decide on the best dose after taking a history and examining the patient. If a patient has a history of complications with dermal fillers, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen to start with.

With dermal fillers, a typical way to plan marionette improvement is to inject 2mls at a time,  injecting  every  month until the the patient and doctor are satisfied with the appearance

Typically, I will inject 1 ml at a first treatment then review the patient at a month. If they said ” I liked the swelling after the last treatment and was disappointed when it went away” then I would recommend them to have a further 1ml, and repeat this until they don’t like the swelling afterwards.

Volume loss in the upper and lower face should be assessed and treated to give the best results.

Pain relief during treatment

A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.

If a cannula is used, local anaesthetic is used prior to the cannula being introduced into the skin

There is local anaesthetic in the dermal filler

Ice is always used to decrease pain and to reduce the risk of bruising.

Very rarely patients will use Penthrox for dermal filler in marionettes

Nitrous oxide (happy gas) is available for patients to use

What happens during the injectables treatment itself?

The face will be cleaned with alcohol.

Ice will be applied to the area briefly before treatment The doctor will inject using a very fine needle. Then pressure with gauze will be applied.

If a cannula is used, a small injection of local anaesthetic is injected into the skin and then a fine needle makes a small hole in the skin where the cannula is inserted. Cannulas are commonly used for treatment of marionette folds

How will I look after dermal filler in the marionette lines?

There may be redness and swelling. Patients often like the swelling in the first couple of days

Side effects /risks with dermal fillers

Bruising occurs in a significant number of cases.

Swelling in the injection area will occur. This will laser for 48 hours

Asymmetry: Sometimes one side is better treated than the other, this is usually because the patient is asymmetrical to start with.

Infection is a very rare complication, but always a possibility when the needle goes into the skin.

Necrosis (blood vessel being blocked, interfering with blood supply to the skin) is very rare. This could lead to scarring

Need for further treatment: Often with lips, it will take several syringes of product to get to where the patient wants to be.

Instructions for care afterward

No makeup for 4 hours

No heavy exercise that day

No acid face products for 24 hours

No spas no saunas, no hot yoga for 1 week post treatment

What to expect after a dermal filler  treatment?

The effect of the dermal filler will be obvious immediately

Most of the swelling from the dermal filler will have resolved by 2-3 days after the procedure. There may be a small amount of swelling for even 2-4 weeks after the procedure.

What if I get asymmetry at some time before the 2 week point? Do I call the doctor?

No. No need to call the doctor. Sometimes asymmetry will occur because one side is more swollen or bruised. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be examined at the review appointment. There is no point in coming in early for treatment of asymmetry as there is often swelling associated and so the final result cannot be seen until at least 2 weeks. Treating asymmetry too early could lead to further asymmetry

How long will the treatment last?

The answer to this is very individual and depends on the patient’s anatomy, metabolism, the dose, the placement, the product etc. Typically with our most commonly used dermal filler: If the patient is happy with the results at 1 month (ie there has been adequate fill) they should be treated at 6 months, then at 6 months and then once yearly. If the patient is not satisfied with the results at 1 month (ie more dermal filler is required to obtain the results that they desire), then further dermal filler should be injected every 1-3 months until the desired appearance has been reached, and then the patient should have treatment at 6 months, then 6 months, then once yearly

Cost of dermal filler in marionette lines:

Cost is per syringe. Typically 1-2mls at least are required =$700 – $1400. Some patients will require more than this

Before and after 1ml to marionettes (nasolabial fold also filled)

Before and after 1ml to marionettes (nasolabial fold also filled)

Before and after dermal filler for sagging, jowls, marionettes and lower face ageing

Before and after dermal filler for sagging, jowls, marionettes and lower face ageing

Before and After dermal filler to marionettes, jawline, chin, cheeks and nasolabial folds

Before and After dermal filler to marionettes, jawline, chin, cheeks and nasolabial folds

Before and after dermal filler in lower face for sagging jowls and downturned mouth

Before and after dermal filler in lower face for sagging jowls and downturned mouth

Before and after dermal filler in marionettes, accordion lines and cheeks

Before and after dermal filler in marionettes, accordion lines and cheeks

Before and after treatment with dermal filler to reduce lines around mouth, including accordion lines nasolabial folds and marionettes

Before and after treatment with dermal filler to reduce lines around mouth, including accordion lines nasolabial folds and marionettes

Before and after dermal filler for marionettes and jowls

Before and after dermal filler for marionettes and jowls

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