Dermal Filler for Marionettes Top 10 FAQS

Before and after marionette filler sydney
Before and after marionette filler sydney

1. Where are Marionettes Folds and Lines?

Marionette folds and lines are creases that extend vertically from the corners of your mouth to your chin.
These folds can also give the lower third of your face a sagging effect due to the folds and lines. They may make the patient’s mouth look like they are sad or frowning when they are not due to the lines giving this illusion.
They derive from the muscle you use when you smile or speak or just when you move your mouth in general.
A loss of volume in your face can also cause the effect of marionette lines. This is why we fill marionette lines in with filler when a patient is looking for anti-aging results – hollowness of the face is a normal part of the aging process.

2. Who is suitable to have dermal filler in their marionette folds?

A suitable patient for the treatment filling the marionette lines or folds are those who want an anti-ageing effect and to improve the whole appearance of the lower third region, including mouth and chin area.
Sometimes wrinkles in the marionette region could be genetic and younger adults may be suitable for this treatment.
Those who are unhappy with the appearance of their lower third of the face may request dermal filler in the marionette folds or lines alone of to accompany other regions of the face they want to improve

3. What dermal filler is best for marionette folds and lines? And what dosage?

Generally, a soft to medium filler is best for the marionette area depending on the depth required. This usually fulfills the desired results we are after. Anything too thick may not be appropriate for the area if we are injecting superficially, Although we may be able to use a firmer filler in younger patients
Regarding the dosage of filler to the marionette area, the medical professional will assess the patient’s face and anatomy and see how much is suitable.
At the Manse we like to suggest a couple of treatments as we want to sculpt a face slowly and cautiously and would not like to pormise that we could achieve the desired results  in just one treatment.
Slow and steady will always be the way to go to reach the patient’s desired goal.
Usually 1mL is a good starting dosage for the marionette lines and folds.

4. What is better for marionette lines – antiwrinkle injections or filler?

Every individual patient is different in what treatment they need in order to achieve their desired goal. It is important to see an experienced medical professional that is able to distinguish what is best for your face and what will give you the best end result. Anti wrinkle treatment is a drug used to relax the facial muscles, with the aim of removing or softening wrinkles.
It will help enhance the expressions you make with your face and will assist your downward turn lines on your marionettes.
Anti wrinkle treatment can definitely assist the lines around the mouth help prevent worsening in this area, however the marionette folds will usually
need treatment of filler to fill the hollowness that the fold is causing.
A filler will be used to fill the fold in the marionettes, and to  soften any surrounding lines that are visible.
The filler will last anywhere from 6 months to 2 years. Filler is also great for those patients who have thinning skin due to age and would like a smoother, more volumized appearance.

5. Why do marionette lines happen?

Marionette lines/folds generally tend to happen due to aging in the patients 20s to 50s as volume is lost and skin weakens and becomes looser and thinner. Genetics also plays a big role for when your marionettes will appear.
It is important to maintain your skincare and avoid sun and keep weight healthy and stable to avoid the early occurrence of marionette lines/folds.
We also encourage our patients to wear sunscreen daily as part of their skin care routine which will help early wrinkles appear or the worsening of wrinkles. This will also minimize sun damage to the face.
Although it is difficult to avoid, pursing your lips frequently may cause worsen wrinkles around the mouth from overusing the muscles. For example, smokers are constantly pursing their lips and they often want the wrinkles around their mouth treated.

6. Are there other alternatives than dermal filler to fix marionette lines/folds?

Long Threads

Dermal filler would be the most popular treatment for the majority of patients that have an issue with their marionettes, some may take the route of having long threads in the lower face along the jawline which  will pull up the lower face. Although this will be subtle, it can be effective for some patients.

Short Threads

Some patients may like to have collagen stimulating threads in this area


Biostimulator, also known as powder filler is also very popular for the lower third of the face

Antiwrinkle Injections

Another alternative treatment is antiwrinkle injection  on the marionette lines which we use to relax the depressor anguli oris muscle, which will lift the drooping corners of the patient’s mouth. Some patients may even have a combination of antiwrinkle injctions and filler treatment of the marionette lines/folds to tackle this area.

7. Can filler make Marionette lines worse?

If it is injected appropriately it will not make the lines worse
If it is injected too superficially or if the patient’s skin is too thin, it may cause the Tyndall Effect (a bluish appearance).
If it is injected in the wrong, place, eg outside the fold it will look worse

8. How Painful are fillers for Marionette Lines?

The treatment of marionette lines and folds are usually used with the cannula technique when using dermal filler. It is usually not painful, but a pressure is felt throughout the treatment.
We offer a couple of options for pain relief to minimize the discomfort of treatment.
Post treatment you may feel some tenderness in the area treated and swelling and bruising may be seen which are common side effects like
all other injections. However, things will start feeling better within 2-3 days, and it should fully heal and settle in about 4 weeks.

9. How do we manage the pain for injection of marionette lines?

For those who have a low pain tolerance I generally may put lidocaine topical anesthetic cream around the area where I will be injecting for 15 minutes just to minimize some pain of injection. We may offer happy gas for the patient to use throughout treatment to calm their nerves which will put them in a better place. This will overall improve the whole experience of treatment.
After treatment if the patient is in some pain I like to give them ice which will reduce swelling and bruising, and if they are desperate to minimize
the swelling and bruising quickly I usually suggest going to their local pharmacy and buying over the counter arnica cream.

10. How to prevent marionette lines occurring?

Let’s start with the basics! To prevent any lines or folds in your face we must stay hydrated by drinking the correct amount of water everyday. The usual amount suggested by medical statistics is around 2 litres per day – this will improve one’s skin dramatically. Another effortless way to prevent facial lines occurring is eating the correct foods, such as fruits and vegetables. When your gut is happy and full of nutrients it will show on your face! As previously mentioned sunscreen should be worn everyday as part of your skin regime to prevent damage from the sun to your face. Also a good cosmeceutical skin range with retinol, niacinamide and AHAs .
At home peels and at-home LED devices will help maintain and optimise your skin.
A significant factor in aging is stress. Stress can contribute to wrinkles occurring.
With negative movements in the face ie the muscles pull down the mouth corners, so staying happy is important so it’s reflected in your face 🙂
A contributing factor to stress is not getting enough sleep due to our busy schedules. Sleep is also an important factor for our overall health, including skin generation. If we are not getting enough rest it can impact the quality of our skin health.
Most importantly STOP smoking! In general it is known that smoking fastens the aging process and fastens the appearance of wrinkles. Cut the habit and let’s try to prevent those lines from appearing early.
Antiwrinkle injections can be used to relax the muscles that pull down the mouth corners, so ask your injector about  this  “DAO” muscle treatment that you can add to your regular antiwrinkle routine.