The marionette lines are wrinkles located on either side of the face, extending from the corners of the mouth to the jawline. They gradually develop with ageing as a result of the loss of collagen, elastin, and hyaluronic acid, combined with skin laxity and the progressive depletion of the underlying support structures. These folds can give the face a sad, stern, or tired appearance, even at rest. In aesthetic medicine, treatment is based on a comprehensive facial assessment to address the underlying causes of ageing rather than simply filling the visible crease. Hyaluronic acid injections are the reference treatment and are often combined with Sculptra® or Skinbooster injections.
Key facts about marionette lines
Clinical study findings on marionette lines
The appearance of marionette lines is linked to aging. Several changes in the face are responsible :
The appearance and progression of marionette lines vary depending on several factors such as age, genetics, repeated facial expressions and sun exposure.
Understanding the stages of severity of marionette lines is essential in order to choose the most suitable treatment, as treatment options vary depending on the stage. The possible solutions depend on the depth of the lines and the specific needs of each patient. A consultation with an experienced doctor will determine the most effective treatment.
Stage 1 : mild marionette lines
Description
Appearance of slight lines around the mouth, mainly visible during facial expressions.
The skin begins to lose a bit of its elasticity, but the lines are not permanent yet.
Treatment
Hyaluronic acid injections : performed to fill the first fine lines and restore lost volume.
Hydration and preventive care : use of moisturizing creams and anti-ageing treatments to slow the progression of wrinkles.
Stage 2 : moderate marionette lines
Description
The lines become more visible and are present even when the face is at rest.
Moderate loss of volume and skin elasticity around the mouth and cheeks.
Treatment
Hyaluronic acid injections : more product may be needed to fill the lines and restore the lost volume.
Sculptra injections : to improve skin quality and stimulate collagen synthesis. One vial is often enough.
Fractional ablative laser : to treat fine lines and improve skin elasticity.
Description
The lines are deep and well defined, even at rest.
Significant loss of volume and sagging of the facial tissues.
Treatment
Hyaluronic acid injections : use of sufficiently volumizing products to fill deep lines.
Sculptra injections : to improve skin quality and stimulate collagen synthesis. One vial is no longer enough.
Continuous ablative laser : performing a medium peel.
Description
The marionette lines are very deep and accompanied by a significant sagging of the malar and buccal fat.
Very severe loss of volume and skin elasticity around the mouth and cheeks.
Treatment
Hyaluronic acid injections : combination of lifting techniques with hyaluronic acid injections and filling of the line.
Combination of treatments.
Marionette lines can be naturally reduced through lifestyle changes and proper skincare.
Here are a few tips to reduce these lines naturally.
Marionette lines can have a significant impact on the overall appearance of the face, making it look older and less cheerful.
Treating these wrinkles rejuvenates and refreshes the face, improving its symmetry and harmony.
Techniques of aesthetic-oriented medicine help reduce and sometimes erase marionette lines.
Advanced stages most often require surgical management.
The proposed treatment is decided after a clinical examination, and the protocol is personalized.
The primary cause of marionette lines is the downward displacement of the superficial malar fat pad.
The most physiological treatment approach, aimed at restoring a younger-looking face without creating excessive fullness or unnatural volume, is to reposition this descended fat.
This therapeutic strategy should be carried out before any direct injection into the wrinkle itself, in order to avoid weighing down the jawline or creating a puffy appearance.
This is the medical lifting technique using hyaluronic acid injections developed by Dr Mauricio de Maio. As one of the applications of the MD Codes®, it provides immediate results and is designed to restore the youthful facial triangle.
Hyaluronic acid can be injected directly into the line. In the treatment protocol, the filling of the line must be performed after the lifting technique.
The injection is often done with a cannula to avoid the appearance of bruising. The result is immediate.
Depending on the indication Doctor Romano will use a volumizing hyaluronic acid if the melted fat needs to be replaced, or a hyaluronic acid of the Skinbooster type if there is a skin break.
Most often Doctor Romano performs a technique called “sandwich” : during the same session the doctor uses in depth a fairly dense hyaluronic acid and on the surface a hyaluronic acid with very small particles.
A firm, volumising hyaluronic acid filler is injected into the chin, para-chin, and cheekbone areas when bone and fat resorption is present.
The aim is to replace the facial support structures that have progressively diminished with age.
The injections are often performed using a cannula.
Sculptra is an innovative and effective treatment to improve marionette lines. This product, made of poly-L-lactic acid, a biocompatible and biodegradable substance, stimulates the skin’s natural production of collagen.
It gives a progressive result, visible three months after the injection.
This treatment must be combined with hyaluronic acid injections and is strongly recommended from the age of thirty. Sculptra injection cannot, on its own, treat or prevent the appearance of marionette lines.
The goal is to treat or prevent skin thinning and the resulting laxity.
By stimulating collagen synthesis and increasing skin thickness, Sculptra gives the face a younger and more harmonious appearance, while significantly reducing marionette lines.
Marionette lines can be reduced thanks to the fractional ablative laser.
The laser does not act on the sagging of fat nor on the loss of subcutaneous tissue located beneath the line.
The aim of the treatment is to stimulate collagen production and improve the density and firmness of the skin. Thicker skin slightly corrects the marionette line, and the real benefit of this technique is to soften the skin break associated with the line. Indeed, the alternative to this procedure would be a medium peel, but this treatment is rarely performed because a demarcation (difference in colour) is frequent.
Two to four sessions are necessary. If, afterwards, the marionette line is treated annually with hyaluronic acid injections, it is not necessary to repeat the laser treatment.
Although the procedures described above to treat marionette lines without surgery are generally effective, they do have certain limitations. When the patient has an excess of skin forming a bulge above the jawline, the results may be less satisfactory. In this case, for an optimal outcome, it is better to consult a cosmetic surgeon for a potential cervico-facial lift.
After the surgical procedure, hyaluronic acid injections in the marionette lines may be necessary to fill the residual folds and obtain a perfect result. It is therefore essential to consult an experienced doctor to evaluate the best therapeutic options.
The result is immediate and improves over the three weeks following the treatment. It lasts about one year.
The lifting technique restores the youthful triangle and refines the facial contour.
The face appears rested, the wrinkles will be reduced in a physiological way or completely erased, depending on the patient’s request and her anatomy.
The immediate after-effects include slight swelling and the appearance of small bruises. These are rare and their duration does not exceed a few days. Usual activities can be resumed immediately after the injections.
In Geneva, the price of hyaluronic acid injections for the treatment of marionette lines is CHF 600 per syringe.
The cost of Sculptra® treatment for marionette lines is CHF 900 per vial, Skinbooster treatment is CHF 400 per syringe, and fractional ablative laser treatment starts from CHF 300 per session.
How much does the treatment of marionette lines cost ? The price of injections to treat marionette lines varies depending on several factors : the type of product used, the quantity required and the technique performed, which is linked to the doctor’s expertise.
Doctor Romano welcomes you to her practice in Geneva. All procedures are carried out with high-quality products, in strict compliance with safety and hygiene standards. Prices vary according to the chosen treatment plan and the required quantities, but remain transparent from the very first consultation. A precise estimate is provided during the initial consultation, after medical evaluation. Each treatment is personalized and may combine several techniques for an optimal result.
The prices for the treatment of marionette lines are :
What are the reviews on marionette line injections ?
Patients’ reviews on medical treatments to make marionette lines disappear are positive.
Patients describe a noticeable improvement in the appearance of the face, they feel rejuvenated and more confident after the procedures.
The results are considered natural and respect the expressiveness of the face.
The procedure is described as quick, minimally painful and convenient because this treatment does not require recovery time.
Treatments for marionette lines are very minimally painful. Local anesthetics can be used to reduce discomfort during the injections.
A treatment session for marionette lines generally lasts 20 minutes, depending on the technique used.
The objectives of bitterness fold treatment are :
There is no specific age to start treating marionette lines. It depends on individual needs and the doctor’s opinion.
After a treatment for marionette lines, it is recommended to avoid sun exposure, not to massage the treated area and to avoid intense physical activities for 24 to 48 hours.
Marionette lines can start to appear as early as the thirties, but they generally become more pronounced with age, especially from the forties onward.
The results of hyaluronic acid injections are immediate, while Sculptra works progressively over several months. The final result is obtained 3 weeks after the injection.
Yes, the treatments are safe when performed by an experienced doctor. They are approved by health authorities and widely used in aesthetic-oriented medicine.
The results of hyaluronic acid injections for marionette lines generally last between 6 to 12 months, depending on the type of product used and the individual characteristics of the patient.
Treatments for marionette lines must be performed by trained and experienced doctors.
The cost of marionette line treatment varies depending on the type of product used, the quantity required, the associated treatments and the doctor’s experience. A personalized consultation is necessary to establish an accurate estimate.
The results of hyaluronic acid injections are visible immediately after the treatment. The results of Sculptra are visible after a few months.
It is not possible to prevent the appearance of marionette lines. However, it is possible to avoid aggravating factors. It is recommended to maintain good hydration, protect the skin from the sun with sunscreen, adopt a diet rich in antioxidants, practise facial exercises, stop smoking and manage stress.
The choice of treatment depends on the severity of the marionette lines and the expected result. A consultation with an experienced doctor will make it possible to establish a personalized treatment plan.
The marionette line is located on each side of the mouth, extending from the corners of the mouth downward toward the chin. These vertical folds are also known as inverted smile lines.
