What causes marionette lines ?
Marionette lines develop through ageing. Several facial changes are responsible.
- Descent (ptosis) of malar fat : fat around the cheekbone descends towards the facial contour.
- Loss of support in the central and lateral cheekbone area : cheekbone fat diminishes, bone is resorbed and their supporting role is lost.
- Loss of support around the chin : fat and bone loss in this area leave the mouth corner unsupported, causing it to descend.
- The action of muscles that lower the mouth corners, particularly the DAO (depressor anguli ori) : they pull the mouth corners downwards.
- Reduced skin thickness.
- An unhealthy lifestyle worsens these folds : habits such as smoking, insufficient sleep and hydration, sun exposure and an unbalanced diet should be avoided.
Severity stages of marionette lines
The development and progression of marionette lines vary according to age, genetics, repeated facial expressions and sun exposure.
Understanding marionette line severity stages is essential to selecting the most suitable treatment, because options vary according to stage. Possible solutions depend on fold depth and each patient's specific needs. Consultation with an experienced doctor determines the most effective treatment.
Stage 1 : mild marionette lines
Description
Fine lines appear around the mouth, mainly visible during facial expressions.
The skin begins losing some elasticity, but folds are not yet permanent.
Treatment
Hyaluronic acid injections : performed to fill early fine lines and restore lost volume.
Hydration and preventive care : moisturisers and anti-ageing skincare to slow wrinkle progression.
Stage 2 : moderate marionette lines
Description
Folds become more visible and remain present even when the face is at rest.
Moderate loss of skin volume and elasticity around the mouth and cheeks.
Treatment
Hyaluronic acid injections : more product may be needed to fill folds and restore lost volume.
Sculptra injections : to improve skin quality and stimulate collagen synthesis. One vial often suffices.
Ablative laser fractional : to treat fine lines and improve skin elasticity.
Stage 3 : deep marionette lines
Description
Folds are deep and pronounced, even at rest.
Significant volume loss and facial tissue sagging.
Treatment
Hyaluronic acid injections : sufficiently volumising products are used to fill deep folds.
Sculptra injections : to improve skin quality and stimulate collagen synthesis. One vial no longer suffices.
Continuous ablative laser : performing a medium-depth peel.
Stage 4 : very deep marionette lines
Description
Marionette lines are very deep and accompanied by substantial malar and cheek fat sagging.
Very substantial loss of skin volume and elasticity around the mouth and cheeks.
Treatment
Hyaluronic acid injections : combining lifting techniques with hyaluronic acid injections and wrinkle filling.
Combination of treatments.
How can marionette lines be reduced naturally ?
Marionette lines can be softened naturally through lifestyle changes and appropriate care.
Here are some tips for reducing these wrinkles naturally.
- Hydration.
- Facial exercises : looking for an exercise for marionette lines ? Muscle activity plays a small role in their development. The exercise involves smiling and lifting the mouth corners with two fingers.
- Physical activity.
- Skincare : use products containing hyaluronic acid, retinol and essential oils. Moisturisers, anti-wrinkle serums and nourishing masks help keep skin supple and hydrated.
- Sun protection.
- Sleep on your back : sleeping on your side or stomach can accentuate marionette lines because of constant pressure on the face.
- Stop smoking.
- Stress management : chronic stress accelerates skin ageing.
How can marionette lines be filled ?
Marionette lines can significantly affect overall facial appearance, making it look older and less cheerful.
Treating these wrinkles rejuvenates and refreshes the face and improves symmetry and harmony.
Aesthetic medicine techniques soften and sometimes erase marionette lines.
Advanced stages most often require surgery.
The proposed treatment is decided after clinical examination and the protocol is personalised.
Hyaluronic acid injections
to lift the face without
surgery
The main cause of marionette lines is descent of superficial malar fat.
The most physiological treatment, aiming to rejuvenate the face without creating fullness or volume, lifts this descended fat.
This approach must precede direct wrinkle injection to avoid making facial contours heavy or the face puffy.
This is the non-surgical lifting technique using hyaluronic acid injections invented by Dr Mauricio di Maio. One variation of the MD Codes, it provides an immediate result and aims to restore the facial triangle of youth.
Hyaluronic acid injections
in marionette lines. The
Skinboosters
Hyaluronic acid can be injected directly into the wrinkle. Within the treatment protocol, wrinkle filling should follow the lifting technique.
A cannula is often used to avoid bruising. Results are immediate.
Which hyaluronic acid for marionette lines ?
Depending on the indication, Dr Romano uses volumising hyaluronic acid when lost fat needs replacing, or a Skinbooster-type hyaluronic acid when there is a skin crease.
Dr Romano most often uses a technique known as «sandwich» : during the same session, a fairly dense hyaluronic acid is used deeply and hyaluronic acid with very small particles at the surface.
Filling marionette lines
with hyaluronic acid injections
A firm, volumising hyaluronic acid is injected into the chin, beside the chin and around the cheekbone when bone and fat resorption have occurred.
The aim is to replace facial supporting structures lost over time.
Injection is often performed with a cannula.
How can marionette lines
be corrected ? Injections of
Sculptra
Sculptra is an innovative, effective treatment for improving marionette lines. Based on poly-L-lactic acid, a biocompatible and biodegradable substance, it stimulates natural collagen production in the skin.
It produces gradual results visible three months after injection.
This treatment should be combined with hyaluronic acid injections and is strongly recommended from the thirties. Sculptra injections alone cannot treat or prevent marionette lines.
The goal is to treat or prevent skin thinning and the resulting laxity.
By stimulating collagen synthesis and increasing skin thickness, Sculptra restores a younger, more harmonious facial appearance while significantly softening marionette lines.
How can you get rid of marionette lines ? Laser to reduce
rides du sourire
Marionette lines can be softened with fractional ablative laser.
Laser addresses neither sagging fat nor loss of subcutaneous tissue beneath the fold.
Treatment aims to stimulate collagen production and improve skin density and firmness. Thicker skin slightly corrects the marionette line, but the technique's main value is softening the associated skin crease. The alternative would be a medium-depth peel, but this is rarely performed because demarcation (a colour difference) is common.
Two to four sessions are needed. If marionette lines are subsequently treated annually with hyaluronic acid injections, laser treatment does not need repeating.
Aesthetic medicine procedures to improve marionette lines
Although these procedures for treating marionette lines without surgery are generally effective, they have limitations. When excess skin creates a bulge above the jawline, results may be less satisfactory. For optimal results in this indication, consulting a cosmetic surgeon about a possible face and neck lift is preferable.
After surgery, hyaluronic acid injections in marionette lines may be necessary to fill residual folds and achieve an ideal result. Consulting an experienced doctor to assess the best treatment options is therefore essential.
Before / after results of marionette line filling
Results are immediate and improve over the three weeks following treatment. They last approximately one year.
The lifting technique restores the triangle of youth and refines facial contours.
The face looks rested and wrinkles are softened physiologically or completely erased, depending on the patient's request and anatomy.
Immediately afterwards, mild swelling and small bruises may occur. These are rare and last no more than a few days. Normal activities can resume immediately after injections.
Marionette line injections, prices
In Geneva, a hyaluronic acid injection for marionette lines costs 600 CHF per syringe.
Sculptra treatment for marionette lines costs 900 CHF per vial, a Skinbooster costs 400 CHF per syringe and fractional ablative laser starts at 300 CHF per session.
How much does marionette line treatment cost ? Injection prices vary according to several factors : the product used, quantity needed and technique performed, which is linked to the doctor's expertise.
Dr Romano welcomes you to her practice in Geneva. All procedures use high-quality products under strict safety and hygiene standards. Prices vary according to the treatment plan and quantities required, but are transparent from the first consultation. A precise quotation is provided at the initial consultation after medical assessment. Every treatment is personalised and may combine several techniques for an optimal result.
Marionette line treatment prices are :
- Hyaluronic acid : 600 CHF per syringe.
- Sculptra : 900 CHF per vial.
- Skinbooster : 400 CHF per syringe.
- Fractional ablative laser : from 300 CHF per session.
Marionette line filling reviews
What are the reviews of marionette line injections ?
Patient reviews of medical treatments to remove marionette lines are positive.
Patients describe noticeable improvement in facial appearance and feel rejuvenated and more confident after treatment.
Results are considered natural and preserve facial expressiveness.
The procedure is described as quick, mildly painful and accessible because it requires no recovery time.
Frequently asked questions
Where are marionette lines located?
Marionette lines are wrinkles that extend from the corners of the mouth down towards the chin. Their appearance is associated in particular with loss of tissue support, changes in facial volume and skin sagging. They differ from nasolabial folds, which connect the sides of the nose to the corners of the mouth.
Should injections be made directly into the marionette line?
Not necessarily. Marionette lines may be linked to a loss of volume or support in the lower or middle third of the face. Depending on their cause, the doctor may choose to inject directly into the folds or restore tissue support. Excess hyaluronic acid can make the lower third of the face look heavier. Read more
Can injections for marionette lines also correct jowls?
Hyaluronic acid injections can improve the definition of the facial contour and reduce the appearance of jowls when sagging is moderate. However, they cannot remove significant excess skin. Marionette lines and jowls may have different causes and require specific treatments.
How much hyaluronic acid is needed to correct marionette lines?
The amount of hyaluronic acid needed depends on the depth of the marionette lines, facial anatomy and the product used. There is no single number of syringes that applies to every patient. A gradual correction allows a natural result and an assessment of whether an additional injection is needed.
What are the risks of hyaluronic acid injections for marionette lines?
Injections can cause redness, swelling, bruising, nodules or asymmetry. Infection or a vascular complication is also possible, but rare. Read more
Should marionette lines be massaged after injections?
Massaging marionette lines after a hyaluronic acid injection is not routinely recommended. It should only be done on the doctor’s instructions, depending on the gel used and the injection technique. If there is an irregularity or swelling, it is preferable to have the area examined rather than trying to move the product yourself. Read more
Further reading
Can hyaluronic acid injections for marionette lines be performed in summer?
Understand the precautions to take after hyaluronic acid injections for marionette lines during summer, particularly regarding sun and heat.
How can marionette lines be prevented?
Discover measures that can prevent or reduce the appearance of marionette lines, depending on their cause and age-related facial changes.
Do hyaluronic acid injections for marionette lines alter natural facial expression?
Understand how hyaluronic acid injections for marionette lines can soften these folds while preserving natural facial expressions.
