What are marionette lines and why do they appear?
So-called marionette lines, also known as mentolabial folds, are the grooves that extend vertically from the corners of the mouth down to the jawline. They can give the face a more aged appearance and may also convey a sad or tired expression, even at rest.
These lines become more pronounced over time due to multiple factors:
- Loss of volume in the premaxillary region
- Descent of facial fat compartments
- Laxity of the superficial musculoaponeurotic system (SMAS)
- Hyperactivity of the depressor anguli oris muscle
- Changes in the mandibular bone structure
According to Dr. Ariel Arias and Rosa Irles, specialists in aesthetic and regenerative medicine in Almoradí,
“marionette lines should never be treated in isolation. A rigorous clinical approach that evaluates the face as a whole is always necessary to achieve truly harmonious results.”
How can marionette lines be treated?
Botulinum Toxin Type A (BNT-A)
Especially indicated in patients with strong muscular activity in the area. Its function is to weaken the depressor anguli oris muscle and fibers of the platysma, allowing a passive elevation of the corners of the mouth.
Injectable Fillers
Currently the most commonly used treatment for these lines. Among the most effective:
- Hyaluronic Acid (HA): Resorbable, safe, and with a high volumizing capacity.
- Polymethylmethacrylate (PMMA): A permanent filler used in specific cases, requiring prior skin testing to rule out allergies.
“Typically, around 1 ml of product per marionette line is used to achieve full correction, also addressing the jawline and chin,” explains Dr. Arias.
A combined approach
In many cases, it is recommended to combine botulinum toxin and fillers.
The former relaxes the downward-pulling musculature, while fillers soften the folds, achieving a longer-lasting and more natural result.
Real Cases: When Assessment Makes the Difference
A recent patient came in concerned about her marionette lines. She was looking for a natural result and questioned whether those lines were truly the main cause of her aged appearance. After a thorough evaluation, Ms. Irles identified that:
- There was volume loss in the central malar compartment
- The jawline contour was poorly defined
- The marionette lines were a consequence of overall facial collapse
The treatment addressed not only the mentolabial folds, but also included volume restoration in the cheeks and refinement of the jawline contour. The result was remarkable, even for the patient.
“Treating just the line without considering the whole face is like painting only one wall of an old house,” explains Ms. Irles.
“True rejuvenation requires a global perspective.”
What Injection Techniques Are Used?
Techniques vary depending on skin type, facial anatomy, and the depth of the fold:
- Linear retrograde threading
- Fanning technique
- Cross-hatching
- Serial punctures
The product is placed at different depths: deeper for pronounced folds and more superficial for fine lines. It is essential to massage after injection to prevent the formation of nodules or lumps.
Common Mistakes in Treating Marionette Lines
- Treating only the fold without evaluating the entire face
- Using excessive volumes, leading to artificial results
- Not combining with botulinum toxin when the muscular component is key
- Lack of proper product distribution techniques
Final recommendations from the experts
- Individualized clinical assessment: Not all faces require the same approach.
- Analysis of the mid and lower third of the face, including the neck, SMAS, and fat compartments.
- Proper selection of filler and injection technique based on skin type and depth.
- Avoid overcorrection: In aesthetics, less is more.
- Aim for harmonious and natural results, not just the elimination of folds.
Where to Have the Treatment Done with Confidence?
Dr. Ariel Arias and Lic. Rosa Irles see patients at:
- Skin Esthetic Clinic
You can check their professional profiles, patient reviews, and book an appointment on Doctoralia.
Frequently Asked Questions (FAQ)
Does the treatment for marionette lines hurt?
No. Topical anesthesia is used, along with cannula techniques that minimize discomfort.
How long do the effects of hyaluronic acid last?
Between 9 and 18 months, depending on the type of product used and the patient’s metabolism.
Can it be combined with other facial treatments?
Yes, it is recommended to combine it with other treatments such as non-surgical lifting or biostimulation.
Can it be treated with botulinum toxin alone?
Only if the main cause is muscular. In most cases, it is combined with fillers.
Skin Esthetic Clinic
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“Why didn’t I do this sooner?”