What are marionette lines and why do they appear?

    <p data-start="215" data-end="472">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.</p><p data-start="519" data-end="588">These lines become more pronounced over time due to multiple factors:</p><ul data-start="590" data-end="836"><li data-section-id="13j922k" data-start="590" data-end="635">Loss of volume in the premaxillary region</li><li data-section-id="1rvvht7" data-start="636" data-end="674">Descent of facial fat compartments</li><li data-section-id="on03cl" data-start="675" data-end="737">Laxity of the superficial musculoaponeurotic system (SMAS)</li><li data-section-id="1420dqe" data-start="738" data-end="791">Hyperactivity of the depressor anguli oris muscle</li><li data-section-id="ex47cn" data-start="792" data-end="836">Changes in the mandibular bone structure</li></ul><p data-start="896" data-end="1184">According to <strong>Dr. Ariel Arias</strong> and Rosa Irles, specialists in aesthetic and regenerative medicine in Almoradí,<br data-start="1004" data-end="1007" />“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.”</p>      
                <h3>How can marionette lines be treated?</h3>               
                <h5>Botulinum Toxin Type A (BNT-A)</h5>             
    <p data-start="166" data-end="394">Especially indicated in patients with strong muscular activity in the area. Its function is to weaken the <strong data-start="272" data-end="304">depressor anguli oris muscle</strong> and fibers of the platysma, allowing a <strong data-start="344" data-end="393">passive elevation of the corners of the mouth</strong>.</p>       
                <h5>Injectable Fillers</h5>             
    <p data-start="428" data-end="513">Currently the most commonly used treatment for these lines. Among the most effective:</p><ul data-start="515" data-end="734"><li data-section-id="tvhw2v" data-start="515" data-end="599"><strong data-start="517" data-end="542">Hyaluronic Acid (HA):</strong> Resorbable, safe, and with a high volumizing capacity.</li><li data-section-id="o6k3ws" data-start="601" data-end="734"><strong data-start="603" data-end="637">Polymethylmethacrylate (PMMA):</strong> A permanent filler used in specific cases, requiring prior skin testing to rule out allergies.</li></ul><p data-start="736" data-end="889">“Typically, around <strong data-start="755" data-end="794">1 ml of product per marionette line</strong> is used to achieve full correction, also addressing the jawline and chin,” explains Dr. Arias.</p>       
                <h5>A combined approach</h5>                
    <p data-start="2074" data-end="2103">In many cases, it is recommended to <strong data-start="254" data-end="293">combine botulinum toxin and fillers</strong>.<br data-start="294" data-end="297" />The former relaxes the downward-pulling musculature, while fillers soften the folds, achieving a <strong data-start="394" data-end="436">longer-lasting and more natural result</strong>.</p>       
                <h3>Real Cases: When Assessment Makes the Difference</h3>               
    <p data-start="501" data-end="745">A recent patient came in concerned about her marionette lines. She was looking for a <strong data-start="586" data-end="604">natural result</strong> and questioned whether those lines were truly the main cause of her aged appearance. After a thorough evaluation, Ms. Irles identified that:</p><ul data-start="747" data-end="931"><li data-section-id="1h2zawy" data-start="747" data-end="809">There was <strong data-start="759" data-end="807">volume loss in the central malar compartment</strong></li><li data-section-id="1vpt5la" data-start="810" data-end="856">The <strong data-start="816" data-end="854">jawline contour was poorly defined</strong></li><li data-section-id="1wvdm26" data-start="857" data-end="931">The marionette lines were a <strong data-start="887" data-end="929">consequence of overall facial collapse</strong></li></ul><p data-start="933" data-end="1127">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.</p><p data-start="1129" data-end="1313"><em>“Treating just the line without considering the whole face is like painting only one wall of an old house,” explains Ms. Irles.</em><br data-start="1256" data-end="1259" /><strong data-start="1259" data-end="1313">“True rejuvenation requires a global perspective.”</strong></p>     
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                <h3>What Injection Techniques Are Used?</h3>                
    <p data-start="243" data-end="325">Techniques vary depending on skin type, facial anatomy, and the depth of the fold:</p><ul data-start="327" data-end="436"><li data-section-id="1l8tv1s" data-start="327" data-end="362"><strong data-start="329" data-end="360">Linear retrograde threading</strong></li><li data-section-id="zll6cz" data-start="363" data-end="388"><strong data-start="365" data-end="386">Fanning technique</strong></li><li data-section-id="1a9ue3x" data-start="389" data-end="411"><strong data-start="391" data-end="409">Cross-hatching</strong></li><li data-section-id="1r8pcw5" data-start="412" data-end="436"><strong data-start="414" data-end="434">Serial punctures</strong></li></ul><p data-start="438" data-end="638">The product is placed at different depths: deeper for pronounced folds and more superficial for fine lines. It is essential to <strong data-start="565" data-end="592">massage after injection</strong> to prevent the formation of nodules or lumps.</p>     
                <h3>Common Mistakes in Treating Marionette Lines</h3>               
    <ul><li data-section-id="2fgd3t" data-start="698" data-end="759">Treating only the fold without evaluating the entire face</li><li data-section-id="9usvxv" data-start="760" data-end="822">Using <strong data-start="768" data-end="789">excessive volumes</strong>, leading to artificial results</li><li data-section-id="1i34zjh" data-start="823" data-end="896">Not combining with botulinum toxin when the muscular component is key</li><li data-section-id="ayclo0" data-start="897" data-end="947">Lack of proper product distribution techniques</li></ul>       
                <h3>Final recommendations from the experts</h3>             
    <ul data-start="182" data-end="606"><li data-section-id="2uovpc" data-start="182" data-end="266"><strong data-start="184" data-end="223">Individualized clinical assessment:</strong> Not all faces require the same approach.</li><li data-section-id="1y5cf82" data-start="268" data-end="372"><strong data-start="270" data-end="322">Analysis of the mid and lower third of the face,</strong> including the neck, SMAS, and fat compartments.</li><li data-section-id="zi9e8c" data-start="374" data-end="462"><strong data-start="376" data-end="430">Proper selection of filler and injection technique</strong> based on skin type and depth.</li><li data-section-id="ahu7bz" data-start="464" data-end="522"><strong data-start="466" data-end="491">Avoid overcorrection:</strong> In aesthetics, less is more.</li><li data-section-id="1vkmogr" data-start="524" data-end="606"><strong data-start="526" data-end="569">Aim for harmonious and natural results,</strong> not just the elimination of folds.</li></ul>      
                <h3>Where to Have the Treatment Done with Confidence?</h3>              
    <p data-start="671" data-end="718"><b><a href="https://www.doctoralia.es/z/i3jGxt">Dr. Ariel Arias</a></b> and <b><a href="https://www.doctoralia.es/rosa-irles-moreno/enfermero/almoradi">Lic. Rosa Irles</a></b> see patients at:</p><ul data-start="720" data-end="748"><li data-section-id="1gg06n8" data-start="720" data-end="748"><strong data-start="722" data-end="746">Skin Esthetic Clinic</strong></li></ul><p data-start="750" data-end="848">You can check their professional profiles, patient reviews, and book an appointment on <b><a href="https://www.doctoralia.es/z/i3jGxt">Doctoralia</a></b>.</p>       
                <h3>Frequently Asked Questions (FAQ)</h3>               
    <p data-section-id="1le41de" data-start="163" data-end="216"><strong data-start="167" data-end="216">Does the treatment for marionette lines hurt?</strong></p><p data-start="218" data-end="305">No. Topical anesthesia is used, along with cannula techniques that minimize discomfort.</p><p data-section-id="unzqy1" data-start="312" data-end="368"><strong data-start="316" data-end="368">How long do the effects of hyaluronic acid last?</strong></p><p data-start="370" data-end="462">Between 9 and 18 months, depending on the type of product used and the patient’s metabolism.</p><p data-section-id="tibed7" data-start="469" data-end="525"><strong data-start="473" data-end="525">Can it be combined with other facial treatments?</strong></p><p data-start="527" data-end="633">Yes, it is recommended to combine it with other treatments such as non-surgical lifting or biostimulation.</p><p data-section-id="yg3cg8" data-start="640" data-end="693"><strong data-start="644" data-end="693">Can it be treated with botulinum toxin alone?</strong></p><p data-start="695" data-end="774">Only if the main cause is muscular. In most cases, it is combined with fillers.</p>     
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                <h4>Skin Esthetic Clinic</h4>               
    <p data-start="177" data-end="335">Aesthetic medicine performed in unauthorized centers and by personnel lacking proper training and certification represents a serious risk to patients’ health.</p><p data-start="337" data-end="597">At <strong data-start="340" data-end="357">Skin Esthetic</strong>, we are an <strong data-start="369" data-end="407">Advanced Aesthetic Medicine Clinic</strong>. We provide medical-aesthetic treatments with rigorous scientific standards, delivered by a fully qualified team and always focused on preserving the natural essence that is uniquely yours.</p><p data-start="599" data-end="673">Remember, at Skin Esthetic, we work so that your only concern is to think:</p><p data-start="675" data-end="709"><strong data-start="675" data-end="709">“Why didn’t I do this sooner?”</strong></p>