As marionette lines can lead to a sad or tired expression, many people find this type of wrinkle particularly annoying. This makes the treatment of marionette lines one of the most sought-after treatments. Unfortunately, in some cases, injecting hyaluronic acid alone does not lead to the desired result. In this article, we explain how you can differentiate and, with the right indication, carry out a successful injection!

What are marionette lines and how do they develop?

Marionette lines, also known as mentolabial folds or corner of the mouth lines, are wrinkles that run vertically downwards from the corners of the mouth to the chin.

Mentolabial folds are caused by the natural ageing process: loss of volume at the bony level and in the fatty tissue (in the area of the back and front temples, the zygoma, the midface and the jawline) and sagging of the tissue, which follows the force of gravity and pulls forward and down. The ligamentous apparatus from the nose to the chin keeps the sagging tissue from sliding towards the chin and this is where it “breaks” and the marionette lines (and also the nasolabial folds) become visible.

Can all marionette lines be injected with hyaluronic acid filler?

The short answer: No. The treatment methods depend on the degree of wrinkles. It is important to carry out a patient consultation as a first step, as marionette lines cannot usually be completely removed, but can only be improved by one degree.

Hyaluronic filler treatment or repositioning of the tissue?

Injections with hyaluronic acid filler may be considered for mild to moderate severity. Based on the degree of severity, it is then decided which other areas of the face (back and front temples, zygoma, midface and jawline) also need to be treated in order to achieve an improvement. With the right technique, the area can be specifically lifted, the facial contour improved and the expression made to appear friendlier and fresher.

In very severe cases, minimally invasive methods are often not sufficient to achieve a satisfactory result. In these cases, repositioning of the tissue by means of a face lift should be considered.

Which injection technique is used to inject the marionette lines?

Both the cannula technique and the needle technique can be used. As the risk of complications is lower with the cannula technique, we prefer it. To treat the mentolabial folds, a puncture is made in the chin area and a cannula is then inserted through this to release the hyaluronic acid in a fan-shaped manner. Due to the way in which marionette lines develop, in most cases the temples, zygoma, midface or jawline are also treated, depending on their severity. In this way, the sagging tissue responsible for the formation of wrinkles can be supported and the face given structure.

Which hyaluronic acid is used for this wrinkle injection?

At The Filler Academy, we like to use the hyaluronic filler “Belotero” from Merz Ästhetics. However, there are also other companies that produce very good hyaluronic fillers.

You should pay attention to these factors when choosing a hyaluronic filler

1) Cohesivity: How “stubborn” is the product and how easily is it distributed in the tissue?

2) E-Prime: What elastic capabilities does the product have?

3) G-Prime: What is the lifting capacity of the product?

A product with good lifting capacity is needed in the area of the marionette lines, which is why the products Belotero Intense or Volume are used here to build up volume and so-called hybrid fillers are used in the area of the temples, zygoma, cheeks and jawline.

What complications can occur when injecting the marionette line with hyaluronic acid filler?

Aesthetic treatments with hyaluronic acid also involve risks. It is important to be aware of these, to know how to avoid them and to react correctly if the worst comes to the worst!

Slight complications of hyaluronic acid injections

Minor complications include bruising and slight swelling around the puncture site. These can be treated at home with ice and special creams and usually subside on their own after 1-3 days.

Serious complications of injections with hyaluronic acid fillers

Serious complications include puncturing or compressing a vessel. If not treated in time (within a few hours), this can lead to necrosis and thus the death of healthy tissue. The risk of serious complications can be significantly reduced by using the cannula technique and a cautious dosage of hyaluronic acid.

Training and further education in aesthetic medicine: learn hyaluronic acid & Botox injections at The Filler Academy

At the Filler Academy, we offer the first in-depth training in aesthetic medicine for doctors in German-speaking countries. We want to create a standard that stands for the best quality, distinguishes doctors and provides patients with guidance.

The training to become a certified injector comprises 8 modules (online & hands-on), covering all areas from anatomy and theoretical principles to practical implementation, including injection techniques.

Botox & Hyaluron Filler courses in theory and practice for doctors

You will learn how to use fillers in the mentolabial fold area in our F3 Full Face Botox & Filler Expert course. The F3 is for advanced practitioners and is aimed at doctors with at least one year of professional experience or who have performed more than 100 aesthetic treatments. You can find out more about the F2 course for doctors here . We will soon be launching our own project for alternative practitioners.

Always at the cutting edge of science in the field of aesthetics

Would you like to keep up to date with the latest scientific developments in aesthetic medicine in the field of minimally invasive treatments? Then become a member of our e-cademy, the online platform for continuous training in aesthetic medicine for doctors. New video shorts from the fields of science, practice and anatomy await you here every month, as well as compact treatment videos organized by region on the subject of Botox and hyaluronic acid treatments.