When injecting filler into the marionette line, it is important to understand the positioning of the mental and inferior labial arteries.
A reduction in tissue elasticity as we age causes skin laxity – this, combined with loss of volume above and below the oral commissures, contribute to the development of marionette lines.
Before injecting dermal filler, the length and depths of the lines should be examined for superficial creases as well as loss of volume. The different features will need to be treated with different techniques.
The chin area will also suffer from a loss of volume contributing to the overall appearance of the line.
Loss of volume
An increase in skin laxity due to aging and sun damage
Loss of teeth in the lower jaw
Desired Treatment Outcomes
Improvement in the appearance of jowls
Helps to lift-up the corners of the mouth
Improves the jaw line
Softens and removes the pre-jowl sulcus
Choice of Filler
Medium or high viscosity fillers
Common site-specific side effects
Common Injection Techniques
Fanning – which evenly spreads the filler for volume replacement
Layering – technique ideal for spreading filler in areas of severe loss of volume
Superficial wrinkles at the corner of the mouth may only require less than 0.2ml of filler, whereas more
severe folds may require up to 1ml.