Unit 12: Marionette Lines


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.

Surface Anatomy

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.

Underlying Causes

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

Filler Volumes
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.