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Marionette lines create an aged, sad look due to ageing, volume loss, bone resorption, and lifestyle factors. They typically appear in the late 30s to early 40s but can vary based on genetics and other external influences.
Dermal fillers help soften marionette lines by restoring lost volume, enhancing facial balance, and maintaining natural expression.
Best injection technique practices include holistic facial assessment, selecting appropriate fillers, using a combination of cannula and needle injections, and layering for structural support.

Marionette lines – the vertical folds that run from the corners of the mouth to the chin – are a common concern for many patients. At our Smileworks Liverpool practice, we have patients come to us on a weekly basis complaining of these lines. They tell us they make them look sad and older, and they’re desperate for an effective yet safe solution that will give them their confidence back.

While these lines are a natural part of the ageing process and aren’t a sign of any serious medical problem, they can severely impact confidence levels. This is where marionette line filler comes in. With the right technique, these lines can be dramatically softened. Dermal filler in this area allows patients to get the youthful, refreshed look they’ve been yearning for.

In this post, we’ll explore everything you need to know about marionette line filler, from how the lines form to the best injection techniques. This article is designed both for injectors looking to expand their practice’s scope and for patients curious about their treatment options. All of these tips come from Dr MJ, the world-renowned lead instructor at the Smileworks Aesthetic Training HUB.

What are Marionette Lines?

Marionette lines, also called melomental folds, are lines that extend from the corners of your mouth to your chin. The colloquial name comes from marionette puppets, which have those lines in the same place. These lines divide the chin from the rest of the face and creates an aged, sad look.

Marionette lines form due to a combination of factors. The most common are:

Ageing: Over time, collagen and elastin production, leading to a loss of skin firmness in this area of the face.
Volume Loss: People can lose volume in this lower face with age or with significant weight loss. When this happens, the fat pads in the mid-face shift downward, worsening the appearance of these lines.
Bone Resorption: Structural changes in the jawline contribute to a sagging appearance in the lower face.
Lifestyle Factors: Sun exposure, smoking, and repeated facial expressions can all accelerate the deepening of these lines.

Typically, marionette lines became more noticeable in the late 30s and early 40s. However, keep in mind genetics and external factors play a heavy role, so some people will not develop them at all. Genetics can also play a role in how pronounced they are. If either of your parents have severe marionette lines, there is a chance you will as well. Luckily, dermal fillers act as an excellent remedy for these lines.

How to Get Rid of Marionette Lines with Filler?

Dermal fillers are a highly effective solution for softening marionette lines. While filler might not reduce them completely, it can significantly reduce the appearance. These hyaluronic-acid based injectables can restore lost volume, provide needed support to the skin, and create a smoother, more youthful appearance.

There are three key goals of marionette line filler. The first is to lift and to soften. Strategically placed filler can lift and smooth the lines without looking overfilled. The emphasis is on strategic here. Too much filler, and you risk your patient looking overfilled.

The next goal is enhancing facial balance. Treating marionette lines alone isn’t always enough. Restoring volume in the upper two-thirds of the face can reduce the look of marionette lines and enhance overall facial harmony.

Finally, marionette line filler aims to maintain expression. The best results preserve natural facial movement. Skilled injectors will ensure they avoid creating overly artificial or heavy appearance for their patients.

Most fillers last between 6 to 18 months, depending on the patient and product used.

Marionette Line Filler Injection Technique

Which marionette line filler technique used varies from injector to injector. Every practitioner has their preferred methods for treatment, and which you use typically depends on how you learn during your training day. What matters most is that the injector priorities patient safety above all else. This is the cornerstone value at the Smileworks HUB, and we instill this on all delegates who come through our doors to train.

There are a few technique options available, and we’ll outline some of them here. For more in-depth marionette line filler training, we recommend book a one-to-one mentoring session with Dr MJ for a personalised training day.

1. Holistic facial assessment

Every consultation should start with a facial assessment. Oftentimes an injector will not only inject marionette lines. They should assess the entire face to determine the root cause of the issue. Volume loss in the mid-face, weak chin projection, or skin laxity all contribute to the appearance of marionette lines. A comprehensive approach ensures the best results for the patient.

Treatments that complement marionette line filler include Botox in the depressor anguli oris muscle (the facial muscles at the sides of your chin), mid-face dermal filler, skin boosters, and microneedling. Whether a patient needs additional treatment will be addressed at their initial consultation.

2. Choosing the right filler

More often than not, the filler used for marionette line treatment will be hyaluronic acid-based dermal fillers. Which brand you choose is up to personal preference, but some of the most common filler brands include Juvederm, Restylane, and Teoxane.

Next, it’s time to consider whether they’ll use a firm or soft filler. Firmer fillers offer structure and lift and are best for the deeper layers of the skin. Softer ones integrate more seamlessly into the dynamic areas around the mouth and are injected more shallowly. Depending on the patient’s case, one or both filler types might be used to achieve the desired result.

3. Cannula vs needle injection

Whether to use a cannula or a needle is another factor that comes down to injector preference. A cannula is not as sharp as a needle, but it reduces bruising and minimises vascular complications by linearly threading filler gently under the skin. On the other hand, a needle allows for precision in smaller areas where detailed sculpting is needed.

Many injectors opt to use a cannula to initially fill the area, and then go in with a needle to finetune the results. This combination approach often yields the best results.

4. Layering for best results

Depending on the patient, injectors may need to inject into multiple layers of the skin. Deep injections are beneficial for structural support in the pre-jowl sulcus. This prevents further sagging for the patient.

Superficial injections are good for fine-tuning the results to smooth the skin and soften any remaining harsh shadows.

When Marionette Line Filler Goes Wrong

No patient wants a case of marionette line filler gone wrong. It is an injector’s responsibility to perform the treatment both safely and effectively. Even the most skilled injectors can cause a complication if they don’t watch out for the following:

Overfilling: Too much filler creates an unnatural, heavy look. No patient wants to fall victim to the dreaded pillow face. A conservative approach is always best. You can always add more filler if needed, but it becomes harder to take it away once it’s placed.
Ignoring the Upper Two-Thirds: Treating marionette lines in isolation could lead to an unbalanced appearance. Be sure to assess the full face to determine if there are any other treatments that could reduce marionette line appearance.
Overlooking Chin Projection: A weak chin can worsen the appearance of marionette lines. The chin should be considered during treatment. Enhancing chin structure can improve results.

When marionette line filler does go wrong, you’ll want to be prepared. In our Smileworks Liverpool clinic, Dr MJ Rowland-Warmann hosts the UK’s only dedicated complications clinic where she uses ultrasound to locate and address filler complications. If there is anyone to take advice from for filler complications, it’s Dr MJ. Patients come from all over the world to treat their complications with Dr MJ, and she can tell you from experience that ultrasound is the best tool for treating marionette line filler gone wrong.

For training on how to treat complications with ultrasound, see our foundation ultrasound course and our advanced ultrasound course. These courses were carefully crafted to ensure you can walk away from the course with the knowledge needed to treat and resolve any complications that come your way.

For Patients: What to Expect at Your Appointment

Before Treatment

A good result begins before the needle or cannula touches your skin. You will start with your consultation where your injector will perform a facial assessment and recommend you your personalised treatment plan.

At Smileworks Liverpool, our patients will either move forward with treatment at their consultation or choose to have their treatment at a later date. Regardless of when you have your treatment, be sure to avoid blood thinners like aspirin and alcohol to minimise bruising.

During Treatment

You can expect the actual treatment to take between 20-40 minutes. To make you comfortable during treatment, your injector will inject a local anaesthetic. Their goal should be to minimise discomfort as much as possible.

Next, they will strategically inject small amounts of filler along your marionette lines for a natural, balanced result. Your lines should be noticeably smoother right away.

After Treatment

Don’t panic if you experience mild swelling, redness, or bruising. These side effects are completely normal and should subside within a few days.

The beauty of dermal filler treatment is the zero downtime. You can resume normal activities right away.

Full results will develop within 1-2 weeks as swelling settles and the filler integrates into the skin. Your injector may book a follow-up appointment to check in on your results and top-up with additional filler if necessary.

Marionette Line Filler Cost UK

The price for marionette line filler treatment varies from clinic to clinic. At Smileworks, our medically trained practitioners charge £390 to fill the marionette lines (less if you’re an aesthetic training model!). This price can be higher or lower depending on injector experience, the quality of filler used, and where in the UK the clinic is located.

Remember that cheaper usually does not mean better. You should research potential injectors thoroughly before committing to one. The marionette lines are an advanced area to treat with filler, so you want to look for someone with experience, skills, and reputation.

Learn How to Treat Marionette Lines from the Expert

If you’re interested in diving deeper in marionette line filler technique, look no further than the Smileworks Aesthetic Training HUB – an esteemed aesthetic training centre based in the UK. We pride ourselves on our wide range of online and hands-on courses tailored for every skill level.

Currently, the best way to learn marionette line filler is through Dr MJ’s 1-2-1 mentoring sessions. During this hands-on training day, you’ll receive personalised training on marionette line filler and any other filler treatment you’re interested in learning. Dr MJ will work with you to plan your training day. This ensures you get the most out of it and walk away fully prepared to treat patients by the end of the day. These training days are designed for all skill levels, whether you’re a beginning or advanced practitioner.

Dr MJ does this everyday. She has over a decade experience treating patients and has built one of the most bustling aesthetic practices in the UK. Hundreds of injectors have learned under her expertise. There is no voice in this industry that is more trusted when it comes to marionette line filler.

Maybe you’re still a beginner or prospective injector. Our online lip filler and Botox course can teach you all the best techniques for two of the most popular treatments in the industry. Our lead instructor and co-founder Dr MJ will guide you through how to create gorgeous results for your patient.

It’s time to embrace the prospering world of aesthetic medicine. The HUB provides you with all the right training and guidance you need to succeed. Take control of your professional journey and step into a future filled with endless potential and opportunities.

Join us at the HUB. Let’s shape the future of aesthetic medicine together and ensure safe, effective, and transformative results for every patient.

Want to try out our courses before committing? Take advantage of our free trial for a taste of what learning at the HUB is like.

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