Marionette Line

Safety

When injecting filler into the marionette line, it is important to understand the positioning of the mental and inferior labial arteries.

Anatomy

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

• Retrogenia

•  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 effects

Bruising

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.