Non-surgical Procedures

Why I don’t treat marionette lines with dermal fillers anymore

What are marionette lines?

As we age, the collagen production in our skin cells naturally starts to reduce, and our skin loses elasticity. The skin around the sides of your mouth is thinner than other areas of your face, so you may notice deep lines running down the sides of your mouth – these are called marionette lines. They get their name from marionette string puppets with split jaws so the puppeteers can make them talk. These lines may start to appear when your skin loses thickness, and gravity pulls your face down.

When do signs of skin ageing usually appear?

Marionette lines commonly arise for people in their early to mid forties and many people think that it makes them look and feel older than they are.

treatment for marionette lines puppets face victorian cosmetic institute

Since 2005 Dr Gavin Chan (MBBS, Cosmetic Doctor, Liposuctionist) and his team have been treating patients with marionette lines and folds. Unlike many clinics, Dr Gavin Chan isn’t using dermal fillers to reduce the appearance of marionette lines and folds anymore. With his many years of training, experience and an aesthetic eye for detail, Dr Gavin Chan has discovered the best way to treat marionette lines and folds.


What causes marionette lines and folds?

Marionette folds and lines are caused by three separate factors: gravity, loss of volume and the depressor muscles at the corner of the mouth. Dr Gavin Chan notes that gravity is the main cause of ‘puppet face’ (where your nasolabial lines and marionette folds are prominent). “Your face is affected by gravity every day. Over time you get downward and inward movement of your cheeks and face. This results in your cheeks folding over to create marionette folds and nasolabial lines”

Volume loss is the second biggest contributor to marionette folds and lines developing. Dr Gavin Chan says there are two volume losses that contribute to this:

  • The volume loss of the soft tissues where fat skin becomes thinner, also known as soft tissue volume loss; and
  • The volume loss of bone where the mandible becomes thinner and resorbs, also known as bony resorption of the mandible. This bone resorption is most evident when you see someone who has no teeth or hasn’t got their dentures in.

The final contributing factor to marionette lines and folds and lines developing is when the depressor muscles of your mouth corners are constantly activated. When this muscle called depressor anguli oris (DAO) is constantly activated it creates a ‘sad face’ look. Many people use this muscle unintentionally, causing their mouth corners to pull down.


Marionette line treatments

What is the best way to treat marionette lines and folds?

Since there are multiple causes of marionette line folds developing, there is no ‘easy fix’ to treat them. In the past, we used dermal fillers to treat them, but we don’t recommend this anymore, simply because it doesn’t work. The best marionette lines treatment will differ from patient to patient, because every face is different.

Surgical facelift/cosmetic surgery

The “gold standard” to fix marionette folds is to have a surgical facelift. This is because surgically pulling the folds back from the mid-face area and above is the best way to fix them. Surgical facelifts only appeal to a small percentage of patients who are highly motivated and prepared for the considerable downtime and expense.

ridiculously large cheeks from cosmetic treatment

Anti-wrinkle injections

Patients who don’t want to undergo facelift surgery often wonder if using dermal filler in their cheeks will help treat their marionette lines and nasolabial folds. While this would theoretically help lift the whole face up, it would require a lot of dermal filler to be used and your cheeks would become ridiculously large. Rather than use dermal filler in the cheeks, Dr Gavin Chan prefers to use anti-wrinkle injections in the depressor anguli oris to stop the downward turned mouth that makes you look sad.

depressor anguli oris makes your face look sad


Why we don’t use dermal filler for marionette line treatment

Using excessive amounts of dermal fillers to help alleviate marionette folds or turn mouth corners up is no longer viewed as the best way to reduce the appearance of marionette lines and folds. Dr Gavin Chan recognised that patients who have had their marionette lines treated with dermal filler were often not happy with the results.

Filling this facial area only made it thicker and didn’t remove the marionette folds. In some cases, they had shifted out a bit because the filler was pushing the skin outwards. Overfilling the marionette line area of the face also started to distort some patients’ face shape. Some patients had some extra thickness in the lower half of their face rather than having the desired face shape of fullness in the cheeks and thinness and sharpness around the jawline.

Our Cosmetic Doctors and Cosmetic Nurses aren’t treating marionette folds with fillers anymore. This shift of direction recognises that this area of the face cannot significantly change unless you undergo face-lift surgery. So how do we treat your marionette lines and folds now? We focus on your facial shape and contour while using anti-wrinkle injections and dermal fillers to enhance this.


Treating marionette lines and folds using the principles of facial shape and contour

When you look at someone’s face a few metres away, in most cases you can guess how old they are. From a distance, the facial shape can indicate how old someone is, usually within a 5-year period. While many of our patients are concerned about upper lip lines, crow’s feet and forehead wrinkles, we know that improving their facial shape and contour will make them look and feel more youthful.

Not convinced? Think about how your hair stylist cuts your hair and shapes it to give you the ideal facial shape. If you have hollow temples they’re going to ensure your hair falls across them. If you have a wide jawline they may give you a hairstyle to cover your jawline. The best marionette line treatments should follow a similar logic.

We know patients will often focus on facial wrinkles, lines and folds because they can only see themselves in two dimensions, in a photo or in a mirror. When our highly trained and experienced Cosmetic Doctors and Nurses see our patients, they view them in three-dimensional contours rather than a two-dimensional image.

placing dermal fillers in corners of mouth

After our aesthetic facial assessment, treatment can improve marionette lines and folds by firstly using dermal filler in the corners of the mouth. This adds volume and helps to move the mouth corners forward to support your lower lip, creating a more upwards turned mouth corner. The next thing we do is shape your jawline by using some filler alongside it. This lowers the jawline just adjacent to your chin to give you a straight jawline.

placing dermal filler to give straight jawline

All our clinics now focus on improving the overall shape around the marionette lines and folds by improving the shape and contour of the jawline and mouth.


How to prevent marionette lines

Take care of yourself and your skin

The best way to prevent shallow marionette lines is to live a healthy nourished lifestyle. Some habits that can help prevent facial wrinkles and sagging skin and maintain a youthful appearance include:

  • Getting enough sleep every night
  • Drinking plenty of water
  • Limiting your caffeine and alcohol intake
  • Reducing your sun exposure
  • Eating a healthy diet
  • Managing your stress levels
  • Sticking to a daily skin care routine


The best anti-ageing skincare to make your face feel fresher and look younger

Since deep marionette lines appear as a part of the natural ageing process, it’s useful to consider using skincare products that help reduce this. Biopelle Tensage Daily Serum SCA 15 Biorepair index (30ml) can help improve the visible signs of ageing and is suitable for all skin types. This oil-free daily serum helps brighten and even skin tone, repair photodamage and improve the appearance of fine lines and wrinkles. Used twice daily, the combination of Niacinamide, antioxidants, brightening agents and humectants helps maintain results from non-surgical treatments and aesthetic procedures.

Cosmedix Elite X-Age (30ml) has been specifically formulated to improve your skin’s appearance by making it softer, firmer and free from imperfections. Its unique formula of sodium hyaluronate, Vitamin A and soy biopeptides is ideal for ageing skin as it helps keep your skin hydrated and supple. This skincare product is ideal to use if you have photo-damaged, dry, irritated or dehydrated skin and is useful and suitable to use after peels or laser treatments.

Biopelle Tensage Stem Cell Cream helps combat the multiple signs of ageing for mature skin on the face, neck and décolletage. The nourishing, rich formula reduces fine lines and wrinkles, smooths out rough skin texture, and evens skin tone. This cream is ideal for night with a rich combination of peptides, ceramide NP, Vitamin C and E, retinol, and soothing botanical extracts. It can be used during the day if a high SPF sunscreen is applied over it.


Book your consultation today.

Not sure which skincare is best for you? A consultation with one of our highly qualified and experienced Skin Therapists will ensure your personalised skin care regime delivers optimal results. Contact 1300 863 824 to book your consultation.


Get the best marionette folds and marionette lines treatment in Melbourne

If your facial expressions are creating unwanted smile lines, wrinkles and folds, we can help. Since 2005, we have successfully treated thousands of people’s marionette lines, wrinkles and folds to help them feel and look younger. Led by Dr Gavin Chan, our highly trained and experienced Cosmetic Doctors and Cosmetic Nurses are passionate about creating subtle changes to your face. Simply click the ‘book online’ button above and fill out the form, or call us on 1300 863 824.