Marionette Lines: What are they and what can we do about them?

Most people giggle when they first hear the cosmetic term, marionette lines. It brings to mind the separate mouth section on a marionette puppet’s face that allows them to open and close their mouth and appear as if they are speaking. These are two very distinct lines running from the corners of the mouth to either side of the chin, a very appropriate name for the similar lines on a human face.

(I also like the term, ‘party hat lines’ which describes the lines that form vertically down the cheeks as if you have been wearing a tight party hat.)

By our mid 40’s, most of us are starting to notice these lines creeping onto our faces, totally uninvited I might add.

Why do we get marionette lines?

Just like any lines or wrinkles, a combination of a breakdown in collagen and elastin in the skin, making the skin thinner and less able to recover from the sun and environmental damage and the steady depleting tissue volume and bone loss.

Basically, the balloon is deflating. The mouth area gets a good deal of movement in a day, chewing, speaking and smiling, so it tends to be an area that loses volume early causing the corners of the mouth to turn downward, the lips to thin out and lines to form above and below the lips as well. Curious as to what those are called? Barcode lines. Another perfect, yet rather cheeky cosmetic term.

Hyaluronic acid fillers are still some of the best and safest solutions. You want a long lasting filler with plenty of ‘puff’ and a bit of stiffness to support this area.

Why are they the safest?

There is an enzyme available which can break down hyaluronic acid fillers instantly in the rare event of a blood vessel being constricted. (Hyaluronidase) It’s a good option to have and not every filler has this antidote.

How is the filler injected?

Each injector has their own technique for the correction of marionette lines. A popular one is the fanning technique which lays the filler down in lines, fanning out from the first injection. Then a small amount of filler is injected into the corners of the mouth along the lip line to create a support system for the tissue while also lifting the corners upward.

In some cases where the sagging skin is partially created by cheek-fat-pad loss, rejuvenating the cheeks with the same, thick fillers can have a mild uplifting effect on the marionette areas.

Does it hurt?

The fillers themselves have lidocaine built into them which numbs the tissue as it’s injected. Some clinics also use a topical numbing cream for 10-20 minutes before the treatment to help make it as comfortable as possible,

Marionette lines are vertical lines which increase the appearance of aging most, so reducing them can take years off your face. These lines will only get worse so it’s best to deal with them while your skin still has some decent ‘snap’ left in it so you don’t look like someone is pulling your strings!

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