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Best Dermal Fillers to Treat Marionette lines

Collagen and elastin are two proteins that provide volume to the skin and improve skin elasticity and smoothness. As we age, the production of these proteins decreases, leading to aging signs such as fine lines, creases, and facial wrinkles. Marionette lines are the creases found below the nasolabial folds, forming along the corners of the mouth and running down to the jawline. The name is derived from the vertical lines along the faces of marionette string puppets, which allowed them to appear as though they were talking. These creases should not be confused with nasolabial folds or smile lines, which run from the nose to the mouth. The formation of marionette lines is part of the natural aging process, but excessive sun exposure and regular smoking can contribute to these lines forming prematurely. Once these lines appear, they become deeper with age and cannot be removed. However, many cosmetic treatments are available to help diminish the appearance of marionette lines and create a more youthful appearance.

Dermal filler treatment is one of the most popular non-invasive cosmetic treatments to reduce the appearance of moderate to severe marionette lines. Filler injections can be placed around the lower face to erase fine lines along the skin, restore volume, and provide a non-surgical facelift. Sculptra and Radiesse are two fillers that are most commonly used for marionette lines, as they are both FDA-approved to treat these areas. Although they are formulated with different compounds, they both stimulate collagen production to reverse signs of aging for a long-lasting effect. Hyaluronic acid fillers such as Juvederm and Restylane are also FDA-approved to treat moderate to severe folds along the mouth and work to smooth out fine lines and replenish volume to the skin.

Dr. Michele Green is an internationally renowned board-certified expert in the field of cosmetic dermatology with over two and a half decades of experience providing some of the world’s most discerning individuals with the best non-invasive treatment options available. Due to her dedication to her patients and expertise, Dr. Green has consistently been recognized as one of New York City’s best dermatologists by Castle Connolly, New York Magazine, and Super Doctors. Dr. Green is an expert injector of dermal fillers, approaching rejuvenation with a less-is-more philosophy to achieve the best aesthetic results for each individual.

What are the best fillers for marionette lines?

There are a variety of dermal fillers that can be used for marionette line treatment. Although they differ in formulas, these fillers work to replenish volume loss in the skin to reverse signs of aging and rejuvenate the skin in multiple areas of the face. These fillers do not require any downtime and have minimal side effects, such as swelling and bruising, making them the best non-surgical cosmetic treatment for marionette lines.

Sculptra is formulated with poly-L-lactic acid (PLLA), a biodegradable substance that stimulates collagen production. After injection, the body creates an immune response that releases fibroblasts, which surround the filler and stimulate collagen production in the area. As Sculptra is broken down and excreted, the body keeps synthesizing collagen in the treatment area, resulting in replenished volume, tightened skin, and a diminished appearance of marionette lines. Sculptra works across a series of injections to provide gradual results, with initial results appearing after one month and long-term results lasting for approximately two years. Sculptra does require aftercare massaging five times a day, for five minutes, for five days, to achieve the best cosmetic results.

35-44 year old woman treated with Restylane Lyft

Radiesse is a collagen bio-stimulator made of calcium hydroxyapatite (CaHA) microspheres. Radiesse does not create an inflammatory response but instead uses calcium particles to act as a scaffold to build and synthesize collagen. The formulation of Radiesse is thick and viscous, allowing for results to be visible after just one injection; its gel-like consistency adds immediate volume to the face to fill in marionette lines and create a more youthful appearance. As the CaHA is absorbed into the body, new collagen will continue to be produced around the injection site, and long-term results are visible for about one year.

Juvederm products are formulated with various molecular weights of hyaluronic acid, creating a smooth gel that is easily injected into the skin. The Juvederm fillers are some of the most popular hyaluronic acid fillers in the United States and are used to replenish volume in areas where collagen levels are depleted. Juvederm Ultra Plus and Juvederm Vollure are most commonly used to treat marionette lines, with Juvederm Ultra Plus being specifically formulated to treat these deep creases around the oral commissure. Results from Juvederm injections are immediately visible and can last anywhere between 6-18 months.

Restylane is another hyaluronic acid filler commonly used for marionette lines. Restylane increases the hyaluronic acid in the deep creases around the mouth, instantly restoring volume to the face to provide a “liquid face-lift.” Results from Restylane or Restylane-L can last for about 6-9 months, while results from Restylane-Lyft can last for up to one year.

Botox is a neurotoxin that blocks nerve signaling to freeze facial muscles. If the cause of your marionette lines is a drooping of the mouth, it is a sign that the depressor anguli oris (DAO) muscles of your mouth corners are constantly stimulated. Botox injections in this area will help to relax and lift up the corners of the mouth and stop these lines’ development. Results from Botox injections can start to be visible after one week, with the full effect becoming visible after two weeks. Botox injections typically last for 3-4 months before being metabolized by the body. Although Botox can relax the DAO to prevent the worsening of the appearance of marionette lines, Botox must be used in conjunction with dermal fillers, as it cannot soften or fill these creases on its own. When you have your initial consultation with Dr. Green, she can create the best treatment plan suited for your skin and aesthetic goals.

35-44 year old woman treated with Restylane Lyft

Where are fillers for marionette lines injected?

The placement of marionette line filler injections will depend on your facial anatomy. Dermal fillers are typically injected into the corners of the jaws, below the corners of the mouth, or along the areas of volume loss that create the marionette lines. If injected incorrectly, these fillers may cause asymmetry along the face or cause the appearance of the crease to worsen. Additionally, injecting Botox into the depressor labii muscle instead of the DAO can cause lip asymmetry. Consulting a board-certified expert injector like Dr. Green is vital to achieving perfect aesthetic results. Dr. Green will assess your features and volume loss during your initial consultation and determine the proper injection placements.

How much filler is needed for marionette lines?

The amount of filler needed will depend on your facial anatomy and personal aesthetic goals. At your initial consultation, Dr. Green will assess the treatment area to evaluate the severity of the marionette lines and determine the amount of filler needed. More filler is typically used for moderate to severe creases than mild to moderate creases. After evaluation, Dr. Green will then determine the amount of filler required.

C.W 2 months Before and After Sculptra 2 Vials1 MGWatermark

Do marionette line fillers hurt?

Not at all! A topical numbing cream will be sent to your local pharmacy and should be applied to the entire treatment area an hour before your appointment. Additionally, some of these fillers, such as Sculptra and Restylane, are compounded with lidocaine to make the injections more comfortable. Once you arrive at Dr. Green’s private dermatology office, the cream will be removed, and the skin will be sterilized for the injections. Dr. Green is an expert injector for dermal fillers, and her expertise will provide you with the best experience and cosmetic results. Immediately after the injections, an ice compress will be applied to the area to minimize any risk of swelling or bruising.

How long do fillers last in marionette lines?

The length of time that fillers last will depend on the type of filler injected into the area and the body’s metabolism. Sculptra is a semi-permanent dermal filler that stimulates collagen production in the skin over a series of injections, with results lasting up to two years. Radiesse also boosts collagen growth in the skin and can last about one year after a single injection. Results using Juvederm, a dermal filler comprised of hyaluronic acid, last anywhere from 6-18 months, depending on the body’s metabolism. Restylane, another line of hyaluronic acid-based fillers, produces cosmetic results lasting 6-9 months. Botox injections in the DAO area typically last for only 3-4 months.

G. W 74 yr old Before After Patient had Juvederm Ultra Plus Volbella Restylane Lyft MicroneedlingFRONT MGWatermark

How much do fillers cost for marionette lines?

The price for marionette line fillers will depend on which filler is used and how much product is needed to achieve your aesthetic goals. Sculptra is priced per vial, while other fillers such as Radiesse, Juvederm, and Restylane are priced per syringe. In NYC, the cost for one syringe or vial can generally range between $1,000 and $1,500. Correcting the appearance of marionette lines can be costly; still, it is important to have injections from an experienced, board-certified dermatologist such as Dr. Michele Green to mitigate the risk of unwanted side effects and poor cosmetic results. The total cost of marionette line treatment with fillers can be calculated after a consultation and discussion of your aesthetic concerns with Dr. Green in her private dermatology office.

Will cheek fillers help marionette lines?

Cheek fillers, such as Juvederm Voluma, have a thicker gel consistency to replenish volume around the cheek and lift the face, which can help indirectly reduce the appearance of mild marionette lines. For more moderate to severe marionette lines, cheek fillers in conjunction with dermal fillers, such as Juvederm Ultra Plus and Restylane, will need to be used. An expert cosmetic dermatologist such as Dr. Green can assess your skin and recommend the right filler treatments for you.

Will lip fillers help marionette lines?

When done correctly, lip injections can help to reduce the appearance of mild marionette lines. A Botox lip flip is an injection into the upper middle section of your upper lip that relaxes the muscles in the area and allows your lips to curl upwards. This treatment can lift the corners of the mouth, smoothing out the lines and creases around the mouth. For more moderate to severe marionette lines, dermal fillers in other facial areas may be more effective.

Will chin fillers help marionette lines?

Chin fillers can effectively treat marionette lines, as aging also affects the skin tissue around the chin. Additionally, jowls can also appear as the skin starts to sag down. Restoring volume in the chin area with dermal fillers can help redefine the chin shape, lift the skin, and reduce the appearance of marionette lines. Injecting dermal fillers into the corners of the jaw can also pull away skin from the corners of the mouth, resulting in tighter-looking skin in the marionette line area and diminished appearance of the jowls.

What is the best filler for marionette lines?

Sculptra, Radiesse, Juvederm, and Restylane are all wonderful non-surgical cosmetic treatments for marionette lines. While Sculptra and Radiesse promote collagen synthesis and production, Juvederm and Restylane increase volume in the face and fill creases and lines. When it comes to choosing the best filler for you, Dr. Green will curate an individualized treatment plan based on your medical history, facial anatomy, and aesthetic goals that will leave you with a rejuvenated and youthful appearance.

JM 57yr old Sculptra 3 treatments 2 eMatrix for acne scars and one syringe of Restylane for Nasolabial area MGWatermark

What causes marionette lines on the face?

Marionette lines are part of the natural signs of aging and appear due to loss of collagen and elastin in the face and gravity sagging down the skin. This typically starts to occur around 40 years of age, although there are factors that can contribute to these lines appearing at earlier stages of life. Smoking is one of the most common causes of premature marionette lines, as the repetitive pursing of the lips will cause this crease to appear. Excessive sun exposure and improper sun protection can also lead to early aging, speeding up the onset of marionette lines forming. Marionette lines may have a genetic component, as some individuals have noticed its appearance or development in family members. Additionally, factors that can negatively affect your skin, such as stress, dehydration, malnutrition, and lack of sleep, can all lead to the development of marionette lines.

How do you permanently get rid of marionette lines?

Unfortunately, once marionette lines are formed, they are permanent and cannot be eliminated. However, many cosmetic procedures can be used to diminish the appearance of these lines on the face. For mild or shallow marionette lines, procedures such as chemical peels or Microneedling may help to refresh the skin around the mouth. Chemical peels use acids to remove the outer layers of skin to reveal new, healthy skin underneath and reduce the appearance of fine facial lines. Microneedling uses tiny needles to create small holes in the skin, stimulating the production of new collagen and elastin. Advanced treatments such as Vivace combine Microneedling with radiofrequency technology to enhance results and provide elasticity to the skin. For moderate to severe marionette lines with deep creases, facial fillers are the most popular and effective treatment to increase volume and fill the creases around the mouth.

How do you get rid of marionette lines naturally?

There is no way to get rid of marionette lines completely, but there are lifestyle changes you can make to prevent marionette lines and other signs of aging from worsening.

Sun protection is the most vital step in your skincare routine to combat skin aging. Ultraviolet (UV) rays from the sun can damage deep layers of skin, resulting in aging signs such as fine lines and loss of elasticity. Using a broadspectrum sunscreen with a minimum SPF of 30 is ideal for protecting from the sun’s rays. Sunscreen should also be used on cloudy days, as UV rays can penetrate clouds, as well as on snowy or rainy days, as UV rays can reflect off surfaces like snow and water. Vitamin C is another vital product used for sun protection, as this antioxidant neutralizes harmful free radicals from UV rays.

Retinoids, topical vitamin A derivatives, are excellent products to incorporate into your skincare routine, as they promote healthy skin cell turnover and collagen production. Retinoids can be found over the counter or at prescription strength. It is also important to quit smoking, as smoking cigarettes can deteriorate collagen levels and production over time. Additionally, staying hydrated and eating a balanced, nutritious diet is vital to preventing dry skin, which is more prone to forming lines and wrinkles.

How to get started with marionette line fillers today

Many different dermal fillers can be injected to diminish the appearance of marionette lines, such as Sculptra, Radiesse, Juvederm, and Restylane. If the cause of your marionette lines is overactivity of the DAO, Botox can be administered to relax the muscle. When it comes to getting started with marionette line fillers or an alternative cosmetic treatment, Dr. Green will use her two-and-a-half decades of experience to tailor a treatment plan suitable to you. Dr. Michele Green is an internationally renowned board-certified dermatologist specializing in the field of cosmetic dermatology, providing patients worldwide with the most innovative non-invasive treatments. Her expertise has led to her recognition as one of NYC’s top dermatologists by Castle Connolly, New York Magazine, and Super Doctors. Dr. Green is widely known for her holistic, conservative approach when it comes to injectable fillers. To schedule a consultation with Dr. Green at her private dermatology office in the Upper East Side neighborhood of Manhattan, contact us online to make an appointment or call 212 535 3088.

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