Marionette lines (corner of the mouth) are long vertical wrinkles that traverse from the corners of the lips to the chin. They develop on each side of the chin as a result of the ageing process and other lifestyle factors. They get their name from marionette string puppets, which are known for having split jaws so puppeteers can open and close their mouths to make them give the appearance that they are talking. These creases often give the impression of a sad look to the face

The skin around your mouth is thin, and as a result  it is particularly prone to wrinkling. These lines occur with age, smoking and genetics and can progress to form jowls later on in life. The combination of collagen breakdown and loss of elastin leads to the loosening of skin in the cheeks and lower part of the face.

People typically begin developing marionette lines in their late 30s or early 40s. Marionette lines are barely visible early on, but as time goes by these creases can become very deep and noticeable.

Pdo example

What Causes Nasolabial Folds?

Nasolabial folds become more noticeable due to a variety of factors, including:

Loss of Collagen

With age, the collagen in our skin diminishes. This makes the skin around the mouth and eyes look thinner and weaker than we are used to.

Loss of Fat

As we age, we also lose some of the fat which is usually maintained in the cheeks. With this loss, parts of the face may appear saggy.

Sun Exposure

Over time, constant and continuous exposure to the sun can cause skin damage. This may cause wrinkles and changes in the texture of the facial skin.

How to Treat Marionette Lines / Nasolabial Folds

Marionette lines can be treated with different non-surgical treatment options. During the initial consultation, our Doctors at NYHS will discuss these options with you and devise a bespoke treatment plan to achieve the best outcome.

Treatment options to get rid of marionette lines might include:

  • Dermal Filler Injections
  • Botulinum Toxin Injections
  • Skin Boosters
  • PDO Thread Lifts

Dermal Fillers Injections

Dermal fillers made with hyaluronic acid can be injected below the corners of the mouth to lift the smile and fill out minor creases. They replace the lost volume in your face by hydrating and treating deep wrinkles and folds, improving your skin’s health and youthfulness for a natural look.

There is no downtime for this treatment and results are immediate, lasting 9 to 18 months.

Surgeons Notes

Cheek filler to lift nasolabial folds and rejuvenate the mid-face region.

One contributor to aging is the loss of our facial "fat pads." This begins from our mid-20s onwards, contributing to skin folds, sagging and overall loss of volume. One such fat pad is the malar fat pad.

This lovely lady was concerned about her nasolabial folds. Instead of filling these, we opted to add filler to her cheeks to replace lost volume, particularly from her malar fat pad. This provided a subtle lifting effect which softened the nasolabial folds and provided an overall more youthful appearance. 

Only 2ml STYLAGE XL was used in her cheeks.

REF: Dr Chike - Rejuvenation (2)

Surgeons Notes

This patient with a Tear Trough deformity and associated anterior Cheek volume loss.

The patient was treated with Sub-muscle HA into the SOOF, and also High Density HA into the Malar fat pad and Anterior Cheek.

Pictures show PRE and POST treatment  views. Deep technique done with micro cannula.

Note the point of maximum zygomatic projection.

REF: Dr Chike - Rejuvenation

Botulinum Toxin Injections

Botulinum can be injected into the facial muscles to keep you from making the kinds of expressions that can cement marionette lines into place. In turn, your skin will become smoother with a reduced appearance in wrinkles. In order for botulinum injections to treat marionette lines, patients will need to repeat the treatment every 4 months.

Surgeons Notes

Cheek and Chin Filler

Cheek filler to lift nasolabial folds.

One contributor to aging is the loss of our facial "fat pads." This begins from our mid-20s onwards, contributing to skin folds, sagging and overall loss of volume. One such fat pad is the malar fat pad.

This lovely lady was concerned about her nasolabial folds. Instead of filling these, we opted to add filler to her cheeks to replace lost volume, particularly from her malar fat pad. This provided a subtle lifting effect which softened the nasolabial folds and provided an overall more youthful appearance. 

Only 1ml STYLAGE XL was used in her cheeks, but this made a huge difference!

Chin Filler can elongate the face to give a slimmer overall appearance.⠀

It can strengthen the  side profile and improves facial symmetry and balance

1 ml STYLAGE XXL was used in the Chin

REF: Dr Chike - Rejuvenation (7)

Surgeons Notes

This patient with a Tear Trough deformity and associated anterior Cheek volume loss.

The patient was treated with Sub-muscle HA into the SOOF , and also High Density HA into the Malar fat pad.and Anterior Cheek.

Pictures show PRE and POST treatment  views. Deep technique done with micro cannula.

Note the point of maximum zygomatic projection.

REF: Dr Chike - Tear / Cheek (3)

Skin Boosters

Skin boosters can help to gradually improve your skin’s condition, stimulating collagen production, hydrating the skin from the deeper layers, increasing elasticity, and reducing fine lines and imperfections. Unlike traditional dermal fillers, they are not injected beneath the skin to volumize or accentuate certain features of the face. Instead, they are injected directly into the dermis to hydrate and improve overall skin quality.

At NYHS we use STYLAGE HYDROMAX, a skin booster made of hyaluronic acid in a liquid form that gets injected in the cheeks, nose to mouth, chin, neck and décolletage areas. It contains a unique form of stabilized hyaluronic acid (HA) to plump and hydrate the skin, with results that have been proven to last up to 6 months.

Skin boosters work best to prevent marionette lines, or to correct fine lines. They have a cumulative effect, so between 3 to 6 sessions every 2/4 weeks are recommended.

Surgeons Notes

One contributor to aging is the loss of our facial "fat pads." This begins from our mid-20s onwards, contributing to skin folds, sagging and overall loss of volume. One such fat pad is the malar fat pad.

This lovely lady was concerned about her nasolabial folds. Instead of filling these, we opted to add filler to her cheeks to replace lost volume, particularly from her malar fat pad. This provided a subtle lifting effect which softened the nasolabial folds and provided an overall more youthful appearance. 

2ml STYLAGE XL was used in her cheeks.

REF: Dr Chike - Rejuvenation (8)

Surgeons Notes

Cheek filler sculpts and lifts. The ogee curve, the zygomatic arch that juts out or curves, is associated with youth. 

As we age, we start to lose our lovely cheek shape. With age the mid face flattens and the skin begins to sag due to volume loss which supports fat pads in the face and give a youthful appearance. 

Youthfulness is expressed through shape, structure, and contour. 

The goal of mid face enhancement is to help restore the ogee curve for a more youthful look.

This look was created with 2 mls syringes of  STYLAGE XL.

REF: Dr Chike - Cheek (4)

PDO Thread Lifts for Marionette Lines

Correcting marionette lines using PDO threads is another non-surgical, minimally invasive cosmetic procedure designed to provide a more youthful facial appearance without leaving scars and with minimal downtime. PDO threads are used to lift and tighten the skin and the lower part of the face to remove deep lines and correct saggy cheeks. At NYHS we use MINT PDO threads, the latest innovation from South Korea. They consist of a dissolvable suture made from a complex sugar called PDO (polydioxanone), which has been used in biomedical and pharmaceutical applications for many years because of its extremely safe profile. This material is non-allergic and non-antigenic and is also completely biodegradable, meaning the body completely absorbs the PDO material over time.

This procedure consists in inserting the threads into the skin to lift it, providing an immediate rejuvenating effect. PDO threads also stimulates the production of collagen, which helps to regenerate the skin over time by increasing firmness, volume, and making the skin look younger.

Before the treatment, a strong topical numbing cream is applied. After 30 minutes the treatment area is thoroughly cleansed and prepped. Local anaesthetic is injected into all the areas where the threads will be placed, so the patient does not feel any pain during the thread insertions.

The PDO threads are inserted underneath the skin in the predetermined areas, and then lifted upwards to achieve an instant rejuvenating effect. Because the threads are dissolvable, the results will last about six months.

Surgeons Notes

Before and After-Full face lift with MINT FINE.

PDO Threads are effective for contouring the cheeks, tightening the lower face, jawline, and upper neck.

They are our treatment of choice  to help tighten and strengthen loose skin.

MINT™ is an absorbable polydioxanone (PDO) barbed suture indicated for use in soft tissue approximation.

They stimulate collagen production and help lift the tissue. Of note, is the natural but impressive Mid-face tissue repositioning, creating a fuller  Cheek volume and sharpened jawline.

No Fillers or toxins have been used.

REF: Dr Chike - PDO (9)

Surgeons Notes

Before and After-Full face lift with MINT FINE.

A PDO thread lift is designed to subtly lift the facial features to reduce fine lines and wrinkles while encouraging collagen production for more volume in the treated areas.

PDO threads come in a variety of textures for customized treatments

The threads are extremely versatile and can be used all around the face and neck. They can treat drooping cheeks, pronounced nasolabial (nose to mouth) and marionette (corner of mouth to chin) folds, sagging jawline and neck and folds and wrinkles on the chin.

REF: Dr Chike - PDO (11)

Want to know more?

If you are concerned about your signs of Facial Aging and would like a consultation with one of our experts, they will be able to guide you and work out a treatment plan that effectively suits you.

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