Marionette Lines Treatment Guide

Treatment Guide: Marionette Lines

These are the lines that start from the corners of your mouth to either side of the chin. They are named after marionette string-puppets with their split jaws controlled by puppeteers. 

They arise due to the overlying skin becoming lose and saggy as we age due to the loss of fat under our skin. Coupled with the effect of gravity, the marionette lines can form transpire as deep folds. 

Dermal fillers are an innovative way in using skilful injection technique to replace volume within this skin fold. They are made up of Hyaluronic Acid which is a gel like substance we all possess in our skin. The most common brands used to treat marionette lines include Juvederm Ultra ® and Restylane Refyne ®.

The procedure itself takes 15-20 minutes to perform with no down-time. Topical numbing cream or local anaesthetic injection can be used to help manage your pain an ensure no tears when the troughs are being filled. 

In the unlikely event of an adverse reaction, dermal filler can be dissolved using a special enzyme called Hyaluronidase. This is a prescription only agent and so it is important you seek a medically qualified practitioner with the ability to prescribe. 


What is dermal filler?

There are different types of dermal fillers on the market specially designed for different areas of the face. For marionette lines, a hyaluronic acid based filler is required.

Hyaluronic acid is a sugar based protein which is present in our skin which gives it its youthful volume. As it is being injected beneath the skin, it acts like a sponge to draw water molecules to it – adding volume to the area. Typically 1ml of dermal filler should be sufficient to treat both sides however more might be necessary depending on how deep the line is.

What does the procedure involve?

After the skin around the marionette line is adequately numbed, there are essentially two treatment approaches. A cannula (blund needle) can be used or a small sharp needle. With the cannula, a single entry point is made on each side of the face from which the blunt needle is introduced and passed through the soft tissue along the plane of the marionette line. Filler is then deposited as the needle is slowly withdrawn. A small sharp needle can also be used with the same effectiveness however multiple injection points would be needed. 

How long do the effects last?

The effects from treating marionette lines last up to 12-months on average. This number can vary depending on the type of dermal filler used. Over time, the tissues underneath your skin naturally resorb the dermal filler, requiring a top-up to hold the desired effects. 

The filler can also be dissolved using a special prescription only enzyme known as Hyaluronidase which breaks hyaluronic acid down in 24-hours.  



Recovery after your treatment is immediate. You can genuinely go back to work the same day. What you tell your boss is up to you. 

You might experience the following, and if present, here are some great tips in managing them. 

  • Bruising – This can sometimes happen, especially if you are on blood-thinning medication. To help, you can apply some Arnica cream.
  • Mild pain – Not common but if experienced, Paracetamol is your go to. Do not go over the recommended dose. If Paracetamol is not helping, get in touch with your practitioner for a review as there might be another cause for the pain that needs addressing. 
  • Swelling – After any application of dermal filler, some swelling is expected. An ice pack can help but take care in the first 24 hours where it is recommended you do not touch the site of injection. 

Most of these symptoms resolve after 3-5 days following treatment. If they last any longer, we recommend you contact your practitioner. 

Please note, if you develop any blue/grey discolouring of your skin, severe pain/swelling, any skin changes or changes in vision in the minutes/hours after treatment, contact your practitioner urgently to seek some medical advice.

We created some great aftercare literature for you, so if you want to know more, simply create an account and we will email you the details. 

The serious stuff

Following your treatment, it is important to be aware of certain signs and symptoms which may need urgent medical attention. These rarely occur but we want you to be well informed. If these arise, it is vital you contact your medically qualified practitioner for advice. 

  • Infection – If you develop a fever, redness of the skin, warmth of the skin or any itchiness around the area injected – it could mean you have an infection. This is easily treated with a course  of oral antibiotics. If you have a history of cold sores, injectable treatment might cause a outbreak. As a preventative measure, your practitioner will prescribe you a course of oral anti-viral medication before your treatment. 
  • Allergic Reaction – In the minutes/hours following treatment, if you develop severe swelling, itchiness, puffiness around the eyes, any difficulty in breathing – this could indicate a severe allergic reaction known as anaphylaxis. If these symptoms occur, it is important to seek urgent medical attention through A&E. You will also need your dermal filler to be dissolved using Hyaluronidase. 
  • Vascular Occlusion – This occurs if dermal filler accidentally enters a blood vessel. Although rare, symptoms include grey/blue discolouration of the skin and severe pain, If present, urgently contact your practitioner as the only way to treat this is by dissolving the filler. In even rarer circumstances, the occlusion can affect your vision. If you notice any changes, it is vital you go to your nearest eye hospital and also contact your practitioner to meet you there. 


Dermal fillers are widely used in the field of aesthetics however there are some contraindications which if present, would mean it is simply unsafe for you to have the procedure. At Fvce, we never compromise on safety, and so if you meet any of the following criterion, we would not allow you to book through us. There is some grey area with every case, and we more than welcome you to contact our dedicated medical team to get some free advice on whether you would be eligible for treatment.
  • Active skin infection on the face/planned injection area eg Cellulitis
  • Known allergy/hypersensitivity to hyaluronic acid based dermal filler
  • Known allergy/hypersensitivity to lidocaine (local anaesthetic agent)
  • Currently pregnant 
  • Previous history of glabellar skin necrosis (previous vascular occlusion around the forehead following dermal filler injection)

Email us on [email protected] for any queries regarding contraindications to treatment.

How much are we talking?

Treatment of marionette lines start from £150 upwards, with prices varying dependent on the experience of your practitioner and the brand of dermal filler used. 

Let me fvce some professionals

We only on-board medically qualified aesthetic practitioners who have been vetted by us. Simply click the link below to find a practitioner in your area and book online. After booking, you can communicate with them through e-consultations on the platform to address any concerns you might have.

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