Unfortunately, there is nothing we can do (at least for the moment) to stop the process of aging and the degrading effect it has on our skin. It could be a bit disheartening, considering people have been utilizing various anti-age techniques for the past several thousand years. On the other hand, while we are not there yet, the progress the beauty industry has made, especially in the last couple of decades has been nothing short of astonishing with the use of various highly effective tools like dermal fillers. A versatile beauty solution, it excels at dealing with problem like today’s topic – marionette lines. But before we do a more thorough review of the full list of the candidates for best filler for marionette lines 2024, let’s start from the beginning.

What is a marionette line?

In short – this is the one of the most common and pronounced markings of aging skin, which most people have to deal with. Starting from the corner of the mouth, they run down to the sides of the chin. The name comes from the association of the shape of these skin folds similar to marionette dolls where the mouth of the doll is the only moving part of the face. It makes the face of a person (a bit) look like that of a doll. When treated correctly with the best filler marionette lines will visibly correct and smooth out these lines, thus reducing the perceived age of a person.

What causes marionette lines on the face?

The answer to this question is complex. While the short reply would be: age, in reality it’s more nuanced, meaning that multiple factors and aspects must be taken into consideration. Overall, the main culprits and adverse factors are:

  1. Lack of collagen and elastin – young and healthy skin has a lot of collagen and elastin, making it very “stretchy”. With age, its ability to synthesize both decreases. As it becomes less elastic, wrinkles and skin folds form.
  2. Loss of hydration – aged and tired skin also has limited ability to retain moisture. This is directly related to the decrease of Hyaluronic acid in the dermis. Part of the factors defining what is the best dermal filler for marionette lines, is related to the ability to restore the HA amount in the treated area.
  3. Reduced strength of supportive tissues – our skin does not just stick to the muscle tissues underneath. There is layer of connective tissues which keep the dermis attached to the tissues beneath (in this case – the facial muscles). The process of ageing degrades these supportive tissues and the bonds break the surface skin begins to has, at some point needing an artificial lift, in order to appear more natural and younger.
  4. Muscle contraction – while skin aging and degrading external factors are the main culprits, the normal muscle contractions of the face will inevitably leave their mark (quite literally) on the facial features and the skin on top of them. As you move your mouth, the skin to the sides wrinkles up, over time, combined with the loss of natural elasticity, more and more pronounced skin depressions – wrinkles, folds, lines (like oral commissure lines) will form, due to the purely mechanical pressure on the dermal tissues in the affected areas.
  5. Adverse factors – anything from bad air, unhealthy food, smoking or just a bad lifestyle. Combine that with stress, fatigue and lack or proper sleep and your skin will look like that of somebody ten years older than you. While fillers are good for immediate filling of the visible depressions, drastic changes to the lifestyle and habitat are often required to extend how long the anti-age effect will last.

Marionette Lines Treatment Options

Having described what marionette lines are and how they affect the overall facial features, let’s review the options to deal away with them. It’s worth noting that dermal fillers for marionette lines are just one of the avenues of action which might be undertaken. In fact, they are not always the necessary approach, or to be more precise – they might not be enough to alleviate the problem.

Most dermatologists and licensed skincare practitioners prefer a multi-vector approach, which combines more than one technique for treating wrinkles, folds and skin sag. As seen above, the factors causing wrinkle and fold formation, as in this case – marionette lines, are usually mixed and so using different forms of technique for anti-age treatment, skin lift and facial rejuvenation are usually recommended. The main methods include:

  • Plastic surgery – considered the “classic” approach, this is the most invasive form of treatment for wrinkles, folds and skin lines. It’s been gradually sidelines by more innovative methods for skin volume restorations such as collagen boosters or fillers for marionette lines (in this specific instance), which are more flexible, affordable and non-permanent.
  • Lifting threads – not to be confused with the surgical thread lifting, the concurrent popular method for lifting is using resorbable treads made from biocompatible and biodegradeable materials like PLLA, PLACL or PDO. While they physically lift the sagging skin, they also stimulate the collagen production, in the area of use, meaning they are good for natural volumization of skin depressions, as well.
  • Hyaluronic acid fillers – normally, this is a moderately to dense gel, made from Hyaluronic acid. HA being natural to the body, means the product is very biocompatible and safe. Outside of the immediate volumization of the skin, they also hydrate as the Hyaluronic molecules are absorbed by the skin over time. Minimal after care required.
  • Non-HA fillers – usually, in this category, we’ll find fillers based on PLLA, PCL or Calcium. PLLA and PCL fillers are polymer based and they do not immediately add volume, but instead build up collagen in the affected area over time. Calcium based fillers usually do add instant volume and also help with collagen deposit buildup in the affected facial spot, providing long term results. Often considered the best filler for deep marionette lines, they tend to be quite expensive, unfortunately.
  • Mesotherapy – while traditional meso treatment will boost your overall skin condition with minimal issues like swelling, the lift effect of the standard meso cocktail is quite limited. Fortunately, modern beauty machine can be very effective to induce rapid collagen synthesis in a localized facial area. The formed collagen deposits will offer very long term volumization and subsequent maintenance procedures (the standard initial cycle is four treatments) can help to retain the results.
  • Cosmetics and skin care – every little bit helps. While even the best of beauty creams will have little effect on severe marionette lines, having an effective skincare routine is good for your overall dermal health. When dealing with problems like marionette lines best treatment includes just taking proper care of your skin on a daily basis, too.

How does filler work to fix marionette lines?

On the topic of using dermal fillers to deal with visible deep wrinkles and skin folds and marionette lines, specifically, we have to understand how they work. Collagen boosters like PLLA (and it’s derivative PDLLA fillers), as well as PCL, introduce small polymer spheres into the area where a skin fold is formed. They can be suspended in gel, which will itself add instant volume. What is more important, however, over time, new skin cells will form around these polymer particles and new natural cell structures will form. In addition, this cell regeneration is very good for collagen production and synthesis, which adds further filling effect. The long-term effect of calcium fillers is similar. Overall, these non-HA products as marionette fillers is undoubtedly a very effective method for dealing with pronounced skin depressions.

As opposed to them, Hyaluronic acid-based fillers are more immediate. Their main goal is to just add volume, fill up the wrinkle or skin fold and smooth out the surface. They are inherently less durable than non-HA fillers, although calculating how long a Hyaluronic filler will sustain its effect is very subjective. Their advantage, is Hyaluronic acid fillers are much more flexible, allow for a better control of what the end result looks like and if it’s dissatisfactory – can be easily dissolved, as opposed to polymer and Calcium based solutions.

How do you permanently get rid of marionette lines?

There really isn’t a permanent method to remove them. Marionette lines are a natural sign of aging and this process cannot be stopped. Fortunately, fillers can drastically limit its effect and make the facial appears of a person to be substantially more youthful. A 40 something man or a woman will doubtfully look like a teenager, but with the proper skin care, including effective treatment for marionette lines, the perceived age could be dropped well into the 30’s.

As mentioned, the effect of different products will vary a lot and so does the after care to maintain it. Which method to take will depends in large part to the preference of the patient. Fillers, especially those based on HA offer enough convenience and flexibility, combined with durability, to be the technique of choice for more and more people.

Action time of fillers for marionette lines

When looking at the durability of the filler effect, several key elements must be factored in before answering the question of how long a filler can hold:

  • Type of filler – Hyaluronic acid fillers don not last as long. The give initial volumization in a limited area. One the filler is applied (as far as marionette lines go – deep) the natural methabolism of the body will slowly degrade it, dissolving it with enzymes. Polymer or Calcium product, on the other hand, might offer no or more limited effect, but their appeal as fillers for wrinkles around mouth is the long-term collagen boosting effect, which can be double or more the duration of HA fillers.
  • Brand – not necessarily in terms of only use premium European and American fillers, but more in the sense of use brands which are effective and offer the necessary quality. Good fillers are made by companies with have done the proper R&D, clinical testing. They also have good manufacturing facilities and only work with high quality base for the fillers.
  • Health and lifestyle – your metabolism will greatly affect how useful a filler is. While sports and an active lifestyle might be somewhat detrimental to Hyaluronic fillers, they will certainly help your skin overall. And the negatives of a bad lifestyle will always outweigh the lift of the skin given by the filler. Similarly, polymer fillers will offer far better and longer lasting results to people that lead a healthy and balanced life, allowing them to get rid of marionette lines for a longer period.

In general, good Hyaluronic acid fillers will give volumizing effect for a period of 9 to 12 months. PLLA and PCL solutions will boost the collagen production for up to 18 months, while using Calcium based product are often good for up to two years.

Do marionette line fillers hurt?

This is a broader question, which encompases fillers in general. The procedure does involve certain levels of pain and discomfort. However, overall, it’s a drastically less invasive approach to how to get rid of marionette lines, as opposed to lifting threads, let alone plastic surgery. There are several factors which affect the overall experience. For one, the pain tolerance of the person will play a huge role. That being said, as a whole, filler treatments are not particularly painful and only people will low pain tolerance will hell really uncomfortable. What is more important, is that a lot of dermal fillers contain a small amount of lidocaine, to even further reduce the unpleasant feeling during their use. Topical anesthetics are also utilized widely and some creams also help against subsequent swelling.

Another major factor is the technique used by the dermatologist or licensed practitioner and, what is more important – their skill level. Having an experienced and skilled specialist handle the process will minimize the chances of a marionette lines filler gone wrong experience for the patient. A doctor or cosmetologist with “steady hands” will help a person to have as pain-free experience as possible.

Preparing for the marionette line filling procedure

As a much simpler alternative to plastic surgery, fillers have a much lower requirement bar and the person getting the beauty treatment has less thigs to consider. Normally, the dermatologist or specialist taking care of the procedure does a preliminary interview. This is done both to establish what a patient is expecting and looking for in terms of results, review their medical history and possible intolerances to certain products etc. While it might be tempting to just go with Juvederm Ultra 3, the proper evaluation is necessary.

There isn’t much else for the person to do once this stage is done. One of the main advantages of dermal fillers is the much-simplified process. The patient must have clean skin with no makeup. Standard protocol is followed after the filler is applied, in regard to swelling, bruising, redness, etc.

Amount of filler for marionette lines

How much filler to use, including in the mid face area, is determined on a case-by-case basis, meaning that the practitioner will take under consideration both the wishes of the patient, as well as the actual condition of the skin and the severity of the skin folds and lines. Ideally, when doing the marionette lines filler before and after comparison, the “after” will appear completely natural and smoother out in an indistinguishable way.

Same goes for non-HA fillers – the goal is for the facial appearance, once the collagen has been accumulated is to seem perfectly natural and not “off”. From purely aesthetic point of view, it is vital not to overdo the amount of filler. Based on the very nature of marionette lines, specialist do not use much volume of filler gel.

Dermal Fillers for marionette lines: Costs

Before getting to what is the best filler for marionette lines, we need to discuss one final aspect – the price. As with any beauty product, the spectrum of prices is very wide. There are fillers to accommodate any budget. Price alone does not determine the quality of a product, although if you go with Juvederm, expect to pay a premium price for premium quality. In general, you can “buy smart” when it comes to fillers. Your dermatologist or licensed practitioner will most likely offer you multiple options, fitting different price ranges, all of which will be good for marionette line treatment.

Choosing the Best Filler for Your Marionette Line Treatment

This can be a very complex task. Price is a major factor to consider – there is no way around it. Sculptra will cost you more than Aesthefill or A-Jax D’azure, and Juvederm will be more expensive than Revolax or Glowing Fill. Doesn’t mean the cheaper option is worse, but on the other hand, there is a reason why the premium brands like the above (or Restylane, Stylage, Teosyal, etc.) make it onto the best filler for lips wrinkles list all the time.

Once you have determined your budget, your practitioner will most likely give you a recommendation. However, you are not limited by the products they normally work with and can ask them to use different solution. Most specialists will be happy to look into alternatives and you can gather some valuable information online to point them into a certain direction.

As a whole, the best product for marionette lines, which are not collagen stimulants, are medium thickness Hyaluronic acid gel solutions. While you can use soft filler for the less pronounces marionette lines or the opposite – dense filler for the more severe instances, most patients will need medium viscoelasticity gel a way to fill that area.

Will cheek fillers help marionette lines?

Usually, chin fillers are quite dense, as the loss of skin volume in that part of the face necessitates the usage of a dense enough gel, to achieve the proper support for an effective lift. Only the deepest lines are treated with them. Some overlap exists with collagen fillers.

Will lip fillers help marionette lines?

In short – most likely. The mid face area, including lips, nasolabial folds, smile and marionette lines are normally treated will gel that is neither too thick or too soft. Although there are specialized lip fillers, as a whole something of medium thickness like Revolax Deep, for example, will work equally well for lines around mouth fillers.

Will chin fillers help marionette lines?

The chin is a peculiar facial area for filler treatment. The typical moderately dense gel would not be ideal for it, but the optimal solution is between something which is just soft enough to use for the mid face up to a proper contouring filler. Again, the correct product to use is determined for each person individually, but there is definitely an overlap.

In summary

Wrinkle removal and skin list in the mid-face area, including the marionette lines is substantially simplified by the advance of dermal fillers, be they Hyaluronic acid based or some polymer/Calcium solution for volumization via collagen build-up. There many marionette lines fillers to choose from, varying in effect, density, cost and durability, meaning any person and their preference can be properly accommodated.

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Author: Maya Sharma

Maya Sharma is an accomplished aesthetician, renowned for her expertise in holistic skincare. With a decade of experience, Maya specializes in personalized treatments such as facials, chemical peels, microdermabrasion, and various forms of mesotherapy. Incorporating her Indian cultural heritage and continuous education in skincare, Maya delivers bespoke solutions tailored to each individual's needs. Her curious personality pushes her to research the latest and greatest innovations of the beauty industry and then share them with her customers and online followers.