woman getting dermal filler injection in her cheek

Marionette lines, or oral commissure lines, are a common concern among patients seeking facial rejuvenation. These deep lines running from the corners of the mouth to the jawline can give a sad or aged appearance, impacting a patient’s self-esteem and confidence.

For medical professionals in the aesthetic field, being well-informed about the most effective dermal fillers to address marionette lines is essential to providing the best possible patient outcomes.

What Causes Marionette Lines?

This type of wrinkle is primarily caused by a combination of factors, including age-related volume loss, decreased collagen and elastin production, and repetitive muscle movements. Marionette lines often deepen over time due to the downward pull of gravity on facial tissues, leading to sagging and drooping in the lower face.

Several factors contribute to the development of marionette lines:

  • The skin’s ability to produce collagen and elastin decreases with age, leading to a loss of facial volume and elasticity;
  • Sun exposure accelerates skin aging and collagen degradation;
  • Smoking can damage collagen and elastin fibers, exacerbating the formation of lines and wrinkles;
  • Some individuals may be more predisposed to developing marionette lines due to genetic factors;
  • Repetitive facial movements, like frowning or squinting, can contribute to the formation of these lines.

The Role of Dermal Fillers in Marionette Line Treatment

Dermal fillers offer numerous advantages as a treatment option for marionette lines:

  • Patients can notice visible improvements in their appearance immediately after the procedure;
  • Such treatments are minimally invasive, avoiding the need for surgery and its associated risks;
  • Patients typically experience minimal downtime and can resume their daily activities shortly after treatment;
  • Doctors can tailor treatments to address each patient’s unique needs and concerns.

However, it is essential to recognize the limitations of marionette line fillers:

  • Dermal fillers provide temporary effects and require maintenance treatments over time;
  • While generally safe, dermal fillers can cause side effects such as bruising, swelling, or allergic reactions in some patients;
  • The proficiency and experience of the medical professional administering the fillers can significantly impact the results.

Factors to Consider When Choosing Fillers for Marionette Lines

Dermal fillers are classified into different categories based on their composition. The three main types commonly used for marionette lines are hyaluronic acid-based fillers, calcium hydroxylapatite fillers, and polylactic acid fillers.

The choice of filler should be based on several factors, including:

  • The depth and extent of the marionette lines influence the choice of filler and injection technique;
  • The patient’s skin type, thickness, elasticity, and other characteristics may affect the outcome;
  • Product characteristics: each filler has distinct viscosity, cohesivity, and longevity properties, which can impact the results.

A personalized approach to treatment is crucial for achieving optimal results.

Best Fillers for Marionette Lines in 2023

Choosing the right filler for marionette lines can significantly impact the treatment’s success and patient satisfaction. Here, we gathered the TOP 5 dermal fillers recommended by experts for effectively addressing marionette lines:

Juvéderm Volift with Lidocaine is a hyaluronic acid-based filler specifically formulated to target moderate to severe facial wrinkles, including marionette lines. Manufactured by Allergan, this filler offers natural-looking results and patient comfort by adding lidocaine for pain reduction.


  • Vycross technology for optimal cross-linking and longevity of results;
  • A volumizing effect that lifts and supports sagging skin in the lower face;
  • Results last up to 15-18 months, reducing the need for frequent touch-ups.

Radiesse is a calcium hydroxylapatite filler produced by Merz Aesthetics. This unique filler provides immediate volume to the treated area and stimulates collagen production, delivering long-term rejuvenation effects.


  • Stimulates collagen synthesis, leading to continued skin improvement;
  • Ideal for addressing both moderate and severe marionette lines;
  • Duration of up to 12-18 months, offering lasting results.

Sculptra, manufactured by Galderma, is a poly-L-lactic acid filler designed to stimulate collagen production and volumize the face gradually. It is an excellent solution for patients seeking a subtle, natural-looking correction for marionette lines.


  • Poly-L-lactic acid microspheres stimulate collagen synthesis over time;
  • Suitable for patients with moderate marionette lines and volume loss;
  • Results lasting up to 2 years, providing a prolonged rejuvenation effect.

Restylane Defyne is a hyaluronic acid-based filler from Galderma, specifically formulated to correct deep facial wrinkles and folds, including marionette lines. It offers a natural range of facial expressions while providing structural support.


  • XpresHAn Technology for natural-looking results and flexibility;
  • Ideal for deep facial lines and wrinkles with dynamic movement;
  • Duration of up to 12-18 months, reducing the need for frequent touch-ups.

BELOTERO® BALANCE, manufactured by Merz Aesthetics, is a hyaluronic acid-based filler designed to address moderate to severe facial wrinkles and folds, including marionette lines. Its unique, cohesive polydensified matrix technology ensures seamless integration with the skin for smooth results.


  • Suitable for fine lines and deep wrinkles in the lower face;
  • Natural integration with the skin for undetectable results;
  • Longevity of up to 9-12 months, providing a lasting correction.

How Long Do Fillers Last for Marionette Lines?

The duration of fillers for marionette lines varies depending on the type of filler used, the individual’s metabolism, and the injection technique.

Approximate longevity of different fillers for marionette lines:

  • Hyaluronic acid (HA) fillers, such as Juvéderm and Restylane, typically last around 6 to 12 months for marionette lines. Some specific formulations may last up to 18 months in some cases.
  • Calcium hydroxylapatite (CaHA) fillers, like Radiesse, generally last between 12 and 18 months. These fillers stimulate collagen production, providing longer-lasting results.
  • Poly-L-Lactic acid (PLLA) fillers, like Sculptra, are known for their collagen-stimulating effects. The results may appear gradually and can last up to 2 years.

Over time, the filler gradually breaks down and is absorbed by the body, gradually returning to the pre-treatment appearance.

To maintain the desired results, patients may require periodic touch-up treatments or follow-up injections, as advised by the doctor.

Alternatives to Lip Fillers for Marionette Lines

While dermal fillers for the perioral area are an effective option for addressing marionette lines, some individuals may prefer non-invasive or alternative treatments. Here are some alternatives to lip fillers for marionette lines:

Dermal fillers in other areas. Instead of using lip fillers, patients may opt for dermal fillers in different facial zones to provide an overall rejuvenating effect. Fillers in the cheeks, nasolabial folds, or jawline can help lift and support the lower face, indirectly reducing the appearance of marionette lines.

PDO thread lift – a non-surgical treatment that uses dissolvable threads to lift sagging skin. The threads stimulate collagen production, improving skin elasticity and reducing the severity of marionette lines.

Radiofrequency or ultrasound-based skin tightening use energy-based devices to stimulate collagen production and tighten the skin. By improving skin elasticity, these procedures can help diminish the appearance of marionette lines.

Chemical peels or laser resurfacing can improve skin texture, tone, and pigmentation irregularities, providing a smoother and more youthful lower-face appearance.

Microneedling, combined with the application of growth factors or platelet-rich plasma (PRP), stimulates collagen production and enhances skin rejuvenation.

Botulinum toxin treatment for jawline contouring can be used strategically to relax the muscles around the jawline, reducing the downward pull and softening the appearance of marionette lines.

Skincare – quality skincare products containing retinoids, antioxidants, and hyaluronic acid can help improve skin texture and hydration, indirectly benefiting the appearance of marionette lines.

Facial exercises and massage may improve facial muscle tone and circulation, potentially reducing the appearance of marionette lines over time.


Selecting the right dermal filler for marionette lines is crucial for successful outcomes in facial rejuvenation treatments. While many products on the market can be used to treat marionette lines, the fillers reviewed in this article have demonstrated their efficacy, longevity, and safety in addressing this aesthetic issue and have gained popularity among doctors and their patients.

Combining dermal fillers with other aesthetic treatments can offer enhanced results and a comprehensive approach to facial rejuvenation.


Which filler lasts the longest for marionette lines?

Poly-L-lactic acid fillers for marionette lines (like Sculptra) designed to stimulate collagen production gradually stand out for their longevity. While the initial results may not be as immediate as some other fillers, their collagen-stimulating effects lead to continued skin improvement. As a result, the correction achieved with PLLA fillers can last up to two years, making them one of the longest-lasting options for addressing marionette lines.

But doctors must consider each patient’s specific needs, preferences, and medical history when selecting the most suitable filler. Aspects like safety, patient comfort, and the desired level of correction should also be considered before making a final decision.

Which is better, Restylane or Juvederm, for marionette lines?

The choice between Juvederm and Restylane for marionette lines depends on various factors, including the patient’s specific needs, the doctor’s preference, and the characteristics of each filler.

Both are reputable brands of HA-based fillers, and they have different formulations designed for specific purposes, including fillers for marionette lines. Here are some factors influencing which filler may be more suitable for marionette line treatment:

  • The consistency of the filler can influence the treatment outcome. For some cases, a firmer filler will be better, while for others, doctors may opt for a softer, more flexible filler, depending on the desired effect and the patient’s facial anatomy.
  • A doctor with extensive experience with a specific brand may feel more confident achieving optimal results with that particular filler.
  • Sometimes, patients may have preferences or previous positive experiences with a particular brand or have sensitivities to certain filler components.

Ultimately, Juvederm and Restylane are trusted brands widely used to address perioral wrinkles effectively. When deciding what is the best filler for marionette lines, the key is to consider the patient’s factors and the doctor’s expertise and experience to determine the most suitable filler for achieving the desired results safely and effectively.

Is 1 ml of filler enough for marionette lines?

The amount of filler for treating marionette lines can vary depending on several factors, including the severity of the lines, the individual’s facial anatomy, and the specific filler being used. In many cases (for patients with minimal lines or those seeking subtle improvements), 1 ml of filler may be enough to address mild-to-moderate marionette lines.

However, an additional amount of filler may be needed for patients with more pronounced marionette lines or those seeking more significant correction, so the dose might be 1.5 ml or 2 ml to achieve the desired outcome.


Mess S. A. (2017). Lower Face Rejuvenation with Injections: Botox, Juvederm, and Kybella for marionette lines and Jowls. Plastic and reconstructive surgery. Global open, 5(11), e1551. https://doi.org/10.1097/GOX.0000000000001551.

Percec, I., Bertucci, V., Solish, N., Wagner, T., Nogueira, A., & Mashburn, J. (2020). An Objective, Quantitative, Dynamic Assessment of Hyaluronic Acid Fillers That Adapt to Facial Movement. Plastic and reconstructive surgery, 145(2), 295e–305e. https://doi.org/10.1097/PRS.0000000000006461.

Sattler, S., Casabona, G., Cotofana, S., Fabi, S. G., Goldie, K., Gout, U., Kerscher, M., Lim, T. S., Pecora, S., Sattler, G., Wanitphakdeedecha, R., Werschler, P., & Pavicic, T. (2021). Consensus on the Use of Hyaluronic Acid Fillers from the Cohesive Polydensified Matrix Range: Best Practice in Specific Facial Indications. Clinical, Cosmetic and Investigational Dermatology, 14, 1175-1199. https://doi.org/10.2147/CCID.S311017.

Solish, N., Bertucci, V., Percec, I., Wagner, T., Nogueira, A., & Mashburn, J. (2019). Dynamics of hyaluronic acid fillers formulated to maintain natural facial expression. Journal of Cosmetic Dermatology, 18(3), 738-746. https://doi.org/10.1111/jocd.12961.

Ko, E. J., Choi, H. G., Kim, H., Park, S., Kim, B. J., & Kim, M. N. (2015). Novel Treatment Using Intradermal Radiofrequency and Hyaluronic Acid Filler to Correct marionette lines. Annals of Dermatology, 27(3), 351-352. https://doi.org/10.5021/ad.2015.27.3.351.