How can I improve the appearance of my marionette lines damaged by cannula needle? (Photos)

Question

One year ago, I had filler put in my marionette lines for the first time ever. Now it has disintegrated and left me with these horizontal pits or ripples. I had a cosmetic nurse look over it and she said the filler did not mitigate but it had metabolized. What would be a quick fix for superficial appearance and then which long term procedures do your recommend to improve this area (RF, microneedling)?

Anna Chacon, MD, FAAD · Answer

From your description and photo, the horizontal pits and ripples in the marionette area are likely due to a combination of natural volume loss, skin laxity, and surface irregularities left after the filler has metabolized. Here’s how I would approach it:

Quick, Short-Term Fixes

Hyaluronic Acid Filler (Superficial Placement): A soft, low-viscosity filler such as Belotero Balance® or Restylane® Silk can be placed very superficially to smooth pits and ripples without adding bulk.

Skin-Boosting Microinjections: Microdroplet hyaluronic acid or polynucleotides can rehydrate and plump the dermis to improve surface texture quickly.

Blurring with Dermal Airbrushing (Dilute Radiesse®): A diluted calcium hydroxylapatite solution can give subtle thickening and improve the skin’s support structure.

Long-Term Improvement Strategies

Collagen-Stimulating Devices

RF Microneedling (e.g., Morpheus8, Secret RF): Tightens skin and smooths surface irregularities.

Fractional Laser Resurfacing (CO₂, Er:YAG): Improves texture and collagen density.

Biostimulatory Fillers

Sculptra® or Radiesse® (Undiluted): Gradually improves collagen support in deeper layers, softening the marionette area over months.

Supportive Skin Care

Prescription-strength retinoids and peptides to enhance dermal remodeling and elasticity.

Treatment Approach
I often recommend starting with a quick filler-based correction for immediate visual improvement, then transitioning into RF microneedling or laser sessions to address the underlying collagen weakness. Combining both gives you short-term smoothness and longer-term structural support.

How can I improve the appearance of my marionette lines damaged by cannula needle? (Photos)

Answers (1)

Recommended reading

Everything you need to know about Chin Filler

Our mission is to create a world where every investment in modern beauty is Worth It.

How can I improve the appearance of my marionette lines damaged by cannula needle? (Photos)

Answers (1)

Browse related questions

Recommended reading

Everything you need to know about Chin Filler

Our mission is to create a world where every investment in modern beauty is Worth It.