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)?

Nick Slenkovich, MD · Answer

Hello! I’m Lauren, the aesthetic provider here at Colorado Plastic Surgery Center.  For long-term improvement, RF microneedling is a great option it helps stimulate collagen, tighten skin, and smooth out texture irregularities. You may need a few sessions for best results.

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)

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

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Everything you need to know about Chin Filler

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