Can Botox Be Used to Correct Marionette Lines? Is That Possible?

What's best for marionette lines? botox or fillers? I've heard a small amount of botox can be injected to correct marionette lines, is that true? If so, how about the tight feel it leaves? Is it safe? I had botox in between my eyebrows and crow's feet.I even like that tight feel it brings, but around the mouth area I feel it might be a different story. My doctor said I dont' need any correction to marionette lines, but suggested a small amount of botox there if I really insisted.

Answers (33)

Botox can be used to soften Marionette lines

Botox can be used to soften Marionette lines around the mouth. The danger is that if not properly injected it can alter the shape of one's lips and one's smile.

Chicago Dermatologist

Marionette lines: Botox vs Filler

Your best bet would be to use a filler since Botox only block muscle movement.

Depending on how significant your marionette lines are, a Hyaluronidase acid filler (Juvederm or Restylane), fat or more long acting filler (ArteFill) could be used.

Botox for marionette lines

Typically, we use fillers (Restylane, Perlane, Juvederm, Radiesse) to correct or improve the marionette lines but in some patients it can also be a benefit to inject the DAO (depressor anguli oris) muscles and the chin. When the DAO muscles are working to much it can draw the corners of the mouth down, making patients look unhappy.  So, for some, the combination is actually the best approach.

Botox for marionette lines

Very good question.  It depends on the severity of volume loss.  If you are extremely mild and have a strong pull downward from the DAO muscle, then I would recommend injecting a small amount to each DAO muscle.  A consultation would be your best bet.  I do on occasion use botox in conjunction with fillers.  The purpose of fillers is to replace volume so if you have significant volume loss, botox is not your best option at this time.

David V. Poole, MD
Altamonte Springs Plastic Surgeon

Botox can be part of the fix for marionette lines.

Botox can help some of the downward pull on the corners of the mouth, but it will not really soften very deep folds in that area. This is a very individual placement issue that has more to do with how you hold your face at rest and during expression. Sometimes the best treatment is a combination of some Botox with the proper amount of filler also placed in the area to soften the folds and lift a downward turn on the corners of the mouth.

Is Botox Suggested for Marionette Lines?

Hi Rosie.  We do at times use Botox in the chin area, but not specifically for marionette lines.  We use Botox to relax the mentalis, which is the chin muscle that can cause a condition called "pebble chin".  This constant flexing of the chin muscle can cause the chin to look mottled or bumpy almost as if acne scars are present when they are not.  But I digress....

We use Restylane, Juvederm, Perlane or Radiesse in the lower face.  We do not use Botox for marionette lines. Most often Restylane, Perlane or Juvederm in the marionette lines and Radiesse for the jowls at the outer edge of these lines.  Take a look at the link below for more information on the facial areas we treat and how we treat them.

Harold J. Kaplan, MD
Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
7 reviews

Combination Therapy - Dermal Filler and Botox

Marionette lines are facial lines that extend down from the corners of the mouth. As they deepen, they can start to form a grimacing expression, even though you are not intentionally producing it. They are caused by a loss of soft tissue and support structures under the skin (which occurs naturally with age), and thereby causes the overlying skin to sag and accentuate the lines. As this is an issue primarily of volume loss, the recommended treatment is dermal fillers (such as Juvederm or Perlane) which will restore a smoother appearance to the area.

As an adjunct to the treatment, quite often I will also recommend Botox into the muscles which pull down the corners of the mouth. Although Botox alone will not correct the lines, it can help downturned corners of the mouth to assume a more horizontal position.

Consult with an experienced Dermatologist in your area to determine the appropriate treatment for your concerns.

Frances Jang, MD
Vancouver Dermatologic Surgeon

Botox is not the best treatment for marionette lines

Botox is used to relax the muscles that "fold" the skin, creating a "dynamic wrinkle" over time. The muscles that are partly responsible for causing the marionette lines are the "smile" muscles, and paralyzing those would not be a desirable look. If the corners of the mouth "turn down" when smiling, then a small amount of Botox at the jawline area, (in the Depressor Anguli Oris muscle), can decrease this effect. The other contributing factor to the marionette "fold", is volume loss in this area, which responds very well to volume fillers such as Radiesse, (firm support), or Juvederm, (softer fill), so fillers are generally the best option for correcting the marionette folds..

Debra Irizarry, MD
Salida Plastic Surgeon

Botox for marionnette lines

Botox is very effective for wrinkles on the upper part of the face, forehead, frown lines (between the brows) and crow's feet.  These lines are due to repeated muscular movement and are known as dynamic wrinkles.  The lower face wrinkles, such as the marionnette lines (lines radiating from the lateral corners of the mouth towards the chin) are better treated with fillers to replace volume.  Occasionally, a tiny amount of botox can be used in the depressor angularis oris (DOA muscle), a lip depressor, to relax marionnette lines and create an uplifting effect on the mouth corners.  This is better done in combination with a filler.

Radha Mikkilineni, MD
Washington DC Dermatologist

Botox not the preferred treatment for marionette lines

Marionette lines refer to lines that are visible from the corners of the mouth, down towards the jaw line on either side of the chin. This is caused by a fold of cheek skin folding over around the mouth and usually this results from loss of fullness in the cheeks, or decreased skin elasticity, or both.

Botox can help turn up the corners of the mouth, but it will not get rid of marionette lines. If you just have a tiny line of a centimeter or so turning down from the corners of the mouth, you can try Botox, otherwise filler is a better option.

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.

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