Is Restylane Best for Marionette Lines?

I'm 35 years old, and I have several medium marionette lines on the sides of my mouth. It almost looks like my face is gaunt (especially in the cheek area), and it doesn't help that I have a narrow face. I have been looking into fillers--namely Restylane. Is this treatment best for someone like me, or should I go for other fillers?

Doctor Answers 26

How to Treat Marionette Lines

For treatment of marionette lines, we are fortunate in 2014 to have some really good fillers which will help soften the area. These include both Restylane and Perlane — and even the newest one, Restylane Silk, which is coming to the market soon and may find a nice home with these lines. Juvederm will also work, and so will Belotero.

I suggest that the most important point of the discussion focus on who is doing the injection. I always recommend a board-certified dermatologist or plastic surgeon office. These offices offer the most knowledge of the anatomy of the area you are concerned about and can tailor the treatment to be the best for you.


Nashville Dermatologic Surgeon
4.0 out of 5 stars 18 reviews

Marionette line filler

I find that for deeper lines usually in the "marionette" area, that Perlane is a better option or layering Perlane deep and Restylane on top of that. However, the picture that you show here, one needs to balance expectations, as if the lines you are shooting for are really tied into your natural facial musculature, i.e. dynamic, thus really created when you smile, then your results will be minimal and your expectations should be managed appropriately.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Fillers are great for marionette lines!

Injectable fillers are an excellent option for treating marionette lines. When utilizing this approach a large variety of injectable fillers are currently available. These include Restylane, Juvederm, Sculptra, Artefill and Radiesse to name a few. The filler chosen is dependent on the patients’ anatomic findings, aesthetic goals and the surgeons’ comfort level.
In the vast majority of cases we prefer either Juvederm or Restylane when treating these lines. Although there are differences between these products, they are both associated with excellent clinical results. Both fillers last about 6 to 9 months and are associated with high satisfaction rates.
If patients are satisfied with the results of these injections we occasionally switch to a longer lasting injectable. In most cases we prefer Radiesse which can last 2 to 3 years.
If you’re considering injectable fillers for marionette lines, consultation with a board certified specialist is appropriate.This specialist should be able to formulate an appropriate treatment plan for this problem.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Quit smiling!

It would be interesting to see your face in repose- with no facial expression- to get a sense of the depth of your Marionette lines, and to see if you have a pre-jowl sulcus.

A fine marionette line can be filled with virtually any filler. I'm favoring Evolence for this application because of its ease of injection and longevity.

If you do have a pre-jowl sulcus- this tends to deepen the appearance of a marionette line, in my opinion. In patients with both problems- I will treat the pre-jowl sulcus with Juvederm or Evolence (about the same price, roughly), and then treat the marionette line with whatever product the patient is interested in. I think the sulcus needs to be treated with something more substantial than just Restylane.

Most Kindly,

Scott Sattler MD FACS

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

Many filler options for the marionette lines

Remember the expresssion: there are many ways to skin a cat.  Not a pleasant expression but you get the idea.  There are lots of options for improving marionette lines. If you go to an experienced cosmetic dermatologist, she can discuss why she recommends one filler over another for you.  Generally for this area, I'll choose the filler based on what I need for the rest of the face.  Restylane L, Restylane Lyft, Restylane Defyne and Restylane Refyne are all appropriate fillers from that line for this area.  Juvederm ultra, Juvederm ultra plus, and Voluma are appropriate from the juvederm line.  And radiesse could be used if they are deeper or belotero if they are more superficial.  If you aren't treating any other area and looking for a filler specifically for that area, you should consider Restylane refyne or defyne which are produced with XpressHAn technology to improve their flexibility for areas of expression.

I hope this answer was helpful. Best wishes.

Heidi A. Waldorf, MD
New York Dermatologist
5.0 out of 5 stars 10 reviews

Marionette Lines

Restylane can treat marionette lines. However, the newest additions to our practice, Restylane Refyne and Restylane Defyne can be great options as well. These fillers work to provide a natural, smooth look to the face, treating both marionette lines and nasolabial folds. A consultation with your doctor can help to best determine which filler is right for you.

Charles M. Boyd, MD
Birmingham Facial Plastic Surgeon
1.0 out of 5 stars 1 review

Marionettes and Restylane

Your photograph can not give me the needed  information but likely at your age a dermal filler should do well for you. Restylane is meant for a dermal injection and this should plump out any early shadowing.  Restylane Lift is used for a deeper injection  and is best used for the cheeks. Restylane Silk can used in a more superficial fashion. Marionettes are more of a shadow problem rather than a line. Therefore, Restylane is better filler of this line to use.



Robert W. Sheffield, MD
Santa Barbara Plastic Surgeon
4.9 out of 5 stars 26 reviews

HA fillers can be good for treating marionette lines

Hyaluronic acid fillers such as Restylane and Juvederm are good options for treating marionette lines. Thicker fillers such as Restylane Lyft or Voluma can work to add volume back to a gaunt face caused by volume loss as well. It’s best to see a board-certified, expert dermatologist for an in-person consultation to determine what treatments will work best for your individual case. 

Margaret Weiss, MD
Baltimore Dermatologic Surgeon
3.7 out of 5 stars 7 reviews

Injector skill matters more than specific filler.

Restylane® is a hyaluronic acid-based filler very similar to JUVÉDERM®, Perlane® and other HA fillers. They all work in the same way, are formulated similarly and deliver equivalent results for roughly the same length of time (give or take). That being said, it’s absolutely the case that some patients see a better result with one HA filler over another, and many surgeons see more positive results working with one product instead of a different product. For the best results, focus on finding an experienced injector who knows exactly how to address marionette lines and who has plenty of experience. Try some options and see which one you prefer. Once you find what works best for you, then you can commit to brand loyalty.

Restylane for Marionette Lines

Thank you for the question and the great picture. Restylane is a great option for marionette lines, as well as other folds or hollow areas of the face (such as nasolabial folds, the under-eye area, etc.). This product is made from hyaluronic acid (HA), just like Juvederm, Perlane, and Belotero.  The differences between these have to do with crosslinking and viscosity (thickness and flow). This type of filler can last between 6 and 9 months in most patients. Radiesse is a different material (calcium hydroxyapatite) and lasts a little longer (9 to 12 months). The key to getting the best treatment for you is having a positive relationship with a provider you trust -- that was you can work together to achieve the aesthetic results you want. Best of luck moving forward!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 110 reviews

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.