Should Juvederm Be Injected Directly into Marionette Lines?

Question

My dermatologist told me that Juvederm should be injected alongside my marionette lines instead of directly into them.  The result was good, and it lasted for some 6 months, but towards the end of the 6 months, I noted that periodically the product would swell and I'd have lumps to the outside of the marionette lines.  It seems to me that directly into the lines would have been a better idea. Any opinions on this?

Siamak Agha, MD, PhD, FACS · Answer

There are different techniques for injection. I personally prefer to inject into the marionette lines, but also next to it and often across the marionette lines for more substantial support. Injection of the vermillion (white lip border) also results in significant imporvement of the marionette lines.

Michael A. Persky, MD · Answer

Hi Sherri,
Replacement of volume in the face, and marionette area specifically involves adding volume to the area, not necessarily adding to fill just the lines.  We find that improved results are achieved when the area is supported.  In the future you may ask to have a little extra filler in your line as well.
Good luck and be well.
Dr. P

Steven Wallach, MD · Answer

Marionette line occur along the oral commisure and below near the jowls. I will often inject anterior to this region to camouflage.

Darryl J. Blinski, MD · Answer

You and your doctor injector are correct. It is a three dimensional injection, into the valley or crease and along the edges also. Maybe you should see another opinion of an expert injector. Regards.

Chad L. Prather, MD · Answer

You're both correct.  Juvederm should be injected into the marionette lines (at the appropriate dermal depth) for improvement, but it also needs to be injected beside and often across the marionette lines for more substantial support.
Different injectors have different techniques, and advanced injectors will place product both into the lines and around the folds to achieve the best results.  6 months is a pretty typical duration for injections around the mouth, though.  Juvederm can last longer (if enough is allowed by the patient and given by the injector) in other parts of the face, but the mouth is such a mobile area, the results don't typically last as long there.

Arnold R. Oppenheim, MD (retired) · Answer

The beginner injector tends to inject the way you describe, i.e. into the line itself. As injectors become more adept at filling the naso-labial folds they learn to inject both into the line, alongside the line and across the line. This technique also decreases the chances of seeing a line ackwardly running along the nasolabial crease.

Ritu Saini, MD - Account Suspended · Answer

The marionette lines can be tricky because they can be quite "cavernous." Therefore, while injecting into them is very important for achieving desired results, the surrounding tissue often needs to be filled as well to support marionette lines. This provides a less bulky, unnatural looking marionette line from too much filler directly into it while provding the softening and aesthetically pleasing contours you are looking for. So, in essence, both you and your doctor are correct. you can request to maybe have a touch more product placed directly into the marionette lines.

Should Juvederm Be Injected Directly into Marionette Lines?

Answers (7)

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