Technique problem or is Perlane wrong for marionette lines? (photo)

Hi Doctors! Over the span of 7 months, I had Perlane injected into my marionette lines. The first time, I had 0.5 mLs injected. The second time was 3 months later with 0.5 mLs and still no improvement. Most recently was 2 weeks ago, another 0.5 mLs. I still don't see any improvement. I am 34 and now they actually look deeper than before. Can anyone please explain why this is happening? He is injecting at the sides of the lines and a bit below for support. Thank you so much for your help!

Doctor Answers 3

The chin is the Black Box

I like to call the chin area the Black Box as it requires many syringes to achieve the desired effect. I like to use Perlane in the chin; I think it is very effective. Sometimes I inject 2 or 3 syringes into that area before the issue is corrected. If you are only doing .5 mls per treatment that is at most .25 per side not including what he is injecting “below for support” in my opinion that amount is too little to see very much improvement. Over the course of 7 months you have injected 1.5 mls which is usually what I inject all at one treatment with most people needing more.

Irvine Dermatologic Surgeon
4.7 out of 5 stars 19 reviews

Perlane to treat marionette lines

The anatomical placement of injectable fillers is the most important aspect of having a desirable outcome. Many physicians have different techniques, and therefore this becomes more of an art of injecting than a science. You might like another technique. You may need to volumize in a different location to decrease the appearance of this skin fold.

The second most important aspect is the amount of injectable filler used. If you had 0.5mL to your marionette lines (or 0.25mL to each line) three times over a 7-month period, then that would be 0.75mL to each marionette over 7-months. Even 1mL of Perlane, which sounds like a lot, is only 1/5 of a teaspoon. This is probably not enough product to treat the structural scaffold and volume loss that I see in your photo. That being said, I would not recommend to use it all in the lines themselves.

Jordan C. Carqueville, MD
Chicago Dermatologist
5.0 out of 5 stars 5 reviews

Resolution of marionettes may be technique driven.

I am unable to give an accurate assessment without reviewing your before and after pictures. Given the fact you are 34 years old, you probably do not have a significant amount of skin laxity unless you were to have had a significant amount of weight loss. If the attempt is being made to correct lateral commissures and/or marionettes, it is technique driven. There are many techniques taught. Perlane is a good product for this area but must be placed correctly, not superficially. Possibly the addition of a more superficial product may help, such as Restylane or Juverderm Ultra.

Nana N. Mizuguchi, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 49 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.