Lecture on Marionette Line Filler Injections
Level of Difficulty: Basic
Patient Satisfaction: Moderate
Risk Level: Low
Indications for Treatment
Marionette lines, also referred to as drool lines or melolabial grooves, extend vertically from the mouth corners towards the mandible. These lines are major indicators of aging due to volume loss in the prejowl area, often imparting a sad or tired look that contributes significantly to an aged appearance.
Anatomical Background
The presence and prominence of the marionette lines are largely due to the activity of the depressor anguli oris (DAO) muscle, which deepens these folds. Additionally, volume depletion in the chin and adjacent soft tissues exacerbates the depth of these grooves.
Recommended Injection Technique
To address these lines, injections should be administered perpendicularly and medially to the fold. Enhancing visibility of the line by pinching the skin can aid in accurately marking the treatment area. This approach ensures that injections fill concave sections and avoid areas where the skin is more convex.
Precautions to Consider
Insufficient treatment may lead to minimal improvement, often leaving patients dissatisfied. Typically, up to 1 mL of filler per line may be necessary to achieve seamless integration with the surrounding areas, including the chin and along the mandible.
Post-Injection Care
Applying ice and pressure post-injection can help minimize bruising. Early firmness due to product swelling is common but tends to blend smoothly within a week. Gentle massage post-injection can also help alleviate any lumpiness.
Potential Complications
Risks are generally low but include bruising and the Tyndall effect, which results from overly superficial injections.
Expert Tips for Optimal Results
– Overcorrection is rare but can occur if initial lines are very faint.
– Bruising is a frequent occurrence but manageable.
– Enhancing the oral commissure concurrently can significantly improve the aesthetics of the marionette lines.
Can be combined with DAO botulinum toxin. Cross hatch method is preferred to avoid line migration . Avoid inferior labial artery.
