Marionette Lines

Oral Commissure | Marionette Lines

The area at the corner of the mouth where the upper lip meets the lower lip is called the oral commissure.  Over time, the marionette lines undergo a gradual folding.  In many people, the depression contributes to the formation of wrinkles and lines around the lower face. The effect is a sad or stern appearance. We know at Castleknock Cosmetic Clinic Dublin that oral commissure lines may extend downward from the corners of the mouth, giving an individual  an unnatural puppet or marionette-type appearance. In other instances, oral commissure lines may fan out from the corner of the mouth.

marionette lines dermal filler treatment

Treatment for Oral Commissure Lines

Oral commissure lines are almost always treated with speciality dermal fillers at the Dublin based cosmetic clinic. In instances where individuals have not developed deeper lines or folds, our cosmetic doctors will place a dermal filler like Juvederm or Restylane under these lines. When the oral commissures have developed into deeper folds, the area may be treated with a supporting filler like Teosyal or Radiesse.  These fillers help provide structural support to the folds.  Dermal fillers placed in other areas of the face (the upper cheeks for instance) may also give a subtle lift to the oral commissure area.

In some instances, toxin injections are also used to help alleviate oral commissure lines.  When botulinum toxin is injected into the depressor muscles it provides subtle lift  to the appearance of oral commissures. It also helps with lip positioning. Placement of toxin injections for oral commissure correction varies  from patient to patient, depending on the patient’s particular facial characteristics.  Toxin Injections are placed in the depressor anguli oris muscle (which extends from the chin to around the corners of the mouth) to help lift the corners of the mouth. This is part of the Nefertiti Lift treatment which treats lower face heaviness. Toxins may in some instances be placed in the mentalis (chin) muscle further enhancing facial definition. This may help relax some of the lines around the mouth and chin and clearing chimple effect.

Which Marionette Folds Filler?

The most popular injections used are Restylane, Juvederm and Teosyal. These are made using synthetic hyaluronic acid – which is a substance similar to collagen that is naturally found in your skin. Although there are a few other longer lasting injections offered like Radiesse and Ellanse. These are brilliant dermal fillers. However, I would advise against them in people with thin skin because they use substances like calcium-based micro-spheres, which feel harder in this central face areas.


HA-based fillers like Juvéderm Voluma and Restylane Lyft are high G-Prime fillers. The have the ability to lift skin better than softer fillers. They are suitable alternatives for those who would rather shorter duration of correction, 8-10 months or consider reversible effect. The most popular injections used are Restylane, Juvederm and Teosyal.


Ellanse is a fabulous dermal filler from France. It is most suitable for deep augmentation in people seeking long term marionette folds enhancement. Ellansé is a unique dermal filler lasting up to 4 years. Ellansé dermal filler is injected in a similar manner to Radiesse with results being immediate and long lasting.


Radiesse provides natural definition by restoring a more youthful-looking appearance. Provides immediate lift and definition by restoring lost volume in areas of the upper face and replicates the body’s process of generating collagen. Radiesse can last up to a year or more in many patients.

Like many other aesthetic procedures it is important that the doctor performing the procedure has extensive experience with toxins and advanced dermal filler use. For example, if toxins are placed in the depressor labii instead of the depressor anguli oris muscle, the patient may experience a temporary facial expression deformity or not be able to close the mouth properly. With Dr Hazem Kahlout’s extensive experience in the field of cosmetic procedures, the probability of this happening is remote.


When getting marionette lines treated with fillers, the cost depends not only on the amount and type of filler used but also on the skill and expertise of the treating doctor. Follow this link to see our current hyaluronic acid filler prices and this second link for Radiesse and Ellansé Price Guide.

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Sagging Jowls Treatment