Ask Dr Molton: Removing Marionette Lines

Premier Cosmetic Medical Clinic, Adelaide South Australia

Ask Dr Molton: Removing Marionette Lines


I hate the corners of my mouth which looks like I’m a marionette puppet. I had dermal filler and anti-wrinkle injections put in there but the last two times they haven’t lasted… Can you make a recommendation? What can you do to help, how much will I have to pay, and will it hurt?


Dr Molton replied:

Marionette lines are not caused from losing volume at the corners of the mouth so it makes little sense inject dermal filler into them. The cause of marionette lines are threefold:

  • Volume loss in the middle and upper face
  • Loss of elasticity of the skin of the face
  • Loss of ‘tensile strength’ in the skin

The third cause is a little hard to get the head around. The best way to think about this is the old party balloon that has deflated a bit. The wall of the balloon is now soft and flimsy. It has low tensile strength. If we want to stretch the wrinkles out of the old balloon we are going to have to blow it up to a bigger volume than it was originally…OK for a balloon but not the patient’s face unless you want two golf balls!


So what can you do to help this problem?

We always begin with a 3D assessment to measure any volume losses and evaluate the elasticity and tensile strength of the skin of the face. Where there is good elasticity and tensile strength, the marionette lines will lift simply by replacing lost volume in a treatment that doesn’t involve big chunky abnormal cheeks. Remember, we want natural and normal appearance.

Where there is loss of tensile strength from sun-damage, Fraxel laser would probably be the best choice. Finally, where loss of tensile strength has occurred, as well as volume losses, Selphyl PRP often gives the best value for money.


How much would I expect to pay to remove marionette lines?

A lot less than a surgical face-lift, and still with natural appearance my treatment plan and costs would pan out something like this. Let’s say the patient is 50ish. There are volume losses, loss of tensile strength and elasticity with cumulative sun damage.

Session 1
Selphyl PRP 2-4 syringes, $1200-$2400
Full face Fraxel laser $1400*

Session 2 (6-10 weeks later)
Selphyl PRP 2 syringes $1200 (possibly 4 but not normally)
2nd Full face Fraxel laser

Session 3 (6 months later)
Review and fine tune focusing on fine lines and any residual minor volume losses.

Downtime: All treatments cover with makeup, some mild puffiness lasting 48 hours in some patients. No downtime or camouflage is required for Session 3

Review in 3 months and follow up 12 months later.


How painful are the procedures?

Patients find the Fraxel laser is a prickling sensation of about 4/10, (10/10 being the worst imaginable prickle).

I’m sure you will find the end result, and the progress towards it, will be rewarding and will provide that refreshed appearance we all crave.