The lines typically appear as part of the ageing process and are given their ‘marionette name’ after the marionette puppets. They normally present as a feature of more advanced ageing in combination with other sings of ageing such as sagging cheeks, jowls, and nose-to-mouth lines and they are usually treated as part of a more global rejuvenation.
Adding volume to the fold itself can be effective to reduce the depth of the wrinkle. When taking this approach however the volume added needs to be very, very conservative. This is one of the treatments that inexperienced practitioners tend to get wrong because although it is relatively easy to inject in a straight line, it is more difficult to judge when to stop and avoid over-treatment.
Fat transfer involves removing fat from one area of your body (normally the tummy) and injecting it into areas of fat loss on the face, e.g. the marionette line. The advantage of this technique is that you are using your own tissue to achieve the augmentation. The downside is that the fat can be quite unpredictable, it doesn’t always survive, the downtime can be quite extensive and complications can be very difficult to correct. Because of the safety and predictability of injectable fillers by comparison, we no longer offer fat transfer as a procedure in our clinic.
