August 22, 2022

marionette linesIf patients complain that friends think they look unhappy, with a downturned smile or creases at the corners of the mouth, then it may be time to consider treatment for melolabial folds, commonly known as marionette lines.

In this blog, Dr Tim Pearce will share some expert tips on the 4mm needle technique for lip shaping and contouring of the vermillion border, and adding volume to the lip as a low trauma injection technique. He will also discuss the advantages and disadvantages of the technique.

Shh…Dr Tim will soon be revealing a very exciting new ‘ultimate’ lip course that will cover EVERYTHING you need to know about injecting the lips. Sign up >> to be the first to know when it goes live!

How to improve marionette lines and lift oral commissures

To improve melolabial folds or marionette lines around the mouth, we must support the weak point in the skin between the cheek and the jowl, often called the prejowl sulcus.

melolabial foldIf you exaggerate the problem by placing your thumb on the lower cheek and you finger on the base of the chin and draw them towards each other, you will notice that the patient’s skin will crease in a fold from the corner of the mouth, towards the jawline.

When injecting, to improve these lines, instead of running parallel with the line, Dr Tim advocates superficial linear threads at 90 degrees to the crease. This will produce small structs in the tissue that will push the corner of the mouth back to its original position. The injections should be superficial as this produces the most amount of traction in the skin.

The first injection should run lateral to the mouth, entering as close to the corner of the mouth as possible (lateral to the pink part of the lip), with further linear threads running across the crease at intervals down towards the jawline. Entry with your needle ought to be at 30 degrees to a maximum of 2-3mm of penetration, whereupon you should straighten and elevate your needle so you remain superficial in the skin as you insert the remainder of the needle; blanching should be visible when the needle is raised within the tissue.

Although, if done correctly, you should be above the inferior labial artery, Dr Tim recommends aspiration for safety at this point. A retrograde thread of approximately 0.05ml-0.1ml of hyaluronic acid-based dermal filler can then be deposited (depending on the softness of the product).

As you move down the face with linear threads, it is important that you do not deposit filler in the (raised) area where the cheek meets the melolabial fold (the mountain top) as this may exacerbate the original problem. All filler should be placed in the fold, in the direction towards the chin, penetrating the skin with the needle before the crease and after the jowl (in the valley floor).

Treatment should be completed by massaging the area to smooth the dermal filler product; this can be done by placing your fingers and thumb both inside and outside the patient’s mouth and applying firm pressure.

A final superficial linear thread (with the same product deposition) can be applied directly into the crease of the oral commissure to lift the corner of the mouth. This linear thread will be at 90 degrees to the lines deposited along the melolabial fold.

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Lip Filler Treatment & Complications

With all the conflicting advice out there about lip filler treatments – vertical or horizontal? needle or cannula? – it can be difficult to know how to inject to create the lips your patient desires.

If you are suffering from technique overwhelm, worrying about causing a vascular occlusion (VO), or panicking about injecting thin lips, then Dr Tim Pearce’s brand-new ultimate lip course is going to teach you the different techniques, anatomy, and skills you need to create medically beautiful lips.



Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.

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