Nasolabial Folds and Marionette Lines: Treatment Options

Nasolabial folds and marionette lines can be softened with several treatments, but filling the lines themselves is not always the most natural approach. These folds usually deepen because of changes above and around them, including midface volume loss, skin laxity and muscle pull. A plan that looks at those causes, often combining small amounts of filler with skin-quality treatments, tends to give a more balanced result.

Understanding the two lines

Nasolabial folds run from the sides of the nose to the corners of the mouth. Everyone has them; they are a normal part of facial anatomy and become more visible when you smile. Children have them too. They become a concern for some people when they look deep at rest.

Marionette lines run downward from the corners of the mouth toward the chin. They can give the mouth a downturned or sad appearance even when you feel neutral. They often appear alongside early jowls.

Both lines are influenced by the same ageing changes: fat pads in the cheek lose volume and shift lower, bone support recedes, skin loses collagen and elasticity, and certain muscles pull the corners of the mouth downward.

Why filling the fold directly isn't always the answer

It can seem logical to inject filler straight into a crease. Sometimes a small amount placed this way is appropriate. But in many people, this approach has limits:

• The fold is often a border, not a hole. The nasolabial fold forms where cheek tissue meets the firmer tissue around the mouth. Heavy cheek tissue sitting on top of it is part of the cause.
• Overfilling can look unnatural. Too much product in the fold can create a puffy ridge, especially when smiling, and may make the lower face look heavier.
• The cause remains. If midface support is missing, the fold may keep deepening, prompting more and more filler in the same place.

For this reason, many injectors consider whether restoring support higher up, in the cheek, could soften the fold indirectly. Our article on cheek filler and midface volume loss explains how this works.

Approaches that may help

Midface support

A small amount of firmer filler placed deep along the cheekbone can lift and support tissue that has descended. In suitable people, this may make nasolabial folds look softer without adding product near the mouth. It does not erase the folds, and results vary from person to person.

Targeted filler in the line

Where a fold or marionette line remains etched after support is restored, a softer filler can be placed carefully in or beneath the line. Conservative amounts help keep movement natural.

Jawline and chin support

Marionette lines often improve when the area beside the chin and in front of the jowl is supported. Filler here can smooth the transition between the chin and jaw. See jawline and chin filler for more detail.

Neuromodulator for the mouth corners

A muscle called the depressor anguli oris pulls the corners of the mouth downward. Small doses of a neuromodulator can relax it slightly, which may lessen a downturned look. Doses must be precise, as too much can affect smiling or speech.

Skin quality treatments

Laser resurfacing, chemical peels, microneedling and evidence-based skincare such as retinoids and daily sunscreen can improve texture and firmness over time. These do not replace lost volume, but they can make lines look less sharp and improve how skin reflects light.

Surgical referral

When skin laxity and jowling are significant, a facelift or other surgical procedure may provide the most meaningful change. Injectables can delay or complement surgery in some people, but they cannot replicate it.

Building a combination plan

Because several factors contribute, a staged plan over weeks to months is common. A typical sequence might start with assessment and photos, then address support, then refine lines, then work on skin quality. Not every person needs every step, and some need none. Spacing treatments allows swelling to settle so each change can be judged properly, and it lets you decide based on your priorities and budget.

Risks and who should wait

Filler in this area commonly causes swelling, tenderness and bruising for several days. Less common risks include lumps, asymmetry, filler migration and infection. The facial artery runs close to the nasolabial fold, so vascular occlusion, though rare, is a particular concern here. Signs include severe pain, blanching or a mottled, dusky colour, and it requires urgent treatment with hyaluronidase in a medical setting.

Treatment is generally not recommended, or should be delayed, if you are pregnant or breastfeeding, have an infection or cold sore near the mouth, have had a reaction to hyaluronic acid filler or lidocaine, or have recently been ill or had dental work. Neuromodulator treatment around the mouth is not suitable for people with certain neuromuscular conditions. If you take blood thinners, discuss this with your physician rather than stopping them yourself.

Frequently asked questions

Should I try to get rid of my nasolabial folds completely?

Generally not. Some fold is part of a natural face. Erasing it fully often looks odd when you smile. Softening is a more realistic goal.

Why does my injector want to treat my cheeks when my concern is around my mouth?

Because the tissue above the folds influences how deep they look. Restoring support there can sometimes achieve a more natural improvement with less product near the mouth.

Can skincare alone help these lines?

Skincare will not replace lost volume, but retinoids and consistent sunscreen can improve skin texture and slow further damage. For fine surface lines, that may be enough.

Does weight change affect these lines?

It can. Losing weight may reduce cheek volume and make folds more visible, while gaining weight may add fullness around the mouth and jaw. This is one reason plans are reviewed over time.

If lines around your mouth are bothering you, a consultation at HealthPark Medical Aesthetics can look at what is driving them and outline options, from skincare and conservative injectables to referral, so you can choose what fits your goals.