Filler for Nasolabial Folds and Marionette Lines

People tell you that you look tired, sad or stern, when that is not how you feel. In the mirror, you see a nasolabial fold deepening between your nose and mouth, or folds that pull the corners of your mouth down. Filler can soften a hollow; it does not tighten skin that is sagging. The doctor examines your face before recommending anything.

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Three-quarter close-up of a mature woman's nose, mouth and chin, with a natural fold between the nose and mouth.

At a glance

Five things to know before deciding

The two folds: the nasolabial fold runs down from the side of the nose to the corner of the mouth; the marionette line runs from the corner of the mouth toward the chin.
What filler changes: a gel aims to soften the hollow of the fold by changing its contours; it does not tighten sagging skin and does not necessarily erase the fold.
Duration: with an absorbable gel, the effect is temporary; the effect of a hyaluronic acid gel can last from six months to a year or more, depending on how the skin has aged, the area and the product.
Risk that requires immediate care: gel accidentally injected into a blood vessel, which is rare but serious.
Before any treatment: a medical assessment, which can lead to offering, changing, postponing or declining the injection.

Where Do Nasolabial Folds and Marionette Lines Come From?

The nasolabial fold is the crease that runs down from the side of the nose to the edge of the mouth. The marionette line starts at the corner of the mouth and runs down toward the chin and the jawline. It is often accompanied by a small hollow just in front of the jowl. When these folds are pronounced, the corners of the mouth can seem pulled down, which explains the sad or stern look people attribute to you.

Front view of a mature man's nose, mouth and chin, with folds between the nose and mouth and below the mouth corners.

Neither of these folds has a single cause. With age, the skin becomes thinner. The fat under the skin and the fat pads of the cheek change, as does the bone that supports them. Gravity, the sun, smoking, heredity and stress also contribute to the loss of facial contours.

Below the corner of the mouth, marionette lines can deepen when the jawbones lose volume and the deep fat under the muscle that pulls this corner down decreases. The skin and supporting tissues sag, while the fat in the jowls and cheeks descends. The muscle can also compress the tissues; their attachment points on the jaw contribute to the fold. Even in a young person, bone support that sits further back can contribute to a pronounced nasolabial fold.

The difference between a hollow and sagging tissues matters when choosing a treatment: adding volume can soften a hollow, but it does not tighten sagging skin.

Nasolabial fold: Between the side of the nose and the corner of the mouth.
Marionette line: Below the corner of the mouth, toward the chin.
Expression line: Visible mainly when the face moves, along the muscle that pulls the corner of the mouth down.
Set-in line: Visible even at rest, with no expression at all; with age, an expression line can become permanent.

What Filler Changes in These Folds, and What It Does Not

A hyaluronic acid gel, which holds water, can be used to fill a hollow. Injected into or under the skin, it fills a space and aims to make the fold less visible by changing the contours. The choice of material and whether it is appropriate for this area are discussed during the assessment. Absorbable fillers are specifically intended for moderate to severe wrinkles and folds of the face, with the nasolabial fold as the typical example. Filler in a nasolabial fold, as in a marionette line, therefore acts on the hollow, not on skin that is sagging: it does not tighten that skin and does not give the same result from one person to the next. The result depends on the structure of your tissues, the amount of gel and the type of product.

What it aims to do: Soften the hollow by changing the contours of the fold.
Who it is for: An adult whose nasolabial fold or marionette line is mainly due to a hollow, after assessment by a doctor.
What it does not change: Sagging of the skin and tissues, which a gel does not tighten.
What it does not guarantee: That the fold will be erased, or an identical result from one person to the next.
When the injection is postponed: The injection is postponed as long as the skin shows inflammation or infection, such as cysts, pimples, a rash or hives.
Who injects it: A doctor, or a nurse injector supervised by a doctor.
Offered by CARE MD: Filler for nasolabial folds and marionette lines; the choice of material for this area is discussed during the assessment.

When Sagging Is the Main Issue, Filler Is Not Enough

A gel added to a fold does not lift a sagging cheek. If sagging is more prominent than hollowing in your face, filler alone leaves the sagging in place. The choice then depends on the degree of sagging and the condition of the skin. For a marionette line, treatment may require a combined approach.

At CARE MD Declining skin quality: Collagen biostimulators gradually stimulate collagen production; CARE MD offers this type of product.
At CARE MD Mild to moderate sagging: Focused ultrasound, offered by CARE MD, aims to firm the skin; the greater the initial sagging, the less marked the improvement.
Significant sagging: A surgical facelift, which addresses sagging skin, the deepening of the folds between the nose and the corner of the mouth, fat that has descended, and jowls; CARE MD does not offer it.

Not all cosmetic injections work the same way: a gel fills a hollow, while biostimulators stimulate collagen production.

Minimally invasive treatments do not achieve the results of a facelift, but they can delay the point at which one becomes appropriate. The doctor can help you understand whether the sagging in your face justifies considering this surgery.

How Long the Effect of Filler Lasts, and What to Expect

With an absorbable gel, the correction of a nasolabial fold is not permanent: the body gradually absorbs the gel, and to keep the effect, the injection is repeated after some time. The result and how long it lasts vary from person to person.

CARE MD does not publish testimonials or photos of results: a result achieved on one face does not predict the result on another. After examining you, the doctor tells you what filler can do for your nasolabial fold.

Duration: The effect of hyaluronic acid filler can last from six months to a year or more, depending on how the skin has aged, the area and the product.
Maintenance: The injection is repeated when the effect fades; you and the doctor decide how often.
During and after: Pain, bruising, redness and swelling; these effects are generally temporary, but some can last several months and require correction.
Guarantee: Neither erasure of the fold nor the duration of the effect is guaranteed.

The Risks in This Area, Including Blood Vessel Occlusion

Most effects, such as swelling and bruising, occur shortly after the injection and go away within a few days or weeks. Any filler can also cause effects that are temporary, permanent or both, and some appear weeks, months or years later.

This risk exists wherever a gel is injected, including in nasolabial folds and marionette lines. When it happens, it is an emergency: treatment must be immediate. If the injected material is hyaluronic acid, a prescribed treatment can dissolve the gel, but this does not guarantee that all consequences, particularly those affecting vision, will be avoided. Medical care is still urgent.

Less common: Infection, nodules or granulomas that sometimes need treatment, wounds, allergic reaction.
Rare: Anaphylactic shock, which requires immediate emergency medical help, and permanent hard nodules.
Most concerning: Gel accidentally injected into a blood vessel, which blocks the blood supply to the tissues. This complication is rare, but its consequences can be serious and permanent: tissue death (necrosis), vision problems up to and including blindness, stroke.

Seek care right away

During or shortly after an injection: unusual pain, a change in vision, white, grey or blue skin near the injection site, or a sign of stroke (sudden difficulty speaking, numbness or weakness in the face, arms or legs, difficulty walking, a drooping face, a severe headache, dizziness or confusion). These signs require immediate medical care. Only a doctor can determine their cause.

Why a Medical Assessment Comes Before Filler

An examination of the skin helps determine whether filler can make what bothers you less noticeable. Discuss the depth of the fold, what you see at rest and when you smile, lost volume, bone support and sagging. A hollow that needs filling and a sagging cheek do not call for the same approach. Also explain what you would like to change: these points help explain why the doctor can offer an injection, prefer another option, postpone the treatment or decline it. At CARE MD, a doctor or a nurse injector under the doctor's supervision performs the treatment. You can learn about the qualifications of our professionals.

Tell the doctor about anything related to your health, even if it seems unrelated to your face.

Also prepare your questions: How long can the effect last? What side effects are possible, and which risk is relevant to you personally? Which product will be used, and is it approved? What experience does the injector have, and what is the cost? The answers help you know what to expect and make an informed decision.

What to mention: Allergies, blood clotting disorders, cold sore outbreaks, heart disease, previous cosmetic treatments (other injections, implants), easily irritated skin.
Medications and natural health products: All of them, even those taken without a prescription, such as warfarin, aspirin, ibuprofen, vitamin E, St. John's wort, garlic and ginger.
Pregnancy and breastfeeding: The safety of fillers has not been established in these situations; let the doctor know if you are pregnant or breastfeeding.
Under 22: In the United States, FDA approval of fillers applies to adults aged 22 and over, and their safety has not been established in younger people. This U.S. benchmark is not an age criterion at CARE MD. Unknown safety does not mean that harm has been proven.

How to Describe What You Want to Change

Show the doctor the line that prompted your request. Say what draws attention: the fold at rest, or only when you talk or smile. Also say what should not change in your face, for example your smile. This discussion sets the goal; on its own, it does not determine whether an injection is chosen, and it is not a promise that any fold will be erased.

Ask Us Your Questions About Your Nasolabial Folds and Marionette Lines

Frequently Asked Questions

What is the difference between a nasolabial fold and a marionette line?

The nasolabial fold runs down from the side of the nose to the edge of the mouth. The marionette line starts at the corner of the mouth and runs down toward the chin. They are not in the same place, and their causes overlap without being identical: receding bone, fat loss, and sagging of the skin and tissues. The doctor looks at both to see which one bothers you and what is deepening it.

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