Botox or Filler for Marionette Lines: Choose the Right Treatment

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

Choosing between Botox and fillers for marionette lines depends on the specific aging concerns you’re addressing. Botox is excellent for relaxing muscles to prevent the downturn of the mouth, while fillers are ideal for adding volume and smoothing out the creases that form marionette lines.

For some, a combination of both treatments may give the best results, offering both muscle relaxation and volume enhancement to rejuvenate the lower face.

Treatment Options: Botox vs. Fillers

When considering cosmetic interventions for marionette lines, understanding the distinct benefits of Botox and fillers is crucial for an informed decision.

Botox: Mechanism, Effects, and Duration

Botox, a purified form of botulinum toxin, works by temporarily paralyzing the muscles that contribute to marionette lines. By inhibiting muscle activity, Botox can lift the corners of the mouth and soften the appearance of these lines. The effects typically last between three to six months, after which repeat treatments are necessary to maintain the results. The procedure is quick, with minimal downtime, making it a convenient option for those on the go.

Fillers: Types, Effects, and Longevity

Dermal fillers, often composed of substances like hyaluronic acid, are designed to add volume and plumpness to the skin, directly filling in marionette lines and other wrinkles. Fillers come in various formulas, each suited to different areas and depths of injection. The effects are immediate and can last anywhere from six months to two years, depending on the type of filler used. Fillers not only reduce the appearance of lines but also contribute to a more youthful facial contour.

Combined Treatments for Enhanced Results

For comprehensive rejuvenation, combining Botox and fillers can address both the muscle activity that pulls down the mouth corners and the volume loss that deepens marionette lines. This synergistic approach often leads to more pronounced and longer-lasting results. By relaxing the muscles with Botox and restoring volume with fillers, patients can achieve a smoother, more lifted appearance that tackles the multifaceted nature of facial aging.

Procedure, Duration, and Recovery

The journey to smoother skin begins with a detailed procedure plan, followed by a recovery period that is generally swift, allowing for a quick return to daily activities.

Pre-Treatment Consultation and Considerations

A thorough pre-treatment consultation is essential to tailor the injectable procedure to the individual’s needs. During this session, the practitioner evaluates the patient’s facial anatomy, discusses aesthetic goals, and reviews medical history to ensure suitability for treatment. Patients are advised on what to expect during the procedure, the anticipated results, and any potential side effects. Pre-treatment considerations may include avoiding certain medications and supplements that could increase the risk of bruising. This initial step is crucial for a successful treatment outcome and patient satisfaction.

The Injection Process

Botox Injection Sites and Techniques: The success of Botox treatments for marionette lines largely depends on the precision of injection sites and techniques used. Practitioners typically target the muscles that contribute to the downward pull of the mouth corners, such as the depressor anguli oris (DAO). The technique involves injecting Botox into specific points along these muscles to relax them effectively. The number of units and injection sites are carefully determined based on the individual’s muscle strength and the depth of the lines. Proper technique is crucial to avoid affecting unintended muscles, which could lead to asymmetry or an unnatural facial expression.

Filler Strategic Placement and Volume Enhancement: Strategic placement of dermal fillers is key to achieving a natural and aesthetically pleasing result. Practitioners use a detailed understanding of facial anatomy to inject fillers at precise depths and locations, enhancing volume where it is needed most. This may involve injecting directly into the marionette lines or into surrounding areas to provide support and lift. The goal is to create a harmonious balance, restoring youthful contours and smoothing out the skin without overcorrection. The right technique and volume of filler can make a significant difference in the overall rejuvenation of the lower face.

Post-Treatment Care and Recovery

Immediate Aftercare and Activity Restrictions: After receiving injectable treatments, patients are usually advised to follow specific aftercare instructions to ensure optimal healing and results. This typically includes avoiding strenuous exercise, heat exposure, and massaging the treated areas for a certain period. Patients are also encouraged to stay upright for several hours post-treatment to prevent the product from migrating. Sticking to these guidelines helps minimize swelling, bruising, and other potential side effects, allowing for a smoother recovery process.

Managing Side Effects and Complications: While injectable treatments are generally safe, they can sometimes result in side effects such as redness, swelling, or bruising at the injection sites. Most side effects are mild and temporary, going away on their own within a few days. However, patients should be informed about the signs of more serious complications, such as infection or vascular occlusion, and instructed to contact their practitioner immediately if these occur. A skilled practitioner will also provide guidance on how to minimize the risk of complications through proper technique and post-treatment care.

Frequently Asked Questions

Can Botox or Fillers Completely Erase Marionette Lines?

While Botox and fillers can significantly reduce the appearance of marionette lines, they may not completely erase them, especially if the lines are deeply set.

How Often Should I Get Botox or Fillers?

Botox typically requires touch-ups every 3-6 months, while filler longevity varies from 6 months to 2 years, depending on the type used and individual factors.

How Long to See Full Effects of Botox or Fillers?

The full effects of Botox can be seen within 14 days, while fillers provide immediate results with further improvement over several days as swelling subsides.

Can Botox and Fillers Be Used Simultaneously?

Yes, Botox and fillers can be used in combination to address both muscle activity and volume loss for a comprehensive treatment of marionette lines.

What Are the Signs That I Might Need a Touch-Up?

Signs you might need a touch-up include the re-emergence of marionette lines or decreased volume in the treated areas.

How Do I Choose Between Botox and Fillers?

Choose Botox for dynamic wrinkles caused by muscle movements and fillers for static wrinkles and volume loss. A consultation with a professional can help determine the best option.

Are There Any Alternatives to Botox or Fillers?

Alternatives include laser treatments, chemical peels, and skincare products, but they may not offer the same level of correction as injectables.

What Are the Risks Associated with Botox and Filler Injections?

Risks include bruising, swelling, infection, and in rare cases, more serious complications like allergic reactions or vascular occlusion.


In conclusion, Botox and fillers offer effective solutions for softening marionette lines, with each treatment providing unique benefits. While not a permanent fix, they can dramatically improve the appearance of these lines, contributing to a more youthful and refreshed look. It's essential to have realistic expectations, choose a qualified provider, and understand the maintenance required to sustain results. With proper care and consideration, injectable treatments can be a valuable part of an anti-aging regimen.

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Mess S. A. (2017). Lower Face Rejuvenation with Injections: Botox, Juvederm, and Kybella for Marionette Lines and Jowls.,.27.aspx

Moon, H., Fundaro, S. P., Goh, C. L., Hau, K. C., Paz-Lao, P., & Salti, G. (2021). A Review on the Combined Use of Soft Tissue Filler, Suspension Threads, and Botulinum Toxin for Facial Rejuvenation.

Dr. Aurora Kalmanson

Always Consult a Medical Specialist

The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.