Wrinkles on the face known as “marionette lines” extend from the corners of the mouth down to the chin. They are referred to as melomental folds.
They are a byproduct of facial aging, primarily as a result of the loss of facial scaffolding and support.
Always evaluate the overlaying skin’s condition and the degree of the marionette line before beginning treatment. A patient may not be a good candidate for any soft tissue filler if they have poor skin quality or excessive facial atrophy, laxity, and aging and may need surgery instead.
Anatomical consideration
1. A cannula for new injectors is advised because the facial artery runs a perilous course as it ascends and medially from the jawline to treat marionette lines.
2. Botulinum toxin may be taken into consideration as part of the treatment plan because the depressor anguli oris (DAO) muscle beneath causes a pull at the corners of the mouth.
3. improving skin quality should also be taken into account when using skin tightening procedures.
Technique
The layer 2 procedure uses a 25g cannula to apply the soft tissue filler in retrograde threads, supporting the marionette line structurally.
Some beginners common mistakes
1. Ignoring some or all of the aforementioned.
2. Directly treating the marionettes without taking into account the volume loss in the upper two-thirds.
3. Depending on skin laxity, managing patient expectations. never claim to get rid of wrinkles, just to soften them.
4. It can be a mistake to ignore alternative holistic approaches.
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