Nasolabial Fold or Marionette Line? How to Tell the Difference
The nasolabial fold runs diagonally from the side of the nose to the corner of the mouth. The marionette line, on the other hand, starts at the corner of the mouth and extends downwards towards the chin or lower jaw. Both can meet at the corner of the mouth and appear together – but their causes and potential treatments are not automatically identical.
Therefore, for effective treatment planning, it is not enough just to fill the visible line. It is crucial to determine whether the primary issue is volume loss, sagging tissue, declining skin elasticity, muscle activity, or a combination of these factors. Only then can it be assessed whether a hyaluronic acid injection, an complementary treatment or another procedure is suitable.
How do you recognize the difference?
The easiest point of reference is the corner of the mouth:
- If the line runs from the side of the nose to the corner of the mouth, it is the nasolabial fold.
- If it runs downwards from the corner of the mouth, it is a marionette line.
- If lines run both above and below the corner of the mouth, both folds can be present simultaneously.
For this, observe your face once relaxed and once while smiling or speaking. A line that becomes more prominent with movement can also be influenced by facial expressions. A wrinkle that remains visible even at rest usually has a stronger static or structural component.
However, self-observation only shows where a wrinkle runs. It cannot reliably determine why it appeared or where it should be treated.
Why do nasolabial folds appear?
The nasolabial fold is initially a natural boundary between the cheek and upper lip area. How clearly visible it becomes depends, among other things, on the face shape, skin condition, facial expressions, and age-related changes.
Over time, fat compartments and other tissue structures in the mid-face can change. At the same time, skin elasticity decreases. This can make the transition between the cheek and mouth region more pronounced. In some people, the fold is already clearly defined early on, without being pathological.
Therefore, before a hyaluronic acid treatment for nasolabial folds, not only the fold itself is assessed. Cheek volume, facial proportions, and tissue distribution can also be relevant for planning.
Why is the nasolabial fold not always injected directly?
A prominent nasolabial fold can sometimes be exacerbated by changes in the overlying mid-face. In such cases, it may be more harmonious to first assess the missing volume in the cheek area, rather than exclusively injecting material directly into the fold.
Whether a cheek augmentation with hyaluronic acid, a direct injection into the fold, or a combination is appropriate depends on the individual findings. There is no general rule that nasolabial folds should never be treated directly.
The region is also anatomically challenging, as relevant blood vessels run there. Unintentional injection into a vessel is rare but can have serious consequences. Therefore, analysis, education, and injection belong in the hands of licensed doctors with sound anatomical knowledge.
Why do marionette lines appear?
Marionette lines are lines or indentations that run downwards from the corners of the mouth towards the chin and lower jaw. Their development is usually multifactorial. Possible influencing factors include:
- age-related volume loss,
- changes in fat compartments in the lower face,
- decreasing skin elasticity,
- individual chin and jaw structure,
- tissue sagging as well as
- in some people, pronounced muscle pull at the corners of the mouth.
The fold can visually lengthen the corner of the mouth downwards. This can make the facial expression appear tired, sad, or tense, even if the actual mood is different.
What treatment is suitable for marionette lines?
With suitable anatomy, hyaluronic acid can compensate for missing volume in the area of the marionette line or the adjacent lower face. The goal is not a complete elimination of every line, but a softer and more harmonious transition.
On the treatment page for injecting marionette lines, you will find more information on the procedure, possible results, costs, and aftercare.
If an active pull of certain muscles also pulls the corners of the mouth downwards, an additional Botox treatment can be considered in selected cases.
However, Botox does not replenish lost volume. Therefore, whether hyaluronic acid, Botox, or a combination is appropriate must be medically decided. We explain the different principles of action in more detail in the guide Botox or Hyaluronic Acid.
Secure your consultation now
Is a mentolabial fold the same as a marionette line?
The terms are sometimes used interchangeably in everyday language, but anatomically they are not entirely identical. Marionette lines typically run laterally downwards from the corners of the mouth. The mentolabial fold or chin-lip furrow, however, primarily describes the horizontal transition between the lower lip and chin.
This distinction is relevant for treatment:
A prominent chin-lip furrow, a marionette line, and a downturned corner of the mouth can occur simultaneously but do not necessarily need to be treated in the same way.
Can a chin correction improve marionette lines?
A chin correction with hyaluronic acid does not automatically treat marionette lines. However, for certain facial proportions, targeted modeling of the chin can contribute to making the lower face appear more harmonious.
Whether this makes sense depends, among other things, on chin projection, lower jaw contour, tissue distribution, and the actual treatment goal. Chin augmentation should therefore not be understood as a standard solution against marionette lines.
What is treated first if both folds are present?
If nasolabial and marionette lines appear together, the face should ideally not be divided into isolated lines. First, it should be examined what changes occur in the mid-face and what changes occur in the lower face.
Depending on the findings, it may be advisable to first treat structural volume deficits in the mid-face and then reassess the result. In other cases, the corners of the mouth or the lower face are the primary focus. There is no fixed sequence that applies to every face.
If multiple areas are affected, a coordinated full-face hyaluronic acid treatment may be considered. This is not about injecting as many zones as possible, but rather analyzing the actually relevant areas together and treating them cautiously.
When is hyaluronic acid not the right solution?
Hyaluronic acid can restore volume and soften suitable wrinkles. However, it cannot lift significantly sagging or excess tissue at will. If the main issue is pronounced sagging of the skin and tissue, additional filler can make the face look heavier without adequately correcting the actual cause.
Aesthetic hyaluronic acid treatment is also usually not performed if you have acute inflammation or infection in the treatment area, or during pregnancy and breastfeeding. Relevant medical conditions, allergies, medications and previous treatments must be discussed with a doctor before the injection.
A responsible consultation may therefore also conclude that no filler treatment at the moment, or a different procedure, is more suitable for you.
If a hyaluronic acid filler needs to be corrected, it can, under certain conditions, be reduced or dissolved with hyaluronidase. However, this is a separate medical treatment that also carries risks and must be assessed by a doctor beforehand. You can find more information on our page about Hylase treatment.
Treatment at MY HEALTH & BEAUTY
MY HEALTH & BEAUTY has hyaluronic acid injections performed exclusively by licensed doctors. Before your treatment, we take into account not only the visible wrinkles but also your facial anatomy, facial expressions, tissue structure and the result you want.
You can find information about the practitioners and our medical standards on the page of our medical team.
Treat nasolabial folds and marionette lines at your MY location
Whether a nasolabial fold should be injected directly or whether treating the midface makes more sense depends on your individual facial anatomy. With marionette lines, too, we check before treatment whether the visible change is mainly caused by volume loss, sagging tissue or additional muscle pull.
You can get a personal medical examination and consultation at the following MY locations:
Aachen – Aquis Plaza
Berlin – Gesundbrunnen-Center
Duisburg – Forum Duisburg
Düsseldorf – Düsseldorf Arcaden
Kaiserslautern – K in Lautern
Köln – Köln Arcaden
Leipzig – Höfe am Brühl
Mönchengladbach – Minto
Recklinghausen – Palais Vest
Which area should actually be treated cannot be decided from the visible wrinkle alone. That is why our licensed doctors analyse your entire facial structure before every treatment and discuss with you which approach is medically suitable.
