Treating marionette lines with botulinum toxin

For a friendlier, more balanced facial expression - Precise treatment in Zurich

The treatment of marionette lines with Botulinum toxin is one of the most elegant solutions in modern aesthetic medicine to achieve a friendlier and more harmonious facial expression. While surgical procedures mean a surgical intervention with the associated risks, scars and longer healing time, the Botulinum toxin treatment a gentle alternative without a scalpel and with immediate social acceptability. The method is perfect for anyone who wants to lift the corners of their mouth and wants a natural look. The injections are carried out particularly precisely at the corners of the mouth.

The philosophy of Medical NOVA is based on the conviction that true beauty is created through the balance of medical precision and aesthetic sensitivity. This holistic approach is also reflected in our approach to the treatment of marionette lines. We understand that every Unique facial expressions and therefore carefully analyse your individual muscle activity before each treatment. Only through this detailed preliminary analysis can we create a customised treatment plan that leads to harmonious and natural results.

In recent years, modern wrinkle treatment with botulinum toxin has become one of the most popular aesthetic treatments developed. People who are particularly bothered by a grumpy or sad facial expression benefit from the relaxing effect on the mouth muscles. The method offers a Scientifically sound solution for sunken corners of the mouth without losing the natural look or facial expressions.

What are marionette lines?

Marionette lines - also known medically as mentolabial folds - are vertical wrinkles that run from the outer corner of the mouth towards the chin. Their name is derived from the lines of movement of a marionette puppet, whose mouth appears separated from the rest of the face by visible lines. These characteristic folds at the corners of the mouth are caused by a combination of natural skin ageing, loss of collagen and elastin and the constant activity of the facial muscles in the lower part of the face. Targeted injections at the corners of the mouth can effectively reduce these wrinkles.

The basis of this wrinkle formation lies primarily in the activity of the depressor anguli oris (DAO) muscle - a muscle that pulls the corners of the mouth downwards. Unlike other wrinkles on the face, marionette lines have a particularly strong influence on facial expression: they make us look grumpy, sad or exhausted - even if we feel good inside. This effect is often intensified by drooping corners of the mouth, which creates a permanently dissatisfied impression.

Precise injections of botulinum toxin relax these specific muscles, while the muscles responsible for lifting the corners of the mouth remain active. This creates a Natural balancewhich leads to a gentle brightening of the facial expression. The treatment requires a deep understanding of facial anatomy and years of experience to achieve optimal results.

Typical causes of marionette lines

The development of marionette lines is a multifactorial process that has various causes:

• Natural skin ageing: As the skin ages, it loses its elasticity and resilience. The production of collagen and hyaluronic acid decreases, causing the skin to become thinner and wrinkles to form more easily.
• Muscle activity: The depressor anguli oris (DAO) is a muscle that pulls the corners of the mouth downwards. Its constant activity increases the formation of wrinkles in the mentolabial folds.
• Loss of volume: Over the years, the face loses subcutaneous fatty tissue, causing the contours to sink and wrinkles to appear deeper.
• External factors: UV radiation, smoking, stress and an unbalanced diet significantly accelerate the ageing process of the skin.
• Genetic predisposition: Due to their genetic disposition, some people tend to develop pronounced wrinkles at the corners of their mouth earlier than others.

Botulinum toxin: the targeted solution for marionette lines

At Medical NOVA, we focus on precise, medically sound treatment of marionette lines with Botulinum toxin. This proven method offers a safe and effective alternative to more invasive procedures and has been established in aesthetic medicine for years. The injections are minimally invasive and do not require a scalpel.

The method differs fundamentally from surgical procedures or filler treatments. While surgical procedures remove excess skin and hyaluronic acid builds up volume, the Botulinum toxin only with the natural muscles. The result is a gentle, natural relaxation of the corners of the mouth without any visible marks on the face. In addition, the healing time is completely eliminated - a decisive advantage for working people.

How does the treatment work?

Botulinum toxin type A (e.g. Botox®) is a highly effective medication for the temporary relaxation of overactive muscles. When treating marionette lines, we inject the preparation directly into the depressor anguli oris (DAO), the muscle that pulls the corners of the mouth downwards. This precise injection is carried out with the finest needles directly at the affected corners of the mouth.

At Medical NOVA, we generally use 2 to 4 precise injection points per side for the treatment of marionette lines in order to relax the muscle in a targeted manner. Depending on the individual characteristics of the wrinkles, the dose is between 2 and 6 units per side. The treatment usually takes less than 15 minutes

Botulinum toxin or hyaluronic acid?

A frequent question in consultations is: Should marionette folds be treated with Hyaluronic acid or botulinum toxin? The answer depends on the individual cause of the wrinkles. While injections with botulinum toxin relax the muscles, injections with hyaluronic acid serve to increase volume:

A combination of both methods is often optimal: botulinum toxin relaxes the muscles, while hyaluronic acid as a filler fills out lost volume. In some cases, we also supplement the therapy with other procedures such as Mesotherapy or RF microneedlingto further improve the skin quality.

The treatment process step by step

With our Beauty clinic in Zurich, we attach great importance to a personalised, careful approach. Each treatment is tailored to the specific facial anatomy and personal wishes. Our approach is based on years of experience in aesthetic medicine, which enables us to achieve particularly precise and gentle results.

Step 1: Personal consultation and precise analysis

Every treatment for marionette lines begins with a comprehensive consultation, which typically 30 to 45 minutes takes. The doctors not only analyse the extent of the wrinkles at the corners of your mouth, but also your individual facial expressions, facial proportions and personal wishes. High-resolution photos are taken from different angles to document the initial state and determine the optimum injection points.

During this analysis phase, we also discuss possible risks, realistic expectations and aftercare. It will be clarified whether additional treatments such as hyaluronic acid fillers could be useful to achieve an even more comprehensive result.

Step 2: Professional preparation and hygiene

After the consultation, the face is thoroughly cleaned and disinfected. The areas to be treated are carefully prepared to ensure Sterile working environment to ensure the best possible results. We then mark the precise injection points where the botulinum toxin will be placed - usually 2 to 4 points per side. This careful preparation is crucial for the precision of the subsequent treatment and injection.

Step 3: Precise injection with state-of-the-art technology

We use the finest needles to inject the Botulinum toxin targeted into the identified muscle areas. Depending on the individual characteristics of the wrinkles, the dose is between 2 and 6 units per side. The treatment usually takes less than 15 minutes and is carried out without anaesthetic. Most patients describe the feeling as a pinprick, which also passes.

Step 4: Immediate socialising and aftercare

You can resume your usual activities immediately after the treatment. Slight swelling or redness at the puncture sites usually disappears within a few hours. Make-up can be carefully reapplied after about 2-4 hours, although you should avoid rubbing vigorously at first.

An important part of our treatment is the Follow-up appointment after 10 to 14 days. At this point, the botulinum toxin has taken full effect and we can assess the result together. If necessary, we can make fine corrections or re-treat asymmetrical areas to ensure a perfectly symmetrical and natural appearance.

Important rules of behaviour after treatment

After treatment of marionette lines with botulinum toxin, the following rules of behaviour should be observed for 24 hours:

• No sport or physically strenuous activities
• No sauna, steam bath or hot baths
• No massage in the facial area
• Do not lie down or bend your head forwards for a long time (first 4 hours)
• Do not consume alcohol
• Do not rub or press the treated areas
• Make-up can be carefully applied after a few hours

The first effects can be seen after 3 to 5 days, the full result is visible after around 10 to 14 days. The effect lasts an average of 4 to 6 months, depending on metabolism and individual muscle activity. A refresher treatment is usually recommended after this period in order to maintain the results.

Who is the treatment suitable for?

The treatment of marionette lines with botulinum toxin is generally suitable for women and men aged 30 and over who are bothered by a grumpy or sad-looking facial expression. Patients in whom the wrinkles are primarily caused by overactive muscles benefit in particular.

Ideal candidates are:

• People with pronounced folds at the corners of the mouth, which have a negative impact on facial expression
• Patients who want a natural result without surgery
• People who prefer fast treatment without downtime
• People with realistic expectations regarding the treatment outcome

The treatment is particularly effective for patients between the ages of 30 and 60 whose skin is still Sufficient elasticity has. The best and most natural results can be achieved in this age range. However, younger or older patients can also benefit from the treatment, especially in combination with other procedures such as Hyaluronic acid-fillers, Mesotherapy or RF microneedlingto achieve even more comprehensive rejuvenation effects.

In addition, the treatment of marionette lines is also suitable as a Preventive measure for younger patients who want to prevent wrinkles from deepening. This prophylactic application can help prevent deep wrinkles from forming in the first place and keep the skin looking youthful for longer.

Contraindications

In certain cases, treatment with botulinum toxin is not recommended:

• Pregnancy and breastfeeding - for precautionary reasons, botulinum toxin treatments are generally not carried out during this time
• Known allergy to botulinum toxin or ingredients of the preparation
• Acute inflammation or infection in the treatment area - treatment is postponed until the infection has subsided
• Certain neuromuscular diseases such as myasthenia gravis or Lambert-Eaton syndrome
• Taking certain medications - blood thinners in particular should be discontinued before treatment if possible (after consultation with the attending physician)
• Unrealistic expectations - if the desired results cannot be achieved with this method

During the consultation, we create a Detailed anamnesis and check all potential contraindications. Your safety is our top priority, which is why we take enough time for this important preliminary clarification. At Medical NOVA, you will receive an honest assessment of whether the treatment is suitable for you or whether alternative methods promise better results.

Possible side effects and risks

As with any medical treatment, side effects can also occur when treating marionette lines.

Frequent, harmless side effects

Most of the side effects occur directly after the treatment and disappear on their own within a few hours to days:

• Slight swelling at the puncture sites - usually disappear within 2-4 hours and can be easily covered with make-up
• Temporary reddening of the skin, similar to a mild insect bite
• Small bruises (haematomas) - occur in around 10% of patients and usually subside within a week
• Mild tension headache in the first 1-3 days, similar to a mild tension headache
• Feeling of slight heaviness in the treated area, which usually subsides after a few days

These side effects are completely normal and show that the botulinum toxin is beginning to take effect. They usually do not affect everyday life and can be treated with over-the-counter painkillers if necessary.

Rare complications: Prevention and treatment

• Asymmetrical result (can be equalised by subsequent correction in the control appointment)
• Temporary muscle weakness in the corner of the mouth (very rare with correct dosage)
• Slight difficulty drinking with a straw (extremely rare and temporary)

Should such rare complications occur, there are Targeted measuresto minimise or treat them. In most cases, however, these effects disappear by themselves as soon as the effect of the botulinum toxin wears off after a few months. Our medical expertise enables us to quickly recognise and adequately treat such rare complications.

At Medical NOVA, we minimise risks through precise diagnostics, high-quality preparations and the many years of experience of our medical specialists. Should side effects nevertheless occur, we are available to you at any time and will deal with your concerns immediately.

Costs of treatment in Switzerland

The cost of treating marionette lines with botulinum toxin depends on various factors and is always calculated by Medical NOVA. Transparently discussed in the counselling interview.

In a personal consultation, we prepare a customised cost estimate that transparently breaks down all items.

The investment in professional treatment of marionette lines should always be seen in the context of the long-term satisfaction and security be considered.

Further treatment options for mouth corner wrinkles

Although treatment with botulinum toxin is the ideal solution for many patients, depending on the individual situation, there are also Other methodswhich can be useful. At Medical NOVA, we offer a comprehensive range of aesthetic treatments and will advise you on which method promises the best results for you. Injections can be carried out with different substances depending on the objective.

Hyaluronic acid filler for strategic volume build-up

Hyaluronic acid is often used to compensate for lost volume and fill in deep wrinkles. Hyaluron can be the ideal complement to botulinum toxin, particularly in cases of pronounced volume loss in the corners of the mouth. The great advantage of hyaluronic acid treatment lies in the immediate visibility of the result and the possibility of modelling the volume very precisely. Hyaluronic acid injections are ideal for volume correction at the corners of the mouth. Other areas such as the Nasolabial foldswhich Jawline or a Chin augmentation can be treated with hyaluronic acid to harmonise the entire lower third of the face.

Improve skin quality with innovative treatments

Sometimes the cause of a sad facial expression lies not only in the muscle activity, but also in the Quality of the surrounding skin. Treatments like Mesotherapy for the face, RF microneedling or Thulium laser can significantly improve the skin structure, elasticity and radiance and thus support or complement the effect of a marionette wrinkle treatment.

These treatments stimulate the the body's own collagen production tighten the skin and can thus contribute to an overall more youthful appearance. A combination of different procedures is often used to achieve optimal results.

Possible combinations: Utilising synergy effects

The treatment of marionette lines can be Excellent with other aesthetic treatments to achieve even more comprehensive and harmonious results.

Particularly popular and effective is the combination with Botulinum toxin for forehead wrinkles, Frown lines or Crow's feet. These treatments complement each other perfectlyas they address different areas of the face and together create a harmonious, youthful overall appearance. Treating several areas in one session is not only more efficient, but often also more cost-effective than separate treatments.

The supplementary treatment of Dark circles with hyaluron or a Cheek augmentation strengthens the rejuvenating effect considerably. While botulinum toxin lifts the corners of the mouth and relaxes facial expressions, hyaluronic acid fillers can simultaneously restore volume and provide an overall fresher appearance. This holistic approach often leads to more natural and long-lasting results than isolated individual treatments.

A further synergistic effect results from the combination with skin-improving treatments like the Mesotherapy. This can improve the quality of the skin around the mouth and thus enhance and prolong the effect of the marionette wrinkle treatment. We will discuss the optimal combination, the ideal timing and possible synergy effects in detail during your individual consultation.

With our Practice in Zurich your satisfaction takes centre stage. Treatment is carried out by Dr Paloma Petrys-Kulisiewicz, a specialist in ophthalmology and optometry as well as a specialist in aesthetic medicine, with many years of experience in minimally invasive facial treatments. Each treatment is individually tailored to the dynamics of the face to ensure a natural, harmonious result.

Our Team attaches great importance to honest advice: we only recommend treatments that make medical sense and suit your individual needs.

Prevention: How to prevent marionette lines

In addition to professional treatments, you can do a lot yourself to delay the development of marionette lines or minimise their appearance:

• Sun protection: Use a high sun protection factor every day to minimise UV radiation - the main cause of premature skin ageing
• Sufficient moisture: drink at least 2 litres of water a day and use moisturising care products
• Healthy diet: antioxidants, vitamins and omega-3 fatty acids support collagen production
• No smoking: Smoking significantly accelerates the breakdown of collagen and elastin
• Stress management: Chronic stress promotes inflammatory processes and accelerates skin ageing
• Mimic training: Conscious training of the facial muscles can help to reduce excessive muscle contractions

Frequently asked questions (FAQ)

How long does botulinum toxin last for marionette lines?

The effect of botulinum toxin on marionette lines lasts an average of 4 to 6 months, although this period depends on various individual factors. People with very active facial expressions or a fast metabolism may notice an earlier decrease in the effect, while other patients may still notice significant effects after 6 months. It is interesting to note that regular treatments often extend the duration of the effect, as the muscles "get used" to the relaxed position and the formation of wrinkles is reduced. The optimum treatment frequency is usually 2-3 treatments per year.

Is it better to treat marionette lines with hyaluronic acid or botulinum toxin?

The choice between hyaluronic acid and botulinum toxin depends on the individual cause of the wrinkles and is made after a thorough analysis. Botulinum toxin is more suitable for wrinkles at the corners of the mouth caused by muscles, as it relaxes the overactive muscles and visually lifts the corners of the mouth. In cases of deep volume loss, hyaluronic acid is the better choice as a filler to replace lost tissue. Injections of hyaluronic acid fill the wrinkles directly, while botulinum toxin reduces muscle activity at the corners of the mouth. In many cases, a combination of both methods is optimal to both reduce muscle activity and compensate for lost volume.

When will I see the results of the treatment?

The effect of the treatment develops gradual and naturalwhich is one of the great advantages of this method. The first effects of botulinum toxin treatment are already visible after 3 to 5 days, when the muscles begin to relax. The full result develops after around 10 to 14 days, when the medication has reached its maximum effect. Unlike surgical procedures, where the result is visible immediately, the effect develops over several days, resulting in a very natural transition. After 2 weeks, there is usually a follow-up appointment at which fine corrections can be made if necessary.

Is the treatment painful?

Most patients find the treatment virtually painless. We use the finest needles, which means that the injection is only perceived as a slight prick - comparable to plucking the skin. Immediately after the treatment, a slight feeling of tightness may occur, but this quickly subsides. The treatment only takes 10-15 minutes and is much more comfortable than many patients expect.

Is there any downtime after the treatment?

No, one of the great advantages of botulinum toxin treatment is that no downtime is required and you immediately socially acceptable again are. You can resume your usual activities and go back to work immediately after the treatment. You should only refrain from intensive sport, sauna and facial massages for 24-48 hours to ensure optimal distribution of the botulinum toxin. Slight swelling or redness usually disappears within a few hours and can be covered with make-up if necessary.

Can marionette lines also be surgically removed?

Yes, in very pronounced cases with a lot of excess skin, surgical tightening can be considered, for example as part of a facelift or a lower facelift. However, this is a much more invasive procedure with corresponding risks, scars, longer downtimes and higher costs. Most patients achieve very satisfactory results with minimally invasive methods such as botulinum toxin and hyaluronic acid without having to undergo the stress of surgery.

At what age should marionette lines be treated?

There is no generalised age indication, as the appearance of marionette lines varies greatly from person to person and depends on genetic factors, lifestyle and facial expressions. Many patients start preventative treatments in their mid-30s when the first wrinkles become visible. As a general rule, treatment is advisable as soon as the wrinkles are perceived as disturbing or have a negative impact on facial expression. Younger people can also benefit from preventative treatments, while older patients often require a combination of different methods. The decisive factor is always the individual findings, not the chronological age.

What alternatives are there to botulinum toxin?

In addition to botulinum toxin, there are several alternative or complementary treatment options that can be useful depending on the individual situation: Hyaluronic acid filler to build up volume in the corners of the mouth, Mesotherapy to improve skin regeneration and quality, RF microneedling for collagen stimulation or Thulium laser for skin renewal. Injections with different substances offer different benefits depending on the initial situation. Sometimes the treatment of other areas such as a Eyelid lift or a Eyebrow lift positively influence the overall facial expression and indirectly reduce the effect of marionette lines. We will discuss the optimal treatment strategy in detail during your individual consultation.

Conclusion: Naturally friendly radiance through targeted treatment

The treatment of marionette lines with botulinum toxin is a proven, safe and effective method of harmonising facial features and achieving a friendlier, more relaxed facial expression. The targeted relaxation of the responsible muscles can effectively minimise wrinkles at the corners of the mouth - without artificial effects or long downtimes. This minimally invasive treatment offers an elegant alternative to surgery and allows you to go through life with confidence and a natural smile.

At Medical NOVA, we work with you to develop a customised treatment concept that suits your personality and your wishes. Whether pure botulinum toxin treatment, a combination with hyaluronic acid or complementary therapies to improve skin quality - we provide you with professional support on the way to your feel-good self.

Our central location in the Zurich area makes us ideal for patients from the entire region. easily accessible. Each treatment is planned and carried out individually so that you feel completely comfortable in your skin and can go through life with self-confidence.

Dr Tukezban Huseynova, MD
Medical Director Medical NOVA GmbH
Specialist in ophthalmology and optometry | ophthalmic surgeon | specialist in aesthetic medicine
Over 15 years of international experience | 10,000+ successful eye operations
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