Marionette Line Filler Treatment in Berlin

“Merkel lines” – how a nickname became widely recognised

In Germany, marionette lines have sometimes been nicknamed “Merkel lines”, a reference to the appearance of former Federal Chancellor Angela Merkel. Her extensive media presence helped popularise the expression. Whatever name is used, prominent lines at the corners of the mouth can lead many people to consider treatment.

Why are they called marionette lines?

The name comes from the way these folds run downwards from the corners of the mouth towards the chin. Their course resembles the movable lower section of a traditional marionette’s face, which allows a puppeteer to alter the puppet’s expression.

When lines around the mouth become distressing

Marionette lines can be difficult to ignore when you look in the mirror. They may make the chin appear more prominent and give the face a sad or displeased expression. As they deepen, make-up may no longer conceal them and can even collect in the creases, making them more noticeable. Several treatments can soften the appearance of marionette lines.

Treating Marionette Lines in Berlin

At the Caletti practice, I offer aesthetic treatment for marionette lines. Injecting the folds with hyaluronic acid is an established part of my work. For many patients, treatment can produce a natural-looking result that lasts for several months. In more advanced cases, fillers alone may not be sufficient, and a facelift may be considered to address more extensive facial laxity.

What You Should Know About Marionette Lines

There is both good news and bad news:

The bad news is that most of us are likely to develop marionette lines at some point. The good news is that effective wrinkle treatments are available. A combination of preventive measures may also help delay their development to some extent.

What are marionette lines?

The medical term for marionette lines is mentolabial folds. This describes their position around the mouth, extending downwards from its corners. They differ from nasolabial folds, which lie higher on the face and run from the sides of the nose towards the mouth.

The area around the mouth plays a central role in facial expression. When we laugh, smile, grimace or express other emotions, the surrounding muscles repeatedly contract. Over the years, this movement contributes to the formation of lines. In some women and men, the folds become particularly pronounced for several reasons.

Causes: Age, Lifestyle and Genetics

Mentolabial folds have several causes:

During the natural ageing process, the skin gradually loses firmness and elasticity. Facial fat also diminishes and shifts, allowing the cheeks to descend.

The skin’s collagen production declines as well. Collagen consists of linked proteins that play an important role in the elasticity and structural support of tissue. As less collagen is produced, the skin becomes less resilient.

The body also produces less moisture-binding hyaluronic acid. The skin becomes drier and facial volume decreases. Volume loss in the cheeks can place additional weight on the area around the mouth, making marionette lines more pronounced.

Genetics also influence the depth of lines around the mouth. Although the genetic factors involved in wrinkle formation are not yet fully understood, it is clear that some people develop pronounced marionette lines earlier than others.

Lifestyle factors such as chronic stress, insufficient sleep, an unbalanced diet, too little physical activity, smoking and excessive alcohol consumption can also affect the condition and ageing of the skin.

To some extent, however, it may be possible to delay the development of marionette lines.

How to Help Prevent Marionette Lines

The familiar principles of skin protection apply: regular protection against ultraviolet radiation should form part of your skincare routine from an early age.

High-quality facial skincare can support the skin’s moisture levels, firmness and elasticity. Some cosmetic products may also help the skin appear fuller, although their effects are limited.

A balanced, nutrient-rich diet may support healthy skin ageing. Avoiding smoking and limiting alcohol can also help preserve the appearance of the mouth and surrounding skin for longer.

There is no conclusive evidence that facial exercises improve the firmness of the surrounding connective tissue. Relaxing excessive tension in the lower facial muscles may, however, help reduce the appearance of these lines in some cases.

Lines Around the Mouth Do Not Develop Overnight

The formation of marionette lines is a complex, gradual process. It develops differently in each person and produces an individual pattern around the mouth and chin.

One important structure is the depressor anguli oris muscle, or DAO, which pulls the corners of the mouth downwards.

If this muscle is habitually overactive, the lower lip and corners of the mouth may appear to droop, giving the entire area a more downturned or hollow appearance.

When fully developed, marionette lines can markedly alter the expression of the lower face. Gravity and age-related tissue changes contribute to this downward pull.

Addressing Marionette Lines at the Right Time

Treating marionette lines before they become deeply established may help prevent them from becoming more pronounced. Filler treatment can therefore be considered at an earlier stage. If the folds are already very deep and accompanied by substantial skin laxity, injections may no longer be sufficient and a surgical facelift may be more appropriate.

It is therefore worth monitoring the area beside the mouth and how the folds develop over time.

If you are significantly troubled by marionette lines, you may wish to consider non-surgical aesthetic treatment before the folds become advanced. At the same time, not every line requires treatment.

If the skin no longer returns to its former position or laxity extending from the cheeks towards the mouth is steadily increasing, an initial medical consultation may be helpful. At the Caletti specialist practice, I can assess your marionette lines and explain which treatment options are suitable.

Injecting Marionette Lines – Which Substances Are Suitable?

You may already have heard of several substances used in injectable treatments. Hyaluronic acid and botulinum toxin are frequently discussed, but hyaluronic acid filler is generally preferred for treating marionette lines. There are sound anatomical reasons for this.

Botulinum toxin temporarily reduces muscle activity. Around the highly mobile corners of the mouth, excessive or poorly placed treatment can adversely affect the smile and lower facial movement. Although reducing downward muscular pull may soften marionette lines, treatment in this area must be particularly conservative. In selected cases, a small amount of botulinum toxin combined with hyaluronic acid can produce a more balanced result.

Why Hyaluronic Acid Comes First

Hyaluronic acid is usually the first choice for injecting marionette lines. Different products offer varying degrees of firmness and support. Hyaluronic acid fillers bind moisture and restore volume, helping to support the skin and smooth the folds. The result is not permanent, but marionette lines can remain noticeably softened for several months.

Hyaluronic acid is generally well tolerated and can provide a natural-looking result with a useful duration of effect.

Marionette Line Injections – Method and Technique

The outcome depends considerably on the treating doctor’s skill and experience. After assessing your anatomy, I decide whether a blunt cannula, a sharp needle or a combination of both is most appropriate.

Blunt cannulas offer several advantages. They allow hyaluronic acid to be distributed evenly through the treatment area and can reduce the risk of depositing too much filler in one place. Localised overfilling could otherwise compromise the aesthetic result.

Sharp needles, by contrast, can be useful for precise placement in deeper folds. I determine the appropriate technique and amount of hyaluronic acid individually for you.

A Liquid Facelift as a More Extensive Treatment

If your cheeks have already lost substantial fat and volume, a liquid facelift may be appropriate. Rather than injecting only the marionette lines, I also treat selected areas of the cheeks to restore support and reduce the downward effect of volume loss on the corners of the mouth. This is a more extensive non-surgical procedure, and I will discuss its relevant benefits, limitations and risks with you individually.

The lower lip and surrounding lip area may also be included where appropriate. The aim is to create a more supported and balanced appearance across the lower face without overfilling it. This requires careful planning and considerable experience.

I will also explain the individual treatment costs during your personal consultation.

Frequently Asked Questions About Marionette Line Injections

The safety and satisfaction of our patients are central to every treatment at the practice, including marionette line treatment. The Caletti team therefore places great importance on thorough advice before any procedure.

During your detailed preliminary consultation, I will focus on the result you would like to achieve and assess whether it is realistic for your anatomy.

I will also check whether there are any individual reasons why injectable treatment may not be suitable for you.

The following sections answer questions we are frequently asked and provide an initial overview of marionette line treatment at our practice.

Do I Need to Prepare for the Procedure?

Try to arrive at the practice feeling as relaxed as possible. Medicines that affect blood clotting may need to be paused before treatment, but only after consultation with the doctor who prescribed them; never stop prescribed medication on your own. I will discuss any further preparations relevant to you during your consultation.

How Will I Feel Afterwards, and When Can I Socialise Again?

Marionette line injections are now an established treatment in aesthetic practice. Most patients feel well shortly afterwards and can resume their usual routine promptly.

You may notice some warmth, redness, tenderness, swelling or bruising in the treated tissue.

Reducing Redness and Swelling

I will provide guidance on cooling the skin and, if necessary, suitable mild pain relief should the treated areas feel tender. In most cases, you can return to work and social activities immediately, although visible swelling or bruising is possible.

Taking Care During the Initial Recovery Period

The treated skin should be handled carefully after the procedure. You should avoid exercise for the recommended period and refrain from saunas, hot baths and intensive sun exposure while swelling and redness persist. I will give you personalised aftercare instructions.

Effective protection from ultraviolet radiation is essential for ongoing skin care. Products that support the skin’s moisture barrier may also be beneficial. I will be pleased to help you choose suitable care for the treated facial area.

What Are the Risks and Side Effects of Marionette Line Injections?

Hyaluronic acid injections are generally among the less painful and lower-risk procedures offered at my practice, but they are not risk-free.

Temporary redness, tenderness, swelling and bruising are common possibilities and usually settle within a few days. Less common complications include infection, lumps, asymmetry and prolonged swelling. Rare but serious vascular complications require immediate medical attention.

I perform hyaluronic acid injections with careful anatomical planning and regularly update my training in injection techniques and complication management.

Achieving a Balanced Result

Unsatisfactory results are often associated with inappropriate product selection, placement or dosage. For example, depositing too much hyaluronic acid in one location can create an uneven or overfilled appearance.

Incorrect treatment around the corners of the mouth may also distort facial movement or produce an unnatural expression, although this is uncommon when fillers are used appropriately.

Careful assessment, sound technique and precise product placement are therefore essential to minimise these risks.

Is Marionette Line Treatment Painful?

A topical anaesthetic cream can be applied to numb the injection sites and make treatment more comfortable. You may still feel pressure, pinching or brief discomfort, but marionette line injections are generally considered a relatively low-pain procedure.

How Long Do the Results Last?

The length of time hyaluronic acid remains effective in marionette lines depends on several individual factors, including the product used, the amount injected, your metabolism and the mobility of the area. For this reason, I avoid making fixed promises. An average duration of approximately eight to ten months is a reasonable guide.

Marionette line injections can be repeated after an appropriate interval of several months. I will advise you on suitable timing based on your individual result.

How Much Does Marionette Line Filler Treatment Cost?

The cost varies according to the depth of the folds, the size of the treatment area, the product required and several other factors. A straightforward treatment starts from €300, whilst more extensive treatment may cost more. Transparent pricing is very important at my practice.

I will therefore explain the individual cost during your preliminary consultation. You will know the expected price in advance and can then decide whether you wish to proceed.

Is It Superficial to Be Concerned About Marionette Lines?

I believe that everyone should be free to decide how they feel about their appearance. Treatments are now available for many types of facial line, including marionette lines.

If downturned corners of the mouth make you look older or less cheerful than you feel, it is reasonable to seek professional advice. Many patients come to my practice because they no longer feel comfortable with their marionette lines. Wanting to feel at ease with your face is a personal and valid choice.

Our appearance and facial expression can influence confidence and how others perceive us. My aim is to soften marionette lines whilst preserving natural movement and facial character.

You need not base your decision on what others might think. Many patients treated at my Berlin practice report feeling more confident and receiving positive comments, although individual experiences naturally vary.

Will You Recommend a Facelift Even If I Do Not Need One?

My approach is to recommend the least invasive option capable of addressing your concerns appropriately. I will not advise surgery when a non-surgical treatment is likely to provide a suitable result.

Your consultation will clarify whether fillers or a surgical procedure are appropriate.

After considering your anatomy, expectations and all relevant circumstances, I will discuss which treatment is most likely to produce a suitable result for your individual marionette lines. The final decision whether to proceed, and which option to choose, always remains yours.

I Hate My Marionette Lines but Am Very Anxious About Treatment. What Can I Do?

I will take your individual concerns and anxieties seriously. If you are particularly nervous, I can allow additional time for your consultation where needed. You are also welcome to take as much time as you need before making a decision.

Greater Reassurance Through a Personal Consultation

An initial consultation is a useful way to understand the options available for your face without committing to treatment. Knowing exactly what a skin treatment involves often helps reduce anxiety about the procedure.

I will answer your questions fully, and you can discuss any concerns or fears with me openly at any time.

There is no reason to feel embarrassed.

Why Choose the Caletti Practice for Marionette Line Treatment?

Dottore Andrea Caletti and the practice team are committed to providing careful, personalised aesthetic care. The same medical and ethical standards apply to aesthetic procedures as to every other aspect of medicine. Patients entrust us with their appearance, and we remain conscious of that responsibility at every stage of treatment.

Book Your Consultation Today

Marionette lines do not have to define your expression. Modern treatments can soften these folds and help the lower face appear less downturned whilst preserving your natural features. Book a consultation at my Berlin practice to discuss the most suitable way to create a fresher, more relaxed appearance.