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What You Should Know About Botox Injections for Marionette Lines

Jul 26, 2018

What are marionette lines?

Marionette lines are the vertical groves that appear on the corners of the mouth and extend towards the chin, often laterally circumscribing the chin. The oral commissure lines usually develop due to a combination of aging and excessive facial muscle movements. If left uncorrected, these facial creases can give an inaccurate perception of one’s age and emotional cues.

How can Botox be used to treat marionette lines?

While marionette lines are usually treated using injectable fillers, they can also be corrected temporarily using Botox (BTX) injections. Botox is a muscle relaxing injectable that contains highly purified botulinum toxin type A. This neurotoxin is extracted from Clostridium botulinum bacteria that is fermented with casein hydrolysate, glucose, and yeast extract. Once injected intramuscularly into the proposed area of treatment, the botulinum toxin will temporarily paralyze the implicated facial muscles, resulting in softened appearance of marionette lines.

What is the BTX injection technique for treating marionette lines?

Prior to injecting Botox, the patient’s medical history must be extensively reviewed to ensure that they are not allergic to botulinum toxin or the excipients present. Once they are deemed ready, the toxin solution can be prepared by reconstituting the powder with suitable amount of sterile, preservative-free 0.9% sodium chloride solution. The prepared BTX solution can then be injected into the depressor anguli oris muscle that is responsible for marionette lines and downturned appearance of the mouth. The recommended dose of BTX that should be injected for male and female patients are 2 to 4 units in each side. Following treatment session, any residual BTX solution must be inactivated using dilute hypochlorite solution (0.5%) before disposal. Some patients will benefit greatly if the Botox injection is paired with soft tissue filler implantation, especially if the marionette lines are formed from loss of volume. 

How long does the results of BTX injections last?

The muscle relaxing effects usually appear 2 to 7 days after the treatment session and will remain for approximately 2 to 6 months. However, the exact duration of action is determined by the amount of Botox injected and the patient’s physiology. First-time patients may be advised to return for a check-up 2 to 3 weeks after the initial session. Most patients can get repeat injections once or twice annually.

What are the side effects of Botox injections?

Following the treatment session, patients may experience common localized side effects such as slight bruising, which will resolve on it own within a few days.