Marionette Lines Filler vs DAO Botox for Frown Lines


Marionette Lines Filler vs DAO Botox for Frown Lines

Botox for frown lines | Rejuvenation MD Aesthetic | Asheboro, NC

A Complete Guide to Treating Marionette Lines with Botox and Fillers

The quest for timeless beauty has led to the development of various non-surgical cosmetic treatments that target specific problem areas. Marionette lines are one such concern that often bothers individuals seeking a more youthful appearance. These lines, which extend from the corners of the mouth to the chin, are a common area of concern for patients who say they tend to make them look older and tired. Fortunately, there are several effective treatments available to address marionette lines, including Botox/Dysport and dermal filler. We’ll explore what marionette lines are, how to treat them, the use of preventative Botox, where to inject the treatment, the role of the DAO muscle, alternative treatments, their impact on your smile, and who makes an ideal candidate.

Understanding Marionette Lines

Marionette lines, also known as puppet lines or oral commissures, are the vertical wrinkle lines or folds that extend from the corners of the mouth, often curving downwards towards the chin. These lines create a drooping appearance at the mouth corner and can give the impression of sadness or a downturned mouth and jowling. Marionette lines are primarily caused by a combination of factors, including:


The natural aging process leads to a loss of skin elasticity and collagen, making the skin sag and form wrinkles.


Some people are genetically predisposed to develop more pronounced marionette lines than others.


Smoking can accelerate the aging process and contribute to the formation of these facial wrinkles.

Marionette Lines Treatment with Botox/Dysport

Botox (or Dysport) is a popular non-surgical treatment used to reduce the appearance of marionette lines on the lower face. While botulinum toxin is typically associated with smoothing out wrinkles, it can also be used to address marionette lines by targeting specific facial muscles.

The depressor anguli oris muscle (DAO) is responsible for pulling down the corners of the mouth, which contributes to the formation of marionette lines. Botox, when injected into the DAO muscle, relaxes the facial muscle, preventing it from pulling the mouth downwards. This results in a subtle elevation of the mouth corners, reducing the severity of marionette lines.

The amount of Botox required varies from person to person, but a typical range is around 2-4 units on each side. The effects of Botox in this area can last for several months, with some individuals experiencing results for up to six months. As with any medical procedure, there may be some side effects, such as temporary bruising, swelling, or mild discomfort at the injection site.

Is DAO Botox Worth It?

Many patients find that DAO Botox is worth it for its ability to subtly lift the corners of the mouth, diminishing the appearance of marionette lines and restoring a more youthful, cheerful expression. It is a quick, relatively painless procedure that can be performed in a medical aesthetics practice with minimal downtime. However, this is more so a preventative treatment. It will prevent the lines from getting worse, but Botox is not an injectable filler. You will not walk out of the office seeing visible results right then and there from DAO Botox treatments as you would with facial fillers. This is a treatment you do in conjunction with others to give the best result.

Side Effects of DAO Botox

As with any Botox treatment, side effects are typically mild and temporary. Common side effects of DAO Botox may include:

  1. Bruising at the Botox injection site
  2. Swelling
  3. Redness
  4. Slight discomfort

These side effects usually resolve within a few days to a week, and they can be easily managed. Serious complications are extremely rare when the procedure is performed by a trained and experienced medical professional.

How to Treat Marionette Lines with Fillers

Dermal fillers are another popular treatment option for marionette lines. Unlike Botox, which addresses muscle activity, fillers work by adding volume and plumping the skin, effectively “filling in” the deep lines.

The best filler for marionette lines is typically a hyaluronic acid filler. HA filler is well-suited for marionette lines because they are soft, malleable, and provide natural-looking results. The marionette filler is injected directly into the lines, smoothing and lifting the skin.

How Long Does Marionette Line Filler Last?

The longevity of dermal filler treatment for marionette lines varies depending on the specific product used, the individual’s metabolism, and the depth of the lines. On average, hyaluronic acid fillers can last anywhere from 6 to 18 months. After this period, a touch-up or repeat filler injection treatment may be necessary to maintain the desired results.

Can Fillers Remove Marionette Lines?

While dermal fillers can significantly reduce the appearance of marionette lines, they may not completely remove them, especially in individuals with deeply etched lines. However, they can make the lines less noticeable and offer a smoother, more youthful look.

Is 1ml of Filler Enough for Marionette Lines?

The amount of filler needed to treat marionette lines varies depending on the individual’s unique facial anatomy and the depth of the lines. It is important to understand that 1ML of filler is the equivalent of the size of a blueberry. More than one syringe of filler may be needed to address mild to moderate marionette lines. For deeper lines or more pronounced concerns, a larger volume of filler may be recommended. At Rejuvenation MD we will assess your specific needs during a consultation and recommend an appropriate amount of filler.

Alternative Treatments for Marionette Lines

In addition to Botox/Dysport and dermal fillers, there are alternative treatments available to address marionette lines before resorting to plastic surgery:

Laser Therapy

Fractional laser treatment can stimulate collagen production and improve the skin’s texture and elasticity, reducing the appearance of marionette lines.

Thread Lifts

The Thread Lift is a minimally invasive cosmetic treatment that involves the insertion of dissolvable threads under the skin to lift and tighten sagging areas, including marionette folds, while increasing collagen production.

Skin Tightening Procedures

Non-surgical skin tightening treatments, such as radiofrequency or ultrasound, can help improve the appearance of marionette lines by stimulating collagen production.

Retinoids and Topical Skincare

The use of retinoid creams and other anti-aging medical-grade skin care products may help prevent and reduce the appearance of marionette lines over time.

The Impact of Marionette Line Treatment on Your Smile

A common concern among individuals seeking marionette line treatment is how it might affect their smile. Both Botox/Dysport and dermal fillers can have an impact on the way your mouth moves, but the effects are typically subtle and temporary.


When Botox is injected into the DAO muscle to address marionette lines, it can cause a slight change in the way you smile. Some individuals may experience a temporary reduction in the ability to frown or smile broadly. However, with proper injection technique, the results can be adjusted to ensure that your smile appears natural.

Dermal Fillers

Fillers work differently by adding volume to the skin, and they typically do not affect the way your mouth moves. In fact, they can enhance the overall appearance of your smile by reducing the appearance of marionette lines and creating a more youthful, refreshed look.

Before and After photo for Frown lines | Rejuvenation MD Aesthetic | Asheboro, NC

Who Is a Good Candidate for Marionette Line Treatment?

Not everyone is an ideal candidate for marionette line treatment, and a consultation with a qualified medical aesthetics practitioner is essential to determine eligibility. Generally, good candidates for marionette line treatment include individuals who:

Have noticeable marionette lines and desire a more youthful appearance.

Are in good overall health and do not have contraindications to the chosen treatment.

Have realistic expectations about the outcome of the treatment.

Are willing to follow post-treatment care instructions provided by their practitioner.

In some cases, individuals with certain medical conditions or those taking specific medications may not be suitable candidates for Botox/Dysport or dermal fillers. It is crucial to be honest about your medical history during your consultation to ensure your safety and the effectiveness of the treatment.

Ultimately, the choice between Botox/Dysport and dermal fillers depends on your specific needs, preferences, and consultation with Dr. Chaudhary. Whichever treatment you choose, it’s important to remember that results are not permanent, and touch-up treatments may be necessary to maintain the desired look. During your consultation, we look at your entire face, not just your marionette lines. This is why it’s so important to see a board-certified doctor and not just receive treatment at a Botox Party. Be sure to read our other articles about smile line fillers and masseter Botox for full lower facial rejuvenation.

If you still have questions, leave a comment below, reach out on Instagram, or schedule a consultation at our Greensboro or Asheboro clinics. At Rejuvenation MD Aesthetics and Vein Center, we offer a range of in-office facial rejuvenation treatments and skincare products to help you maintain skin you love. Dr. Chaudhary can customize a treatment plan based on your unique needs and preferences, ensuring maximum comfort and safety.

Umbreen Chaudhary, MD
Umbreen Chaudhary is the founder of Rejuvenation MD Aesthetics & Vein Center and Rejuvenation MD Skincare. Dr. Chaudhary has over sixteen years of experience in aesthetic medicine and strives to provide natural-looking results to her patients.

Call Now Button