Marionette lines (vertical lines around the mouth), which treatment is right for you?

Yes, if sagging of the cheek and deep tissue is the dominant cause, it is reasonable to consider lifting first. This is because after restoring the sagging tissue to its original position to some extent, supplementing the remaining valley with dermal filler, collagen injections, or JUVGEN allows you to expect natural results with a smaller amount.

Non-surgical lifting is broadly divided into device-based lifting that delivers thermal energy and thread lifting.

The mouth corner is an area where the marginal mandibular branch of the facial nerve passes, so HIFU Lifting such as Ultherapy PRIME® requires caution as it can cause nerve damage. In such cases, Soprano Titanium can be used effectively. Soprano Titanium delivers energy from multiple laser wavelengths to various skin layers and can safely improve sagging around the mouth without nerve damage.

Thread Lifting pulls sagging skin upward and rearranges the tissue. It can be a good option when sagging of the tissue above the mouth corner is severe.

For marionette lines where volume loss is the main cause, dermal filler can be an effective option. Hyaluronic acid filler immediately fills sunken areas, reducing shadows and unevenness. Depending on the formulation and area, the duration typically lasts 6–12 months. For areas with a lot of movement like the mouth corner, it is important to choose a formulation with good support.

However, if sagging is severe, trying to fill all the wrinkles with filler alone can make the mouth corner look heavy or unnatural. Because filler is a tool to smooth out unevenness, not a procedure that lifts sagging tissue itself, it is advisable to consider combining it with lifting when sagging is present.

JUVGEN is effective for filling narrow, deep marionette lines. After addressing sunken volume or sagging tissue, treating the remaining marionette lines with JUVGEN can effectively resolve the wrinkles with a small amount of hyaluronic acid injection.

Injectable agents that induce collagen production help restore sunken volume in the marionette area and improve skin thickness and elasticity. While filler provides immediate volume, collagen-inducing agents take a gradual approach to strengthen your own skin tissue over time.

Representative examples include Sculptra, which gradually stimulates collagen production over several months and is known to last about 1.5–2 years; RADIESSE®, a CaHA-based agent that provides immediate filling effect and then gradually stimulates collagen regeneration starting 1–2 months later, helping improve skin elasticity; and Re2O®, a human-derived collagen (hADM) agent that supports tissue regeneration and can be used for the mouth corner area where the skin has thinned and fine wrinkles have accumulated. The speed of effect onset and duration vary by agent and individual, so the choice is made based on diagnosis.

The most natural results come from a stepwise combination: reduce sagging with lifting, then supplement the remaining valley with dermal filler, collagen injections, or JUVGEN. One of the most common questions in consultations is, 'Which treatment is most effective?' Rather than trying to eliminate all wrinkles with a single procedure, addressing the dominant cause first in order is the method that produces both effective and natural results.

Even for the same marionette lines, the proportion of sagging and volume loss differs from person to person, and accordingly, the appropriate combination and sequence also vary. Since this area varies greatly between individuals, we recommend establishing a treatment plan after consulting with a dermatologist to identify the composition of your own causes.