What are marionette lines?

Marionette lines are the vertical creases that run from the corners of the mouth down toward the chin, giving the lower face a down-turned or tired appearance. The medical term commonly used is melomental folds. Over time, these lines can create a sad or stern look, even when the face is at rest.

Why do marionette lines form?

Marionette lines develop due to a combination of muscle imbalance, repetitive movement, and age-related structural change:

• Overactivity of the Depressor Anguli Oris (DAO) muscle, which pulls the corners of the mouth downward

• Weakening of the levator complex, particularly the zygomaticus major and minor, which are responsible for elevating the smile

• Loss of facial volume with ageing, especially in the mid-face and jawline

• Gradual reduction in skin elasticity and collagen support

When downward-pulling muscles dominate and lifting muscles weaken, the mouth corners descend, accentuating marionette lines.

Can Botox help marionette lines?

Yes — when used precisely, anti-wrinkle injections (Botox) can soften marionette lines by relaxing the DAO muscle, reducing its downward pull on the mouth corners. This allows the natural lifting muscles to rebalance facial expression, often restoring a more neutral or subtly lifted appearance.

Botox for marionette lines is frequently combined with other treatments (such as volume restoration) depending on the degree of volume loss, but neuromodulators alone can be very effective in appropriately selected patients.

Why technique matters

The lower face contains several small but highly functional muscles that directly affect speech, smile symmetry, and lip movement. Incorrect injection technique can affect nearby muscles, particularly the Depressor Labii Inferioris (DLI), which may result in:

• Smile asymmetry

• Lower lip weakness

• Difficulty with articulation or lip control

For this reason, marionette line treatment should only be performed by a clinician with advanced anatomical knowledge and medical training.

Risks and side effects

While generally safe when performed correctly, risks may include:

• Temporary smile asymmetry

• Lower lip weakness if toxin diffuses into adjacent muscles

• Bruising or swelling at injection sites

• Incomplete correction requiring adjustment

• Very rarely, unwanted changes in facial expression

Why choose Dr Kynan?

As a fully qualified medical doctor, Dr Kynan has extensive training in facial anatomy, neuromuscular function, and complication management. This depth of medical knowledge allows for:

• Safer injection placement

• More accurate muscle targeting

• Reduced risk of functional side effects

• Individualised treatment planning rather than “one-size-fits-all” dosing

When considering Botox for marionette lines in Mermaid Waters or the Gold Coast, choosing a doctor — not just an injector — is critical for both safety and natural-looking results.

Book a consultation

If marionette lines are making you look older, tired, or unhappy, a tailored assessment can determine whether Botox is appropriate for you. Consultations are available at DrKynan.com, with doctor-performed Botox treatments in Mermaid Waters, Gold Coast.

For Injectors: Marionette Lines (DAO) — Technique, Depth, and Risk Avoidance

Treatment of marionette lines using neuromodulators requires precise anatomical knowledge and a conservative dosing philosophy. The lower perioral region contains multiple functionally critical muscles in close proximity, and errors in depth or placement can result in noticeable and distressing asymmetry.

At Dr Kynan Aesthetics (Gold Coast anti-ageing clinic), a single-point injection technique is preferred for safety and predictability.

Injection Technique Selection

While some injectors utilise a two-point approach to the Depressor Anguli Oris (DAO), Dr Kynan believes the single injection point offers the lowest risk of toxin diffusion into adjacent muscles, particularly the Depressor Labii Inferioris (DLI).

The aim is selective weakening of the DAO while preserving normal lower lip and orbicularis oris function.

Injection Point and Depth

• Injection point:

• 1 cm inferior to the modiolus

• Depth:

• Approximately 5 mm

Injection should not be significantly deeper than this. Excessive depth increases the risk of toxin deposition into the DLI, which lies deep and medial to the DAO.

Why Avoid the Depressor Labii Inferioris?

The DLI is responsible for depressing and stabilising the lower lip. Inadvertent weakening of this muscle can result in:

• Lower lip asymmetry at rest and with speech

• Unilateral lip incompetence

• Smile distortion that is particularly noticeable during animation

These effects are often more troubling to patients than the original marionette lines and may persist for several weeks to months.

Dose Strategy

Dr Kynan strongly advocates a low-dose, review-based approach:

• Starting dose: 2 units per side

• Maximum total dose: 4 units

This conservative dosing allows assessment of functional response while minimising the risk of over-correction or diffusion.

The goal is to:

• Reduce downward pull from the DAO

• Maintain normal activity of the orbicularis oris

• Preserve speech, lip competence, and natural facial expression

Post-Procedure Counselling

Patients should be advised to exercise particular care for at least 4 hours post-injection.

The lower perioral region lacks the multiple fascial and fat planes seen elsewhere in the face. As a result:

• Adjacent muscles are close together

• There are fewer anatomical barriers to toxin migration

Patients should therefore avoid:

• Massaging the area

• Applying pressure

• Resting the face against firm surfaces

Clear post-procedure instructions are essential in reducing unintended spread.

Clinical Philosophy

DAO treatment is a high-reward, high-responsibility procedure. Conservative point selection, shallow depth control, and restrained dosing are key to safe outcomes.

This anatomy-led approach reflects Dr Kynan’s practice in doctor-led Gold Coast anti-ageing and neuromodulator treatments, where patient safety and functional preservation are prioritised over aggressive correction.

Marionette Lines