Marionette lines.
Marionette lines run from the corners of the mouth down towards the chin. They can make a face look more serious or more tired than it feels. Whether and how they can be softened is decided after a medical examination.
Marionette lines at the corners of the mouth: why they form, what hyaluronic acid can do, the procedure, aftercare, risks and prices. Essen.
Why they form.
Marionette lines result from a combination of volume loss in the lower third of the face, decreasing skin elasticity and the pull of the muscle that draws the corner of the mouth downwards. Over the years, a slight descent of cheek fat is often added.
Treatment usually does not address the line alone: depending on the findings, volume at the chin or along the jawline can support the tissue so the corner of the mouth is pulled down less. Sometimes muscle activity plays a part as well.
The material is cross-linked hyaluronic acid of a suitable firmness. The aim is a natural impression, not a fuller or altered expression. Deep lines that have existed for years can be softened, not erased.
The treatment at a glance.
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Ask via WhatsAppWho it is for – and who it is not for.
A good fit if …
- volume loss, contours or lines visible at rest
- a wish for a natural, reversible result
- healthy adults with realistic expectations
Rather not if …
- pregnancy or breastfeeding
- acute infection, cold sores or inflamed skin in the area
- known intolerance to hyaluronic acid products or certain autoimmune conditions
The final assessment is made in the medical examination.
How it works and aftercare.
Before: examination, consultation and information about the procedure. Previous treatments, medication – especially blood thinners –, medical conditions and expectations are discussed.
During: after disinfection and, if wanted, anaesthetic cream, hyaluronic acid is placed with a needle or blunt cannula, usually at several points around the corner of the mouth, the chin and the jawline.
After: mild swelling, redness or small bruises are normal. No sport, sauna or tanning bed for 24 hours. Dental appointments are better not scheduled immediately afterwards – mention planned appointments during the consultation.
Result: assessable after about two weeks, once the swelling has settled. Durability is usually six to twelve months.
Possible risks and contraindications.
Swelling, redness, tenderness and small bruises are common after treatment and usually settle within a few days. Less common are nodules, asymmetry or inflammation. Very rare but serious is a vascular occlusion – which is why anatomical knowledge, technique and medical emergency competence are decisive. Hyaluronic acid can be dissolved again with the enzyme hyaluronidase if needed. The treatment is not suitable with acute infections in the area, known intolerances, or during pregnancy and breastfeeding, among others. This information does not replace the medical consultation required by German law (§ 630e BGB).
Guide prices.
All prices are non-binding guide prices and include the consultation.
Invoicing follows the German scale of fees for physicians (GOÄ), based on findings and effort. Every treatment requires a medical examination, consultation and assessment of suitability.
Frequently asked questions.
How much material is needed?
It depends on the findings. Often 1 ml is used first and the result assessed after two weeks before deciding on further steps.
Can botulinum toxin also make sense?
Sometimes, when the muscle pulling the corner of the mouth down is clearly involved. That is a medical decision after examination, not a standard treatment.
Will my face look changed?
The aim is a natural impression. Dose and technique are matched to anatomy and facial movement; over-filled areas are explicitly not the goal.
How long does the result last?
Usually six to twelve months, depending on material, metabolism and area.
When is the treatment not suitable?
Among others with acute infections in the area, known intolerances, certain autoimmune conditions, and during pregnancy and breastfeeding.
Sources and further reading.
- NHS: Dermal fillers – patient information
- MPDG – German medical devices act (fillers are medical devices)
- BfArM – Federal Institute for Drugs and Medical Devices
- DGPRÄC – German Society of Plastic, Reconstructive and Aesthetic Surgeons
- § 630e BGB – duty to inform before treatment (German Civil Code)
- DGBT – German Society for Aesthetic Botulinum Toxin Therapy
- AWMF – German clinical practice guidelines
External links open in a new window; their operators are responsible for their content. Medical responsibility for this page: Katayoun Mostaghimi, specialist in general medicine. Last updated: 2026-10-05.
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