Where to Inject Botox® for Marionette Lines

Author

Dr. Stephen Cosentino

Marionette lines run from the corners of the mouth to the lower extent of the chin on either side of the face. They often appear as extensions of nasolabial folds, which start near the lower corners of the nose and run down to the corners of the mouth.

Both types of lines tend to become more pronounced with age, creating deep folds that give a permanently stern, “frowny” appearance.

Botox® Cosmetic (botulinum toxin type A) is frequently used to treat marionette lines and nasolabial folds, often in combination with hyaluronic acid fillers. Botox works by temporarily paralyzing the facial muscles responsible for marionette lines, softening the folds, removing wrinkles, and lessening the “frowny” effect. Fillers add volume around the Botox injection site for a more natural, durable look.

Where to Inject Botox for Marionette Lines

This Botox face chart shows the proper placement for marionette line injections and other common Botox injection sites.

Depending on the extent of the lines, Botox may be injected up to the lower corner of the nose and down to the lower chin. Injections are typically symmetrical, with equal dosing on either side of the face. The standard dose is 2 to 4 units per injection site.

In the chin, marionette line injections target the depressor anguli oris muscle (DAO). Care must be taken not to inject the depressor labii muscle, which can cause lip asymmetry if exposed to Botox. Optimal needle depth is 5 mm, with placement as close as possible to the DAO muscle’s motor endplate.

It’s common for injectable marionette line treatments to include dermal fillers and Botox together. Fillers further reduce the appearance of deep lines and help volumize the treated area, generating a more youthful appearance than Botox can achieve on its own.

Questions About Botox/Filler Injections for Marionette Lines

It’s natural for prospective patients to have questions about injectable marionette line treatments. Your provider is your best resource for answers relevant to your specific situation, but you’ll find answers to some common queries below.

How Long Does Botox Work for Marionette Lines?

Depending on the type of treatment given, the dosing, and other factors, injectable marionette line treatments may last anywhere from three to 12 months or longer.

Botox-only injections generally last three to six months. Results last longer for combined Botox and hyaluronic acid filler injections — up to and sometimes longer than a year.

How Long Is the Recovery Time?

Botox injections have short recovery times. You should be able to resume normal activity within 24 hours, though visible signs of injection may persist for a few days and results typically take about a week to fully appear.

What Are the Risks?

The risks of Botox injections in the DAO muscle are generally low. However, mild and temporary side effects may occur, such as:

Tenderness or pain at the injection site
Redness, swelling, or minor bleeding at the injection site
Numbness around the injection area

More concerning issues include:

Muscle weakness away from the injection site
Urinary incontinence
Signs of an allergic reaction, such as itching or hives

To reduce the risk of serious complications, work with a provider who has completed advanced Botox and dermal filler training.