Cosmetic surgeons refer to the lines that run from the corners of the mouth down to the chin as marionette lines. A well-known person with these lines is Angela Merkel, which is why they have been given the nickname ‘Merkel lines’. The medical term for these wrinkles is mentolabial lines. They are caused by many factors, for example, the corners of the mouth being drawn down as a result of feeling sad or disappointed, as well as gravity and slackening of the connective tissue and the skin in the entire cheek area. In most cases, corrective surgery is not necessary as good results can be achieved by injecting hyaluronic acid into the wrinkles.
Hyaluronic acid is injected into the bottom of the marionette lines by the cosmetic surgeon. This ensures that water is stored in the connective tissue. Hyaluronic acid can bind water at a ratio of 49:1. This water storage increases the volume of the connective tissue of the skin at the bottom of the marionette lines. As a result, the bottom of the line is raised and the appearance of the lines is considerably reduced; they may even completely disappear with the right dose of hyaluronic acid.
Water is stored in the connective tissue slowly and continuously. This means that the results of the hyaluronic acid treatment cannot be seen immediately. They gradually appear within a few weeks. The benefit is that the changes appear completely natural. The effect usually lasts six to twelve months.
When an appointment for a follow-up treatment at our Klinik am Rhein should be arranged depends on the patient’s individual metabolism. A follow-up treatment can be performed as soon as the marionette lines begin to reappear. At that point, the cosmetic surgeon uses a lower dose than for the first treatment.
Hyaluronic acid is very well tolerated as it is a natural component of the human body. It appears in the vitreous body of the eye and is one of the main components of synovial fluid. The gelatinous core of the intervertebral discs also contains hyaluronic acid. As a result, there are no significant side effects of treating marionette lines. These effects are limited to possible redness around the injection site that disappear after a few hours without any further intervention. Patients may also experience a slight feeling of pressure in the treated area, which is a sign that the desired storage of water to lift the bottom of the wrinkle has begun.
Parts of the facial expression muscles may also play a role in the formation of marionette lines. The surgeon will determine whether or not this is the case during the consultation by feeling the area around the wrinkles. If permanently tense muscles can be felt, the surgeon will advise the patient to treat the wrinkles in combination with Botox. Botox temporarily inhibits the ability of particular facial muscles to contract. If Botox is dosed correctly, the often feared mask-like stiffness does not occur.