There are different techniques used to correct marionette wrinkles, and these techniques evolve, as does our understanding of what causes marionette wrinkles. We used to think of marionette lines as hypertonicity of two small muscles that pull down the corners of the mouth. Correction of this aesthetic defect began with the introduction of a small amount of neurotoxin into the muscles. However, this technique did not lead to a satisfactory and lasting result.
Correction of marionette wrinkles with fillers is more justified. The question remains: which insertion technique is best for your patient?
8 muscles take part in the facial expressions of the mouth. All these muscles converge into one muscle node, which is located at a distance of 0.5-1 cm from the corner of the mouth. The ligament, located from the corner of the mouth towards the lower jaw, is the border that forms the wrinkles of the marionettes. That is why, in order to determine the zone of restoration of volumes in the lower third of the face, it is necessary to displace the cheek medially. This is a kind of test that will clearly show how the tissues are displaced relative to the ligament connecting the corner of the mouth with the lower jaw.
Dr Ofir Artiz (Head, Center for Aestetic Dermatology Tel-Aviv medical center) shows how to restore the volume of the crease that forms marionette wrinkles with five boluses. This is a low-impact and effective technique for correcting the lower third of the face.
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