{"id":4826,"date":"2026-10-27T18:37:23","date_gmt":"2026-10-27T15:37:23","guid":{"rendered":"https:\/\/dermique.bg\/nasolabial-folds-marionette-lines\/"},"modified":"2026-10-27T18:37:23","modified_gmt":"2026-10-27T15:37:23","slug":"nasolabial-folds-marionette-lines","status":"publish","type":"post","link":"https:\/\/dermique.bg\/en\/nasolabial-folds-marionette-lines\/","title":{"rendered":"Nasolabial folds and marionette lines: filler, Sculptra or Morpheus8?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Nasolabial folds, which run from the sides of the nose to the corners of the mouth, and marionette lines, which run down from the corners of the mouth towards the chin, are among the most common reasons patients come to see us. Many describe them by saying \u201cI look tired\u201d or \u201cI look sad\u201d, even when they feel neither. The good news is that there are effective non-surgical options. What matters most, however, is understanding <strong>why<\/strong> the folds have deepened, because that decides which method will help and which will only make the face look heavier.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Nasolabial folds and marionette lines: what is the difference?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The two often appear together, but they have different causes and are treated differently. Plastic surgeons and dermatologists draw the same distinction in an <a href=\"https:\/\/www.realself.com\/news\/marionette-lines-nasolabial-folds-treatments\" target=\"_blank\" rel=\"noopener\">article on RealSelf<\/a>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Nasolabial folds.<\/strong> These are a natural boundary between the cheek and the area around the mouth. Everyone has them, even in childhood. Over the years they deepen, mainly because the midface loses volume and support.<\/li>\n\n\n<li><strong>Marionette lines.<\/strong> These appear later, below the corners of the mouth. They are linked to volume loss in the lower face, to tissue descending towards the jawline and to the muscle that pulls the corners of the mouth downwards.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Why the folds deepen with age<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">There is rarely a single cause. Usually several processes combine:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Volume loss.<\/strong> Facial fat is not one layer but a set of separate compartments. The anatomical study by <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17519724\/\" target=\"_blank\" rel=\"noopener\">Rohrich and Pessa (2007)<\/a> shows that the nasolabial fold is a boundary between such compartments. When the cheek loses volume and shifts downwards, that boundary becomes more visible.<\/li>\n\n\n<li><strong>Ligament laxity.<\/strong> Ligaments act like anchors that hold the soft tissues in place. As the surrounding tissues loosen, they descend, and folds form at the anchor points. A <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10993050\/\" target=\"_blank\" rel=\"noopener\">2024 review of marionette lines<\/a> highlights the role of the mandibular ligament and of tissue sagging towards the jaw (jowls).<\/li>\n\n\n<li><strong>Bone changes.<\/strong> The facial skeleton also changes with age. According to <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC3404279\/\" target=\"_blank\" rel=\"noopener\">Mendelson and Wong (2012)<\/a>, the upper jaw beside the nose and the front of the lower jaw gradually lose bone. The soft tissues lose part of their support and the folds deepen.<\/li>\n\n\n<li><strong>Skin quality.<\/strong> Over time the skin loses collagen and elasticity and becomes thinner. Sun exposure, smoking and rapid weight loss speed this up. You can read more about the effect of rapid weight loss in our article on <a href=\"https:\/\/dermique.bg\/en\/ozempic-face\/\">\u201cOzempic face\u201d<\/a>.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Why filling the fold itself is often a mistake<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The most intuitive solution seems to be injecting filler straight into the line. If the fold is simply a consequence of lost support in the midface, however, filling it directly does not address the cause. Too much product in this area can make the face look heavy and unnatural, and create a bulge beside the mouth that shows especially when you smile. The specialists quoted by RealSelf give the same warning: overfilling the marionette area weighs down the lower face.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That is why our approach starts with an <strong>assessment of the whole face<\/strong>. If the cheeks have lost volume, we first restore support there, with a small amount of product placed precisely. Only then do we decide whether a fine correction in the fold itself is needed. A small clinical study (<a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5733916\/\" target=\"_blank\" rel=\"noopener\">18 patients<\/a>) reported nasolabial folds up to 30.4% shallower three months after treating only the cheeks with hyaluronic acid filler. In another study of midface filler, <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26355611\/\" target=\"_blank\" rel=\"noopener\">14 of 17 participants<\/a> had a clinically significant improvement in their nasolabial folds after six months.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is important to be precise: cheek filler does not \u201cpull\u201d the fold upwards like a thread. A 3D study by <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29334576\/\" target=\"_blank\" rel=\"noopener\">Mowlds and Lambros (2018)<\/a> showed that the product expands the tissue around the injection site and does not lift the fold itself. The improvement comes from better-balanced facial proportions and from precise placement. That is why the plan is always individual rather than a standard \u201crecipe\u201d.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Options at Dermique<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The choice depends on whether the main issue is volume, laxity or skin quality. The best result often comes from a combination of methods spread over time.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Hyaluronic acid filler: support and precise corrections<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Hyaluronic acid fillers restore volume and support in the midface and allow fine corrections around the folds, lips and chin. The effect usually lasts 12\u201324 months, depending on the area and the product. One advantage of hyaluronic acid is that it can be dissolved with an enzyme called hyaluronidase if needed. You can read more on our <a href=\"https:\/\/dermique.bg\/en\/services\/fillers-and-facial-contouring\/\">Fillers and facial contouring<\/a> page.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Collagen stimulators: Sculptra and others<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Collagen stimulators such as Sculptra, Radiesse, Juvelook and HArmonyCa do not add volume straight away. Instead, they prompt the skin to build its own collagen. They suit patients who want a gradual, natural improvement in firmness and density. Sculptra Aesthetic was approved by the <a href=\"https:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfpma\/pma.cfm?id=P030050S002\" target=\"_blank\" rel=\"noopener\">FDA in 2009<\/a> specifically for correcting shallow to deep nasolabial folds. Results develop over 4\u20138 weeks and keep improving for up to six months. Usually 2\u20135 sessions are needed, 4\u20136 weeks apart. See our <a href=\"https:\/\/dermique.bg\/en\/services\/collagen-biostimulators\/\">Collagen biostimulators<\/a> page for more.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Morpheus8 Burst: skin quality and firmness<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Morpheus8 Burst combines microneedling with radiofrequency energy. It stimulates collagen in the deeper layers of the skin and improves density and firmness, including in the lower face. It does not replace the volume that filler provides. Instead, it improves the quality of the skin over the folds. A 2026 systematic review of <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC13058395\/\" target=\"_blank\" rel=\"noopener\">20 studies of radiofrequency microneedling<\/a> describes improvements in wrinkles and skin laxity, with side effects mostly limited to mild, temporary redness and swelling. You will find more on our <a href=\"https:\/\/dermique.bg\/en\/services\/morpheus8-burst-by-inmode\/\">Morpheus8 Burst by InMode<\/a> page.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">XERF: needle-free tightening<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">When the main issue is mild to moderate laxity along the jawline and in the lower face, the radiofrequency treatment <a href=\"https:\/\/dermique.bg\/en\/services\/xerf-by-cynosure-lutronic\/\">XERF<\/a>, arriving at Dermique very soon, may also help. It involves no needles and no downtime. You can read more about the technology in our article <a href=\"https:\/\/dermique.bg\/en\/xerf-skin-tightening\/\">XERF: the needle-free skin tightening everyone is talking about<\/a>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Botulinum toxin for marionette lines<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">In some patients, the muscle that pulls the corners of the mouth downwards is particularly active and deepens the marionette lines. In such cases, a small dose of <a href=\"https:\/\/dermique.bg\/en\/services\/botulinum-toxin\/\">botulinum toxin<\/a> can soften that pull and complement the effect of filler. We decide whether this suits you at your consultation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">When non-surgical treatments are not enough<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Non-surgical treatments have limits. If, with marked laxity, the fold only disappears when you gently pull the skin back towards your ears, the problem is most likely excess, loose tissue rather than a lack of volume. In that case, large amounts of filler will not give a natural result. We will tell you this openly and discuss which options are realistic, including a consultation with a plastic surgeon.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What to expect<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Consultation and examination.<\/strong> We assess your face at rest and in motion, your anatomy, your skin quality and your expectations. Only then do we propose a plan.<\/li>\n\n\n<li><strong>During the treatment.<\/strong> For fillers, a numbing cream is applied, and most fillers also contain lidocaine, so the treatment is usually well tolerated.<\/li>\n\n\n<li><strong>Afterwards.<\/strong> Recovery is usually short. After filler, some redness or swelling for 24\u201348 hours is possible.<\/li>\n\n\n<li><strong>Results.<\/strong> Filler gives a visible effect straight away, while collagen stimulators, Morpheus8 Burst and XERF work gradually over the following weeks and months.<\/li>\n\n\n<li><strong>Maintenance.<\/strong> Ageing continues, so results are maintained with periodic treatments that we plan together.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Safety: why who injects, and how, matters<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The area around the nose and mouth has a rich blood supply. The facial artery and its branches run close to the nasolabial fold and the marionette area, and their course varies from person to person, as an <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10102405\/\" target=\"_blank\" rel=\"noopener\">anatomical review of the facial artery<\/a> shows. According to the <a href=\"https:\/\/www.fda.gov\/medical-devices\/aesthetic-cosmetic-devices\/dermal-fillers-soft-tissue-fillers\" target=\"_blank\" rel=\"noopener\">FDA<\/a>, accidental injection of filler into a blood vessel is rare but can have serious consequences, including damage to the skin and to eyesight. The regulator therefore advises that the treatment is carried out by a qualified, licensed provider.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">At Dermique, injectable treatments are performed by a doctor who knows facial anatomy and chooses the right product, amount and technique. We keep hyaluronidase at the clinic. It is the enzyme that dissolves hyaluronic acid filler and the core of the <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC6257077\/\" target=\"_blank\" rel=\"noopener\">recommended protocol for a vascular complication<\/a>. If, after a treatment, you notice severe or increasing pain, paleness or mottled bluish skin, or any change in your vision, contact us immediately.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Injectable treatments are not suitable if there is an active skin infection in the area, during pregnancy or breastfeeding, and some autoimmune conditions also need additional assessment. That is why we ask detailed questions about your health before every treatment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">What is the best treatment for nasolabial folds?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">No single method is best for everyone. If the cause is volume loss in the midface, we usually start with hyaluronic acid filler or a collagen stimulator to restore support. For lax or thinning skin, Morpheus8 Burst or XERF can help. We decide on the plan after an examination.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">How long does nasolabial fold filler last?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Usually 12\u201324 months, depending on the area and the product. Hyaluronic acid filler can be dissolved with hyaluronidase if needed.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Why don\u2019t you fill the nasolabial fold directly?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Because the fold is often a consequence of lost support in the cheek. Too much filler in the fold itself can make the face look heavy and unnatural. We therefore assess the whole face first and, if needed, make only a fine correction in the fold.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Does Sculptra help with nasolabial folds?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, Sculptra Aesthetic is FDA-approved for correcting nasolabial folds. It stimulates your own collagen, so results develop gradually over 4\u20138 weeks and keep improving for up to six months. Usually 2\u20135 sessions are needed.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Is filler around the mouth safe?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Serious complications are rare, but the area has a rich blood supply. That is why injectable treatments at Dermique are performed by a doctor, and we keep hyaluronidase at the clinic to dissolve hyaluronic acid filler if needed.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Book a consultation at Dermique<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">If you recognise yourself in this article, the best first step is an examination by a dermatologist. Fill in our <a href=\"https:\/\/dermique.bg\/en\/booking\/\">enquiry form<\/a> and our team will contact you to confirm a convenient time. You can also reach us via our <a href=\"https:\/\/dermique.bg\/en\/contact\/\">Contact<\/a> page. Current prices are on our <a href=\"https:\/\/dermique.bg\/en\/price-list\/\">price list<\/a>.<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/dermique.bg\/en\/booking\/\">Send an enquiry<\/a><\/div>\n<\/div>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><em>This article is for information only and does not replace a medical examination. The choice of treatment and expected results are individual and are decided after a consultation.<\/em><\/p>\n\n\n\n<script type=\"application\/ld+json\">{\"@context\": \"https:\/\/schema.org\", \"@type\": \"FAQPage\", \"@id\": \"https:\/\/dermique.bg\/en\/nasolabial-folds-marionette-lines\/#faq\", \"mainEntity\": [{\"@type\": \"Question\", \"name\": \"What is the best treatment for nasolabial folds?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"No single method is best for everyone. If the cause is volume loss in the midface, we usually start with hyaluronic acid filler or a collagen stimulator to restore support. For lax or thinning skin, Morpheus8 Burst or XERF can help. We decide on the plan after an examination.\"}}, {\"@type\": \"Question\", \"name\": \"How long does nasolabial fold filler last?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Usually 12\u201324 months, depending on the area and the product. 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The Dermique approach.<\/p>\n","protected":false},"author":1,"featured_media":3444,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[382],"tags":[],"class_list":["post-4826","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-injectable-treatments"],"acf":[],"_links":{"self":[{"href":"https:\/\/dermique.bg\/en\/wp-json\/wp\/v2\/posts\/4826","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dermique.bg\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/dermique.bg\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/dermique.bg\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dermique.bg\/en\/wp-json\/wp\/v2\/comments?post=4826"}],"version-history":[{"count":0,"href":"https:\/\/dermique.bg\/en\/wp-json\/wp\/v2\/posts\/4826\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/dermique.bg\/en\/wp-json\/wp\/v2\/media\/3444"}],"wp:attachment":[{"href":"https:\/\/dermique.bg\/en\/wp-json\/wp\/v2\/media?parent=4826"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/dermique.bg\/en\/wp-json\/wp\/v2\/categories?post=4826"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/dermique.bg\/en\/wp-json\/wp\/v2\/tags?post=4826"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}