Marionette Filler Seattle & Tacoma

Fine lines and wrinkles tend to appear in the upper and midface first. For example, many people in their twenties and thirties will get Botox injections in their forehead, glabella, and/or crow’s feet due to dynamic wrinkle formation already beginning. Smile lines can also form early on in the aging process and even be genetic. However, some of the more concerning fine lines and wrinkles that begin to appear are those on the lower face. An example of these lower face lines is the marionette lines. Seattle Plastic Surgery provides the best marionette filler Seattle and Tacoma offer.

Overview: Marionette Filler Treatment

The marionette lines are the lines that form along the corners of the mouth and continue down toward the chin. Sometimes the marionette lines can even appear to “pull” the corners of the mouth downward. Marionette lines may cause the face to look aged, weighed down, and grumpy or sad regardless of actual emotions. This can become distressing for patients who still feel and live youthfully. 

Unfortunately, once marionette lines have appeared there are only two primary options: dermal fillers or a facelift. Occasionally, laser resurfacing or Botox may provide some results for the marionette lines. However, it depends on your particular anatomy and skin. Normally, less invasive options such as fillers and potentially some professional skincare like microneedling and chemical peels are recommended as the first line of treatment.

Causes Of Marionette Lines

Marionette lines can have several causes or contributing factors that lead to their formation. First, the natural anatomy does weaken and sag over time. Thus, the sagging of the muscles, ligaments, and skin can all contribute to marionette lines. Also, the skin around your mouth is thinner than other skin which makes it more susceptible to wrinkles.

It is not always clear what causes marionette lines or why certain people get them and others do not. However, a few of the potential causes of marionette lines include:

  • Genetics
  • Sun damage or prolonged sun exposure
  • Poor diet (particularly over a significant amount of time)
  • Environmental damage and free radicals
  • Stress
  • Natural collagen loss
  • Slowing of collagen and elastin production

Benefits & Risks

Like all dermal filler injections, marionette line filler comes with benefits and risks. Your injector will review these with you during your consultation to help gauge if you are a good candidate. Some of the benefits of marionette filler include:

  • Lessens the appearance of marionette lines
  • Overall younger looking appearance
  • Disguise volume loss of the lower face
  • Help raise the corners of the mouth
  • Add volume to the lower face
  • May hold a more positive facial expression and look more approachable
  • Natural looking results
  • Can last several months
  • Many filler options
  • Treats mild to moderate marionette lines
  • Quick injection process
  • Minimal pain
  • Little to no recovery
  • Safe and low risk procedure
  • Easy to combine with other injections like nasolabial fold filler
  • Effective treatment
  • Performed by an experienced and skilled injector

Dermal fillers are generally considered safe, especially hyaluronic acid fillers which are the most common filler used for marionette lines. However, patients should consider the risks before undergoing any filler procedure. Your injector will also use your medical history to determine if you are at a higher risk of complications than the average patient. The risks of marionette filler can include:

  • Infection
  • Asymmetry
  • Unexpected results
  • Prolonged side effects
  • Blood vessel occlusion
  • Nerve damage

Major complications from any hyaluronic acid filler injections are exceptionally rare. Side effects and complications are generally completely treatable and preventable with a qualified and skilled injector. Additionally, the hyaluronic acid filler is reversible with an injection of hyaluronidase.

Before & After Marionette Filler Injections


A consultation appointment with an injector at Seattle Plastic Surgery will start with a conversation about your goals and desired results. Your injector may also ask about aspects of your medical history and lifestyle that could affect the filler injections. You will also have the opportunity to ask any questions you may have. If your injector believes you are a good candidate, they will discuss the dermal filler options and help you choose the one right for you. 

If your injector believes that you are not a candidate for marionette line filler, they will propose other treatment options such as microneedling, facelift surgery, or laser resurfacing. Otherwise, you will receive a tentative price quote and may be able to have the injections performed on the same day.

Injections Process

First, your injector will disinfect the treatment area with alcohol. They may then apply numbing cream to help keep you comfortable during the injections. This will sit for about five to ten minutes. After wiping off the numbing cream, your injector will take your chosen filler and gently inject it into the marionette line area. The entire procedure usually takes about twenty minutes.

Once the filler is injected, your injector may gently massage it to help it settle into place. You can then see your results and your injector will provide you with aftercare instructions. You will also receive advice on when you can expect to see your results.

Aftercare & Side Effects

Aftercare following marionette filler in Seattle is minimal. However, for the days immediately following the injections, you may need to alter your routine slightly. Some of the possible instructions your injector gives you may include:

  • Take it easy with the exercise for a few days
  • Do not partake in any strenuous activities
  • Avoid unprotected sun exposure
  • Do not unnecessarily touch or massage the area
  • Keep the area clean and only apply light makeup
  • Avoid ibuprofen and aspirin as a painkiller, use acetaminophen instead
  • Refrain from drinking too much alcohol or smoking
  • Immediately contact us if you notice any abnormal reactions or have any concerns

Any side effects you experience are generally mild. Some patients may not experience any side effects, but if you do, they tend to improve after a few days and within two weeks. Possible side effects include:

  • Swelling
  • Redness
  • Bruising
  • Itchiness
  • Soreness

Frequently Asked Questions

What Filler Is Best For Marionette Lines?

There is not one “best” filler for treating the marionette lines. Most providers and patients prefer to use hyaluronic acid fillers because they mold well and are reversible. Additionally, you do want to maintain some softness in the area, so hyaluronic acid fillers are ideal for this. A few examples include Restylane L and Juvederm Ultra Plus.

In cases where the marionette lines are especially deep, or a patient has used HA fillers and wants something longer lasting, semi-permanent fillers like Sculptra and Radiesse are also viable filler options for treating the marionette lines.

Are Marionette Filler Injections Painful?

Marionette filler injections do come with some discomfort and pain. Though, our injectors frequently use and offer topical numbing cream. They may also use a vibration device elsewhere on the face that distracts the brain from the feeling of the injections. Finally, most hyaluronic acid fillers contain a small amount of lidocaine which helps ease the injections as well. Most patients tolerate the injections without much pain. 

Can It Help Lift A Downturned Smile?

Yes, marionette lines can cause the corners of the mouth to point downward. While this is not the only cause of this, if it is, marionette fillers can help restore the smile and lip contours.

Will It Be Obvious I Have Had Fillers?

No, as long as you and your injector choose the right filler option, they are injected correctly, and an appropriate amount is used, it will likely not be obvious that you have had filler injections. People may notice that you look younger or more refreshed, but rarely can they immediately point out the filler once healed.

What Is The Cost Of Marionette Fillers In Seattle?

The cost of marionette fillers in Seattle depends on the filler you choose and your provider. For the most popular marionette filler choices, the prices are as follows:

Restylane L:

  • $489 one syringe with Injector

Juvederm Ultra Plus:

  • $550 one syringe with Injector

To view our full suite of dermal filler pricing, visit our price list. You can also use Price Simulator to add up an estimated cost of multiple procedures. Seattle Plastic Surgery does work with Allē Rewards.

I’m 50 and went for my first time to get some injections done and received the most amazing bedside manner, compassionate advice and gentle treatment. I left feeling AMAZING and so well taken care of. I highly recommend them for any self-care service you might want or need. My husband and I are both so impressed with them we are planning to book all of our spa services there going forward. I can’t wait to get my next treatment!


Love Dr. Shahriar Khezri, MD. His bedside manner was excellent, he remembered me from a year ago and the details of my needs. I’ve had a couple consults and one treatment with him. His filler work was painless and beautiful, careful to stay true to the natural contours of my face. Highly recommend


Great experience. I got the Botox and fillers here. Saw immediate changes. Highly recommend!


I had a great experience - pain free and fully informed, the doctor took her time and was very patient with me as I navigated different procedures. Highly recommend.


The Best Fillers For Marionette Lines At Seattle Plastic Surgery

The injectors at Seattle Plastic Surgery have undergone hands-on training and have years of experience as injectors. They specialize in neuromodulator injections such as Botox treatments and dermal fillers such as lip fillers, under eye fillers, and semi-permanent dermal fillers such as Sculptra. The Gallery of Cosmetic Surgery’s injectors offers the best marionette line filler Bellevue and Kirkland provide.

Seattle Plastic Surgery has served the Greater Seattle area for over decades. Offering high quality and luxury surgical and non-surgical cosmetic procedures, the providers at Seattle Plastic Surgery are among the best in Washington State. Coming from many different backgrounds and unique expertise, our injectors and surgeons will work to customize your procedures to fit you.

To learn more and schedule a consultation, call us at 206-324-1120. You can also connect with us online using Price Simulator, chat, or our contact form.