Hyaluronic acid is a natural component of the skin responsible for its firmness and hydration. With age, its level decreases, which causes the skin to become lax, dry and wrinkled. Loss of skin firmness leads to the formation of characteristic folds at the junction of the cheek and chin. These run vertically on both sides of the face, giving it a sad appearance, which is why they are commonly referred to as “marionette lines” or “sadness lines”.
The tendency for them to develop may often be hereditary. Facial structure is also important, as marionette lines are more common in people with fuller cheeks. Weight fluctuations may also contribute to this concern.
In the treatment of marionette lines, hyaluronic acid is most commonly used. It restores proper hydration to the tissues, smooths the skin and improves the overall appearance of the face. The hyaluronic acid filler is injected directly beneath the fold, filling it and restoring more youthful facial contours. The procedure allows for effective softening of marionette lines and improvement of facial appearance. The final result depends largely on the depth of the lines.
The line-filling procedure using a hyaluronic acid preparation provides an immediate effect and does not leave unwanted marks. The only side effect may be redness at the injection site. However, this subsides spontaneously within a few days. The procedure is performed under local anaesthesia, which makes it painless for the patient. The result lasts for approximately 8–12 months. After that time, the procedure should be repeated. Other treatment methods for marionette lines include collagen stimulators – calcium hydroxyapatite, such as Crystalis or Ellanse – which provide a very natural and longer-lasting result, from 1.5 to 2 years.