Addressing Dynamic & Static Lower-Face Lines: Combining Muscle Relaxers with Marionette Fillers

Many people searching for aesthetic treatments notice that the lower face — particularly the area around the mouth, jawline, and chin — can be one of the first regions to show visible signs of ageing. Marionette lines, the vertical creases that run from the corners of the mouth down towards the chin, are a common concern. For some individuals, these lines appear only during facial expressions; for others, they have become etched into the skin at rest.

Understanding the difference between dynamic lines (those caused by muscle movement) and static lines (those present even without expression) is important when exploring treatment options. Combining muscle relaxing injections with dermal fillers for marionette lines represents an approach that addresses both causes simultaneously — and it is a topic many patients are rightly keen to research before attending a consultation.

This article explains how each treatment works, why a combined approach may be considered in appropriate candidates, what to expect, and where to seek professional guidance.

In some cases, a qualified practitioner may consider combining muscle relaxing injections with dermal fillers for marionette lines to address both dynamic and static lower-face lines. Muscle relaxers reduce movement-driven creasing, while fillers restore volume and soften deeper static lines. Suitability depends on individual facial assessment and cannot be assumed.

When discussing lower-face lines with a practitioner, one of the first distinctions they are likely to make is between dynamic and static lines.

Dynamic lines form as a result of repeated muscle contractions. Every time you smile, frown, speak, or chew, the muscles beneath the skin move. Over time, these repetitive movements cause creases to form in the overlying skin. In younger skin with good elasticity, these lines disappear when the face is at rest. In more mature or sun-damaged skin, they may begin to linger.

Static lines are present regardless of facial expression. They have become a fixed feature in the skin's surface due to a combination of volume loss, collagen breakdown, and prolonged repetitive movement over the years. Marionette lines, when visible at rest, typically fall into this category — though they often begin as dynamic lines earlier in life.

Recognising which type of line is present, and to what extent, is essential for treatment planning. A thorough assessment by an experienced practitioner helps determine whether muscle relaxers, fillers, a combination, or an entirely different approach is most appropriate for an individual's concerns.

Muscle relaxing injections — commonly referred to in the context of botulinum toxin type A — work by temporarily reducing the activity of specific muscles. When injected with precision into targeted areas around the lower face, they can soften the repeated muscular contractions that contribute to line formation and deepening.

In the context of lower-face rejuvenation, muscle relaxing injections may be considered for areas such as the depressor anguli oris (DAO) muscle, which pulls the corners of the mouth downward. Relaxing this muscle can reduce the downward pull that contributes to the formation and worsening of marionette lines over time.

However, the lower face is a particularly nuanced area. The muscles here are closely involved in chewing, speaking, and expressing emotion. Treatment in this region requires careful dosing and precise placement to avoid affecting natural function or facial symmetry. This is one of the reasons why lower-face muscle relaxing treatment should only ever be carried out by a suitably qualified and experienced practitioner following thorough assessment.

It is also important to note that muscle relaxers address the dynamic component of lines — they do not restore lost volume or improve the appearance of lines already etched into the skin at rest. This is where dermal fillers may play a complementary role.

Explore our anti-wrinkle injection treatments to understand more about how these procedures are approached at our clinic.

Dermal fillers are injectable substances — most commonly hyaluronic acid (HA) — used to restore volume, smooth static lines, and subtly recontour areas of the face that have lost structural support over time. When used in the context of marionette lines, fillers are typically placed to soften the vertical creases, support the corners of the mouth, and restore definition in the lower face.

Hyaluronic acid is a naturally occurring substance found throughout the body. In the skin, it binds water molecules and contributes to hydration, plumpness, and structural support. As we age, natural HA levels decline, contributing to volume loss and the deepening of lines and folds.

When a filler product is injected by an experienced clinician, it adds physical volume beneath the skin's surface, supporting the overlying tissue and reducing the visible depth of marionette lines. The effect is immediate, though some initial swelling is expected in the days following treatment.

Filler treatments for marionette lines require careful consideration of facial anatomy, aesthetic balance, and the individual's natural facial structure. Results vary from person to person and are influenced by the depth of lines present, the product used, the technique applied, and individual tissue characteristics. No specific outcome can be guaranteed.

To learn more about our approach to facial rejuvenation with fillers, visit our marionette line filler treatments page.

To understand why a combined treatment approach may sometimes be considered, it helps to understand what is happening beneath the skin's surface as we age.

Facial ageing is a multifactorial process involving several interconnected changes:

Collagen and elastin decline: From our mid-twenties onwards, collagen production gradually decreases. Collagen provides structural support and firmness, while elastin allows the skin to spring back after movement. As both decline, the skin becomes less resilient and more prone to line formation.

Volume loss: The fat compartments of the face — which provide youthful fullness and support the overlying tissues — diminish with age. This contributes to a hollowing appearance and causes the skin to sag downward, emphasising folds such as marionette lines.

Bone remodelling: The facial skeleton changes subtly over time. Bone density in areas such as the jaw and mid-face can reduce, altering the structural foundation on which soft tissues rest.

Muscle activity: Decades of repeated muscular contraction etch lines into the skin, particularly in expressive areas. The DAO muscle's consistent downward pull on the mouth corners is a key contributor to marionette line development.

Gravity: Over time, gravitational forces contribute to the downward repositioning of soft tissue, particularly in the lower face.

A combination approach — addressing both muscular activity and volume loss — may reflect an attempt to manage several of these contributing factors. However, the appropriateness of any treatment plan depends on individual assessment.

For some individuals, neither muscle relaxers nor fillers alone may fully address lower-face concerns. In carefully assessed and appropriate candidates, a practitioner may recommend using both treatments together to target different aspects of lower-face line development.

The rationale is as follows:

• Muscle relaxers help reduce ongoing dynamic muscle activity that continues to deepen lines over time and counteracts the effects of filler treatment
• Dermal fillers restore the volume that has been lost and improve the appearance of static lines already present at rest

When used together, the approach aims to address both the cause (muscular movement) and the consequence (volume loss and structural changes) of lower-face line formation. Some practitioners describe this as a more holistic treatment strategy for the lower face.

However, it is important to emphasise that not everyone is a candidate for both treatments simultaneously. There are clinical considerations, contraindications, and timing factors that a practitioner must assess on an individual basis. A thorough consultation is essential before any treatment is planned or undertaken.

Considering a professional consultation is a reasonable step if you have noticed any of the following:

• Deepening lines from the corners of the mouth towards the chin, visible at rest or during expression
• A sense that the corners of the mouth appear turned downward, creating a saddened or fatigued appearance
• Loss of definition or fullness in the lower face
• Concerns about facial asymmetry in the lower jaw or mouth area
• Lines that have become more noticeable over the past few years and are affecting how you feel about your appearance

Seeking an assessment does not commit you to any treatment. A consultation with a qualified practitioner provides an opportunity to discuss your concerns, understand your options, and receive honest, personalised advice about what may or may not be appropriate for your individual anatomy and goals.

It is important to approach aesthetic treatments from an informed position, with realistic expectations about what is and is not achievable. A reputable practitioner will always take the time to discuss suitability, risks, alternatives, and expected outcomes before any treatment proceeds.

Potential Benefits

When treatment is deemed appropriate and carried out by a suitably qualified practitioner, patients may observe:

• A reduction in the visible depth of marionette lines
• A softening of the downward pull at the mouth corners
• A more rested or refreshed appearance to the lower face
• Improved facial balance and proportion
• Results that remain natural-looking when appropriate products and techniques are used

Limitations and Considerations

• Results vary significantly between individuals. Skin quality, the depth of lines, age, lifestyle factors, and anatomy all influence outcomes.
• Neither treatment is permanent. Muscle relaxers typically last three to six months; hyaluronic acid fillers may last from six months to over a year depending on the product, area treated, and individual metabolism.
• A combined approach is not appropriate for everyone. Contraindications, medical history, and facial anatomy must be carefully assessed.
• Repeated treatments may be needed to maintain results over time.
• Swelling, bruising, and temporary discomfort are common following injectable treatments and should be expected.
• Complications, while uncommon when treatment is performed correctly, are possible. These include bruising, asymmetry, product migration, and in rare cases more serious vascular events. These risks should be discussed in full during consultation.

No treatment outcome can be guaranteed, and individual results will vary.

Following any injectable treatment in the lower face, your practitioner will provide specific aftercare guidance tailored to your treatment. General considerations that are often recommended include:

• Avoiding strenuous exercise for at least 24 hours after treatment
• Refraining from touching or massaging the treated area unless specifically instructed to do so by your practitioner
• Avoiding excessive heat — including saunas, steam rooms, and prolonged sun exposure — for the first 24–48 hours
• Staying upright for several hours after receiving muscle relaxing injections to reduce the risk of product migration
• Applying gentle, hydrating skincare to support skin health during the recovery period
• Using a broad-spectrum SPF 30 or higher daily as part of your skincare routine — sun protection is one of the most evidence-supported measures for maintaining skin quality
• Keeping well hydrated and maintaining a balanced diet to support overall skin health
• Attending any recommended review appointments so your practitioner can assess results and address any concerns

If you experience unusual or concerning symptoms following treatment — including persistent swelling, discolouration, pain, or changes in vision — contact your treating clinic promptly.

For a wider overview of skin health and maintenance approaches, our skin health and rejuvenation services provide additional educational context.

• Marionette lines can be dynamic, static, or both, which influences the treatment approach that may be most appropriate for an individual.
• Muscle relaxing injections and dermal fillers work differently — one addresses muscular activity, the other restores volume and smooths static lines.
• A combined approach may be considered in suitable candidates, but suitability must be assessed individually by a qualified practitioner.
• Results are not permanent and vary between individuals depending on anatomy, lifestyle, and the treatment used.
• A thorough consultation is essential before any treatment plan is agreed — there are no one-size-fits-all solutions in facial aesthetics.
• Aftercare and ongoing skin health practices — including daily SPF use and hydration — support the longevity of results and overall skin quality.

How long do the results of marionette line filler last?

The longevity of dermal filler results in the marionette line area varies between individuals. Hyaluronic acid fillers used in this region typically last anywhere from six months to over a year, depending on factors including the specific product used, the volume injected, individual metabolic rate, lifestyle habits, and how the area is treated post-procedure. Some individuals metabolise filler more quickly than others. Your practitioner should discuss realistic expectations regarding longevity during your consultation and explain the process for maintenance treatments if desired.

Are muscle relaxing injections in the lower face safe?

Muscle relaxing injections in the lower face can be performed safely when carried out by a suitably qualified and experienced practitioner who has a detailed understanding of facial anatomy. The lower face is a technically complex area involving muscles essential for speaking, chewing, and expression. Careful patient selection, precise placement, and conservative dosing are important considerations. As with all injectable treatments, there are risks — including asymmetry, temporary functional changes, bruising, and swelling — which should be fully discussed during a pre-treatment consultation.

How soon will I see results after a combined lower-face treatment?

Following dermal filler treatment, results are often visible immediately, though initial swelling can temporarily affect the appearance. Once any swelling subsides — usually within one to two weeks — a clearer picture of the outcome becomes apparent. Muscle relaxing injections typically take between two and four weeks to reach their full effect. If both treatments are performed simultaneously, your practitioner may recommend a review appointment to assess results and address any questions once both treatments have fully settled.

Is there any downtime after marionette filler or muscle relaxer treatment?

Most patients return to their normal daily activities shortly after injectable treatments. However, some temporary side effects are common and should be anticipated. Bruising and swelling at the injection sites are the most frequently reported concerns and may be more noticeable in some individuals than others. Minor tenderness around the treated area is also typical. In most cases, any visible side effects resolve within seven to fourteen days. Strenuous exercise, excessive heat exposure, and alcohol should generally be avoided for at least 24 hours post-treatment, in line with practitioner guidance.

Can marionette lines be prevented from worsening?

While no treatment can stop the ageing process entirely, certain evidence-supported measures may help slow the progression of lower-face lines over time. These include consistent use of a broad-spectrum sunscreen, maintaining good skin hydration, avoiding smoking (which accelerates collagen breakdown and skin ageing), managing stress, and following a balanced diet. Some patients also explore preventative aesthetic approaches in consultation with a practitioner. However, genetic factors and natural ageing processes will continue to influence how the face changes over time, and individual outcomes cannot be predicted or guaranteed.

Is a combined approach more effective than filler alone?

Whether a combined approach is more effective than filler alone depends entirely on the individual's concerns and the nature of their lines. For patients whose lower-face lines are primarily static and volume-related, filler treatment alone may address their concerns adequately. For those with a significant dynamic component — where muscular activity is actively contributing to worsening lines — combining muscle relaxers with filler may offer a more comprehensive approach in the view of some practitioners. This is a clinical decision that should be made following individual assessment, not on the basis of general assumptions.

Lower-face lines — particularly marionette lines — are among the most common concerns discussed in aesthetic consultations. Understanding the distinction between dynamic and static lines is central to exploring treatment options in an informed way. For appropriate candidates, combining muscle relaxing injections with dermal fillers may represent a considered approach to addressing the different contributing factors of lower-face line formation.

However, it is essential to approach this topic with realistic expectations. Results vary between individuals, no outcome can be guaranteed, and not every person is a suitable candidate for either or both treatments. The lower face is a complex anatomical region, and treatment here should only be carried out by qualified, experienced practitioners following a thorough assessment of your individual concerns, health history, and facial anatomy.

Treatment suitability, risks, and expected outcomes should always be assessed individually during a professional consultation.

If you are considering treatment for lower-face lines and would like to discuss your options in a calm, unhurried environment, speaking with a qualified aesthetic practitioner is the most important first step you can take.