The Best Nonsurgical Treatments For Nasolabial Folds & Marionette Lines

The Best Nonsurgical Treatments For Nasolabial Folds & Marionette Lines
A woman after nonsurgical treatments for nasolabial folds and marionette lines

There was a time when the term “damage control” for an aging face meant one thing—a facelift. Now, with advances in nonsurgical cosmetic procedures, your plastic surgeon may prescribe something else a touch more conservative. Of course we’re talking about noninvasive treatments, but are all noninvasive treatments equal when it comes to staving off the deep creep of nasolabial folds and marionette lines? No. No they are not. Let’s unpack.

What are these folds and lines we speak of?

You know who they are: ‘smile lines,’ ‘laugh lines,’ ‘puppet lines,’ those pesky folds/lines that extend from the outside corner of your nose and seemingly connect to the outer corners of your mouth (nasolabial folds) and also run vertical from the outer corner of your mouth down to your jawline. Both are caused by a variation of genetics, repeated facial expressions, a natural reduction in collagen and elastin, and the age-related loss of volume in the face. And no amount of verbal trickery can change the fact that ever-deepening nasolabial folds and marionette lines are neither cute nor funny… and damn it, you are not a puppet.

Take heart friends, modern cosmetic procedures can offer a number of nonsurgical treatments used solo or in tandem to help soften nasolabial folds and marionette lines and temporarily stave off more invasive surgical procedures for the offending folds/lines. Let’s meet them.


For those patients whose folds/lines are still relatively superficial, your plastic surgeon might recommend a series of microneedling treatments . Microneedling uses a power hand-piece to create tiny channels into the dermis of the skin. This helps to stimulate your body’s natural healing process, creating collagen and elastin to plump the folds and wrinkles back to their youthful state, which in turn will make those pesky folds/lines a lot less noticeable. Microneedling is typically recommended as a series (anywhere from 3-6) and some minor side effects can occur, namely redness and swelling, but generally dissipate pretty quickly.

Nonsurgical skin tightening:

It’s not exactly a stretch to imagine that sagging skin plays a part in the appearance of droopy nasolabial folds and marionette lines. This is why your plastic surgeon might also recommend a series of radio frequency, (Thermage, Vivace), IPL (Titan, Halo) and/or ultrasound treatments (Ultherapy, Venus Legacy) to help tighten the skin in your mouth, jaw and cheek area. These laser treatments heat the dermal layer of the skin to stimulate collagen production without damaging the outer layer, eventually producing a lifting and tightening effect. Your doctor will advise a course of treatments, spaced 18-24 months apart and you’ll begin to see gradual results over the 2-3 months post each treatment. With minimal risk and little to no downtime, nonsurgical skin tightening can be a good option for patients whose folds/lines are still relatively superficial.

Dermal Fillers (Restylane, Sculptra, Juvederm, etc…):

With the use of injectables, like dermal fillers, increasing by 39% in the last 5 years, it’s little surprise that we’re including hyaluronic-acid based products like Restylane, Sculptra and Juvederm in this list of the best noninvasive treatments for nasolabial folds and marionette lines. The fillers work to safely replace lost volume that might be colluding with gravity to produce premature facial sagging, as well as to fill in and smooth out lines caused by repetitive movements and expressions. Since fillers come in different viscosities, your doctor will assess the severity and depth of your folds/lines and recommend which one is best for you. The results are immediate, though temporary (lasting anywhere from 6 months to a year), and there is very little risk and recovery time. The rub, if you’re folds/lines are in the advances stages, no amount of filler is going to be able to sort it.

Neurotoxin (Botox, Dysport, Xeomin):

And speaking of injectables, another less obvious tool in your plastic surgeon’s arsenal is neurotoxin—you know Botox, Dysport, and Xeomin. By “relaxing” the muscles that might be pulling the mouth down while the face is at rest, your doctor may be able to stave off the ever deepening appearance of pesky folds/lines. Typically neurotoxins aren’t solely used to treat these areas. Instead, your doctor may recommend a neurotoxin/dermal filler combo to soften the muscles at the corners of the mouth and fill the folds/lines. As with all injectables, placement is key and ensuring that you’ve chosen an experienced injector is the only way to a successful result.

So if you’re at the beginning and or mild-stages of aging, and nasolabial folds or marionette lines are causing you grief, you needn’t rush straight into a facelift. Your board-certified plastic surgeon is the best person to advise what treatments might be best for you.