Nasolabial Folds, Marionette & Perioral Linesin Islington, London
Effective Treatments for Nasolabial Folds, Marionette & Perioral Lines – Understanding the Problem
In the lower face, the changes that concern people most are rarely just about skin. They're about architecture and are caused by diminished volume, bone remodelled and tissue that has gradually descended through gravity.
The most common mistake in lower face aesthetics is treating the visible symptom such as the fold, the crease, the shadowed line, without addressing the structural shift that created it. This can produce unnatural results with a face that looks obviously filled rather than refreshed.
At Refind, every lower face assessment begins with the whole face, not individual lines in isolation.
What Causes Nasolabial Folds, Marionette & Perioral Lines?
The nasolabial fold progression involves several overlapping processes:
Mid-face fat pad atrophy (wasting) is the primary structural driver. The distinct fat compartments beneath the cheek skin gradually shrink from the mid-thirties. As they deflate, the tissue above loses its scaffolding and descends, compressing at the fold line.
Facial bone remodelling occurs as we age and the maxilla and zygomatic bone gradually recede across a lifetime. This reduces the bony projection that supports overlying tissue and can amplify the effect of fat loss.
Gravitational descent makes the ligaments that tether the cheek to the skeleton stretch and weaken with age. This means the fat pads and skin to descend and compress against the fixed fold structure.
Collagen and elastin decline naturally occurs as we age and this means the skin above the fold becomes less able to remain taut.
Repeated muscle activity of the levator labii and zygomaticus muscles to lift the upper lip and cheek during smiling creates a deepening of the nasolabial fold over time.
Three Distinct Lower Face Concerns
Nasolabial folds (nose-to-mouth lines)
These folds run from the sides of the nose down to the corners of the mouth. They're a natural anatomical feature but present as a subtle crease visible only during smiling in youth. They become a concern when they deepen significantly, become visible at rest, or create a downward pull that changes the overall expression of the face.
Marionette lines
These descend vertically from the corners of the mouth toward the chin and pull the corners of the mouth downward. This makes the face look sad, stern, or displeased, regardless of how the person actually feels.
Perioral lines
The fine vertical lines that radiate above and below the lip border are sometimes called smokers' lines, though they occur in non-smokers too. They're technically challenging to treat, because the perioral area is in near-constant motion and their cause involves both repeated muscle activity and specific structural vulnerabilities of the lip and surrounding skin.
How Nasolabial Folds, Marionette & Perioral Lines are Treated
Why we often treat the cheek, not the fold
A common mistake is that inexperienced practitioners treat nasolabial fold treatment by placing filler directly into the fold. While this can produce short-term softening, it doesn't address the volume loss in the cheek that's driving the fold. This technique can result in an overfilled look, or the folds may return quickly because nothing structural has changed above.
Restoring volume to the mid-face by lifting the tissue from above reduces the tension that creates the fold. This technique produces a result that looks like volume restored rather than a line filled. Where direct treatment of the fold is appropriate, filler can be placed selectively within the fold to blend and soften but the goal is always to soften, never to obliterate. Profhilo can be added into the treatment plan to improve skin hydration.
How marionette lines are treated
Filler to the pre-jowl and mouth corner region restores the structural support the pre-jowl fat pad once provided, reducing the visual depth of the line and improving jawline continuity. A carefully placed small volume at the oral commissure can lift the downward-turned corner directly.
Botulinum toxin to the DAO reduces the downward pull this muscle exerts on the mouth corner. By partially relaxing the DAO, the upward-lifting zygomaticus is less opposed and the mouth corner rests in a more neutral — or slightly lifted — position. Many clients describe looking 'less grumpy' at rest without being able to say exactly what has changed. DAO treatment requires precise anatomical placement, as the muscle lies close to adjacent structures.
Profhilo can be added into the treatment plan to improve skin hydration.
Treatment approaches for perioral lines
Botulinum toxin lip flip is one option. Here very small, precise dose of Botox are placed along the upper lip border. This partially relaxes the muscle's upward pulling, allowing the lip to roll slightly outward. This reduces the pursing contraction that generates perioral lines and gives the impression of modest fullness without adding volume. This requires specific training and dosing is critical as the orbicularis oris is essential for speech and eating, and over-treatment causes difficulty with consonants requiring a firm lip seal. At Refind, this treatment is always conservative.
Lip border and perioral filler can also help. Hyaluronic acid filler is placed at the vermilion border re-establishes a defined lip edge. This provides structural support to the skin immediately above the lip, and can restore some of the projection lost with age. Very soft, low-viscosity products are used in this highly mobile area.
Profhilo and polynucleotides can help with perioral skin quality. This is for clients whose primary concern is texture and quality of the perioral skin. They may be worried about crepiness, dryness, or a parchment-like appearance. In these situations, Profhilo can hydrate and stimulates new collagen and elastin and polynucleotides can activate fibroblasts to help rebuild the thinned perioral dermis.
At-home care for perioral lines
Because this area is in near-constant motion, in-clinic results here are typically shorter-lived than in less active regions. As a result, home care is particularly important:
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Retinol or retinoid applied to the perioral skin (not the lips) gradually improves structural quality above the lip border over three to six months.
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Vitamin C serum supports collagen synthesis — particularly relevant for those with significant UV exposure history.
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Daily broad-spectrum SPF slows photoageing in an area that receives substantial UV exposure and is consistently under-protected.
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A lip balm with SPF protects the vermilion border and maintains lip hydration.
Why the Lower Face Requires Particular Expertise
The inferior and superior labial arteries run within the body of the lips. Inadvertent injection into these vessels can cause vascular occlusion, with the potential for tissue necrosis and permanent disfigurement. The angular artery, running along the nasolabial groove near the nose, connects to the ophthalmic circulation and occlusion here is equally serious.
For botulinum toxin to the lower face, imprecise placement can inadvertently affect adjacent muscles can cause asymmetry of the smile, difficulty with speech, or functional problems with eating.
All lower face treatment at Refind is provided by Dr Dana Sobhanpanah, a GMC-registered doctor with specialist training in lower face anatomy and injectable technique. Every assessment involves a whole-face evaluation, correct product selection, cannula use where this reduces vascular risk, and immediate access to hyaluronidase.
Frequently Asked Questions
Results disclaimer
Results may vary between individuals. All treatments are subject to a consultation to confirm suitability. Refind Aesthetics does not guarantee specific outcomes.
North London Location
Refind Aesthetics is based in North London, conveniently located for clients in Angel, Highbury & Islington, Canonbury, Barnsbury, De Beauvoir, and Clerkenwell. Our clinic is designed to feel calm and welcoming, offering a refined space where patients feel at ease.