Nasolabial & Marionette Lines Treatment in London

Nasolabial folds — the lines running from the nose to the corners of the mouth — and marionette lines — the grooves extending from the mouth corners down toward the chin — are among the most common concerns in facial ageing. These creases deepen as midface volume diminishes, skin laxity increases, and the fat pads that once supported the cheek descend under gravity. The result is an appearance of tiredness, sadness, or premature ageing that often does not reflect how a person actually feels.

If you are researching how to reduce nasolabial folds, the evidence supports hyaluronic acid (HA) dermal fillers as a safe, effective, and reversible approach. At PRP London Clinic, our GMC-registered doctors use a combination of direct fold correction and strategic midface volumisation to address the cause — not merely disguise the symptom. Whether you need targeted nasolabial filler london treatment for early smile lines or a comprehensive approach combining fold, cheek, and oral commissure correction, every plan is tailored to your anatomy following a structured facial assessment.

We treat from 33 Cavendish Square, London W1G 0PW — in the heart of the Harley Street medical district — using premium HA fillers including Juvéderm Volift and Restylane Defyne via micro-cannula for maximum safety in this vascular zone. Our approach is rooted in the published clinical evidence, and all patients receive a complimentary two-week review to assess results and refine if needed. For an overview of all our injectable treatments, visit our dermal fillers hub.

Every nasolabial fold filler and marionette lines treatment at PRP London Clinic is performed exclusively by GMC-registered doctors at 33 Cavendish Square, London W1G 0PW. Our medical team includes Dr Bruno Amendola (GMC: 4346629), an internationally recognised aesthetic physician with an international postgraduate qualification in aesthetic medicine and over 25 years of clinical experience, who developed our micro-cannula safety protocol for the nasolabial region; Dr Mohamed Nafei (GMC: 7520509), whose postgraduate training in aesthetic medicine and endocrinology informs a holistic understanding of midface volume loss and facial proportioning; Dr Reem Nouri (GMC: 6149512), who combines nearly 20 years of medical experience with advanced aesthetic training for precise, natural-looking nasolabial and perioral rejuvenation; and Dr Mohammad Akbar (GMC: 5206673), our Founder and Medical Director, a Fellow of the Royal College of Surgeons of Edinburgh whose surgical background ensures the highest clinical governance standards across every treatment we deliver.

Real patient results from nasolabial fold and marionette lines correction at PRP London Clinic. All photographs are taken under standardised clinical conditions with informed patient consent.

Understanding why nasolabial folds and marionette lines develop is essential to treating them effectively. These creases are not simply skin wrinkles — they are the visible consequence of structural changes occurring across multiple tissue layers in the midface and lower face.

Nasolabial Folds: Midface Volume Loss and Fat Pad Descent

The nasolabial fold marks the boundary between the cheek and the upper lip. In youth, the malar fat pad sits high on the cheekbone, providing a smooth convexity that transitions seamlessly into the upper lip. With ageing, several processes converge to deepen this fold:

• Malar fat pad descent — the deep and superficial fat compartments of the cheek migrate inferiorly under gravity, compressing tissue along the nasolabial crease.
• Midface bone resorption — the maxilla loses volume with age, reducing the skeletal scaffolding that supports the overlying soft tissue.
• Skin laxity — collagen and elastin degradation reduces the skin's ability to resist gravitational forces, allowing folds to deepen.

A systematic review and meta-analysis of randomised clinical trials by Stefura et al. (2021) demonstrated that tissue fillers achieve sustained improvement for nasolabial folds. The pooled Wrinkle Severity Rating Scale (WSRS) score improved from 3.23 at baseline to 1.79 at one month and 2.02 at six months, confirming that HA fillers deliver clinically meaningful correction that persists over time. Global Aesthetic Improvement Scale (GAIS) scores confirmed the aesthetic improvement was sustained at 12 months.

Marionette Lines: Oral Commissure Descent

Marionette lines form when the oral commissure (mouth corner) descends, creating grooves that run from the corners of the mouth toward the jawline. The key anatomical driver is the depressor anguli oris (DAO) muscle, which pulls the mouth corners downward. Combined with volume loss in the lower cheek and pre-jowl region, this creates the characteristic 'sad' or 'angry' resting expression that many patients wish to correct.

Direct Injection vs Midface Volumisation

There are two complementary approaches to treating these folds. Direct fold injection places filler immediately beneath the crease to physically lift and soften the line. Midface volumisation addresses the root cause by restoring cheek volume to re-support the descended fat pads. El-Mesidy et al. (2020) demonstrated that nasolabial fold correction can be achieved through midface volume restoration alone — confirming the value of an indirect approach that targets the cause rather than merely filling the symptom. At PRP London Clinic, our doctors frequently combine both strategies for optimal, natural-looking results.

The nasolabial region contains the angular artery — a terminal branch of the facial artery — making injection safety a primary concern. Our Clinical Board selects both the filler product and injection technique based on each patient's anatomy, fold depth, and treatment goals.

Cannula vs Needle: Safety in the Nasolabial Zone

• Micro-cannula (25G blunt-tip) — The preferred approach for the majority of nasolabial and marionette line cases. The blunt tip navigates around the angular artery and its branches rather than through them, significantly reducing the risk of intravascular injection. A single entry point also minimises bruising and allows smooth, linear filler placement along the length of the fold.
• Needle (27G sharp-tip) — Used selectively for precise point correction, particularly at the oral commissure or for small, localised depressions that require targeted bolus placement.

Product Selection

• Juvéderm Volift (Allergan) — A medium-density HA filler with Vycross technology, ideal for direct nasolabial fold correction. Provides smooth, natural integration with surrounding tissue and longevity of 12–15 months.
• Juvéderm Voluma (Allergan) — A higher-density HA filler designed for deep structural support. Used for midface volumisation to restore cheek projection and indirectly lift the nasolabial fold from above.
• Restylane Defyne (Galderma) — XpresHAn Technology provides flexible support with natural movement. An excellent choice for the nasolabial fold in patients who require correction that adapts to dynamic facial expression.
• Restylane Volyme (Galderma) — Designed for deep volume restoration in the midface and cheek, supporting the indirect approach to nasolabial fold correction.

Typical Volumes

Volume requirements vary significantly depending on fold depth, skin quality, and whether the treatment is a first session or maintenance. A general guide:

• Mild nasolabial folds: 0.5–1ml per side
• Moderate to deep folds: 1–1.5ml per side (direct) plus 0.5–1ml per side (midface support)
• Marionette lines: 0.5–1ml per side
• Combined nasolabial + marionette + midface: 3–5ml total across all zones

Your doctor will recommend the appropriate volume during your consultation — we never apply a one-size-fits-all approach.

Our doctors follow a structured clinical protocol to ensure consistent, safe, and predictable results for every patient.

We receive a significant number of patients seeking correction of unsatisfactory nasolabial fold or marionette line filler performed at other clinics. The nasolabial region is frequently over-treated, leading to an unnatural, puffy appearance that adds volume where subtlety is required. Common issues we assess and treat include:

• Overfilled nasolabial folds: Excessive product creating a flattened or swollen appearance in the mid-face, obliterating the natural shadow between cheek and lip.
• Asymmetry: Uneven fold correction resulting in one side appearing deeper or more prominent than the other.
• Tyndall effect: A blue-grey discolouration visible through the skin when filler has been placed too superficially — particularly common in the thin skin of the nasolabial fold.
• Pillow face: Excessive filler volume across multiple facial zones that creates an unnaturally convex, inflated midface.

Our Correction Protocol

Revision cases begin with a thorough assessment, including palpation mapping to identify the volume and distribution of existing filler. Where dissolution is appropriate, we use Hyaluronidase (Hyalase) — an enzyme that selectively breaks down hyaluronic acid — to remove or reduce misplaced product. Patients are typically reviewed at 2 weeks, after which retreatment with correctly placed filler can be planned if desired. Our doctors' extensive experience with nasolabial anatomy means they understand not only how to correct the fold, but how to avoid the complications that brought you to seek revision in the first place.

Several approaches exist for addressing nasolabial folds and marionette lines. The table below compares the most common options to help you understand which may be most appropriate for your concerns.

Nasolabial fold filler cost at PRP London Clinic depends on the volume of product required and the complexity of your treatment plan. Factors that influence pricing include:

• Fold depth: Mild smile lines may require 1ml total, while deep nasolabial folds with marionette lines typically require 2–4ml across multiple zones.
• Treatment approach: Direct fold correction alone costs less than a combined protocol that includes midface volumisation for structural support.
• Product selection: Premium HA fillers such as Juvéderm Volift and Restylane Defyne are specifically selected for this region based on your anatomy and goals.

Treatment starts from £450. All plans include a comprehensive consultation, the procedure itself, and a complimentary two-week review to assess results and make any necessary adjustments. Current pricing is available on our pricing page.

The nasolabial region is one of the most vascular zones in facial aesthetics. The angular artery — a direct continuation of the facial artery — runs alongside the nasolabial fold and anastomoses with branches of the ophthalmic artery. Inadvertent intravascular injection in this zone can have serious consequences, including skin necrosis or, in extremely rare cases, visual impairment. This is why we consider nasolabial filler a procedure that demands genuine anatomical expertise and strict safety protocols.

A systematic review by Kyriazidis et al. (2024), analysing 48 high-level evidence studies, confirmed that HA fillers are generally safe with most adverse events being transient and mild to moderate. However, the review emphasised that the safety profile is technique-dependent — reinforcing why practitioner skill and anatomical knowledge are the most important safety factors.

Our safety measures include:

• Micro-cannula protocol: Blunt-tip cannula technique navigates around the angular artery and its branches rather than through them, dramatically reducing the risk of intravascular injection.
• Aspiration testing: Where needle technique is used for precision point correction, aspiration is performed before each bolus to check for intravascular placement.
• Slow injection technique: Filler is delivered in controlled, small-volume increments with continuous tissue observation for early signs of vascular compromise (blanching, pain, colour change).
• Emergency preparedness: All treatment rooms at 33 Cavendish Square are equipped with Hyaluronidase for immediate vascular rescue, along with a comprehensive medical emergency kit.

Our doctors' combined experience across thousands of nasolabial and perioral treatments ensures both the anatomical expertise to deliver safe results and the clinical training to manage complications immediately should they arise.

First 24–48 Hours

• Avoid touching, rubbing, or massaging the treated area
• Do not apply makeup to injection or cannula entry sites for 12 hours
• Avoid strenuous exercise, saunas, steam rooms, and hot baths
• Limit alcohol consumption to reduce bruising risk
• Sleep on your back if possible for the first two nights
• Apply cold compresses gently if swelling is uncomfortable (avoid direct pressure on filler)

First Two Weeks

• Results settle over 7–14 days as swelling subsides and the filler integrates with surrounding tissue
• Avoid dental procedures for 2 weeks
• Do not have facials or facial massage for 2 weeks
• Attend your scheduled two-week review appointment
• Contact the clinic immediately if you experience unusual pain, prolonged blanching, significant colour change, or visual disturbance

Your doctor will provide written aftercare instructions specific to your treatment at the time of your appointment.

Your suitability for nasolabial fold treatment is determined during your medical consultation. The following conditions are contraindications:

• Known hypersensitivity to hyaluronic acid, lidocaine, or any filler excipient
• Active skin infection or inflammation at the proposed injection site
• Pregnancy or breastfeeding — treatment is not administered during pregnancy or lactation
• Bleeding disorders or current anticoagulant therapy (discussed on a case-by-case basis)
• Previous permanent filler in the nasolabial or marionette region (silicone, PMMA) — increases complication risk
• Active herpes simplex (cold sores) at or near the treatment site
• Autoimmune connective tissue disorders (relative contraindication — requires medical review)
• Unrealistic expectations about achievable outcomes that cannot be managed through consultation

If you are unsure whether any of these apply to you, your consulting doctor will review your full medical history and advise accordingly.

This page is intended for informational and educational purposes only. The content does not constitute medical advice, diagnosis, or a recommendation for any specific treatment. Dermal filler treatments involve the injection of prescription-grade medical devices and can only be administered following a face-to-face medical assessment. Individual results vary based on anatomy, skin quality, fold depth, and baseline proportions. While hyaluronic acid fillers are considered safe when administered by trained professionals, all injectable treatments carry inherent risks including bruising, swelling, infection, asymmetry, and rare but serious vascular complications. A professional consultation is required to determine suitability. All before-and-after photographs represent individual results and should not be interpreted as a guarantee of outcome. This content was last reviewed on 2 April 2026 by the medical team at PRP London Clinic.

PRP London Clinic is located at 33 Cavendish Square, London W1G 0PW — in the heart of the Harley Street medical district. Our clinic is a short walk from Oxford Circus (Central, Victoria, and Bakerloo lines), Bond Street (Central and Jubilee lines), and Regent's Park (Bakerloo line). Whether you are searching for a specialist nasolabial fold filler london clinic or expert marionette lines treatment london with GMC-registered doctors, our medical team is here to provide a thorough consultation and personalised treatment plan.

Whether you are concerned about deepening nasolabial folds, downturned mouth corners, or visible marionette lines, our GMC-registered doctors are here to guide you through every step. Book a consultation at PRP London Clinic and discover what medically led nasolabial fold treatment and marionette lines correction can achieve for your facial harmony.