Marionette & Nasolabial Line Filler — Education & Injection Safety Framework

Published:

October 30, 2025

1. Purpose & Scope

Provide a defensible, anatomy-led protocol for marionette line and nasolabial fold augmentation using hyaluronic acid (HA) dermal fillers. Aligns with Australian regulatory requirements for non-surgical cosmetic procedures ¹.

2. Anatomy & Vascular Risk Zones

The nasolabial and marionette regions are supplied by branches of the facial artery, including superior and inferior labial arteries, with potential anastomoses to the angular and infraorbital systems. Understanding these vessels and depth planes is critical to minimise intravascular injection risk ² ³.

3. Indications & Patient Selection

Indicated for patients with midface/perioral volume loss, deepened folds, or soft-tissue descent. Contraindications include pregnancy, active infection, significant autoimmune disease, or prior vascular compromise. See jurisdictional safety and patient-suitability guidance ⁴ ⁵.

4. Product Selection & Injection Technique

Use only ARTG-listed HA fillers. Preferred planes are mid to deep dermis or subcutaneous using a cannula (25G or larger). Inject slowly with low pressure and small aliquots; document batch number, lot, sites, and depth. Governance and scheduling requirements apply ³ ⁶.

5. Complications & Escalation Pathway

Potential adverse events include vascular occlusion, infection, nodules/granulomas, and asymmetry. For suspected vascular compromise: stop, massage, warmth, and administer high-dose hyaluronidase (e.g., 1500 IU) according to national guidance; report adverse events as required ¹ ³ ⁷.

6. Aftercare & Follow-up

Avoid strenuous activity and heat exposure for 24–48 hours. Urgent review is required for pain, pallor, livedo, or visual symptoms. Schedule review at 2–4 weeks and maintain governance (audits, outcomes tracking) ⁴ ⁵.

7. Governance & Documentation

Maintain informed consent, pre/post photographs, product records, and complication logs. Ensure AHPRA registration, role-appropriate credentialing, and CPD. Advertising and scheduling restrictions apply to prescription-only products ¹ ⁸.

Sources

Australian Health Practitioner Regulation Agency (AHPRA), Guidelines for registered health practitioners who perform non-surgical cosmetic procedures., viewed 30 October 2025, https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub/Cosmetic-procedure-guidelines.aspx ↩
Medical Board of Australia, Guidelines for registered medical practitioners who perform cosmetic surgery and procedures., viewed 30 October 2025, https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Cosmetic-medical-and-surgical-procedures-guidelines.aspx ↩
Therapeutic Goods Administration (TGA), Things to consider before undergoing procedures involving dermal fillers., viewed 30 October 2025, https://www.tga.gov.au/news/news/things-consider-undergoing-procedures-involving-dermal-fillers ↩
NSW Health, Cosmetic medical and surgical procedures – A National Framework., viewed 30 October 2025, https://www.health.nsw.gov.au/publications/documents/cosmetic-surgery.pdf ↩
ACSQHC, National Model Clinical Governance Framework., viewed 30 October 2025, https://www.safetyandquality.gov.au/publications-and-resources/resource-library/national-model-clinical-governance-framework ↩
RACGP (2025), Standards for General Practices (5th Edition) – Cosmetic procedure guidance, viewed 30 October 2025, https://www.racgp.org.au/running-a-practice/practice-standards/standards-5th-edition ↩
Therapeutic Goods Administration (TGA) (2024), Reporting adverse events for medicines, vaccines and medical devices, viewed 30 October 2025, https://www.tga.gov.au/safety/reporting-problems/reporting-adverse-events ↩
AHPRA (2020), Guidelines for advertising regulated health services, viewed 30 October 2025, https://www.ahpra.gov.au/Resources/Advertising-hub/Advertising-guidelines-and-other-guidance/Advertising-guidelines.aspx ↩

Disclaimer for Newcastle Cosmetic Doctor Policies & Procedures

The policies and procedures contained within this document are the exclusive property of Newcastle Cosmetic Doctor and are provided for internal clinical governance and educational purposes only. These materials represent the internal operational framework, safety standards, and evidence-based protocols developed and implemented by Dr. Bart John Scanlon and the Newcastle Cosmetic Doctor team. They are designed specifically for use within Newcastle Cosmetic Doctor and reflect our clinic’s own professional standards, risk assessments, and compliance obligations under Australian law and regulatory authorities. External individuals, practitioners, or organisations must not copy, reproduce, distribute, or rely upon these materials, in whole or in part, for their own clinical, commercial, or educational use without prior written consent from Newcastle Cosmetic Doctor. These materials do not constitute medical, legal, or professional advice and are not intended to be adopted as official protocols or procedures by any other entity. Any external use or adaptation must be independently reviewed and modified to meet the relevant laws, guidelines, and standards applicable to the user’s own jurisdiction, scope of practice, and facility operations. Newcastle Cosmetic Doctor and Dr. Bart Scanlon accept no liability for any loss, injury, or damage arising from the unauthorised use, reliance upon, or misinterpretation of this material.