Hi, Dr Murray here. Marionette lines are the two lines that run down from the corners of your mouth toward your chin, and they’re one of the things I often get asked about in consultations. People notice them, they don’t love them, and they want to know what actually can be done to address them so let’s go through it properly.
What Are Marionette Lines?
Marionette lines, sometimes called puppet lines, are the vertical folds that run from the corners of the mouth down toward the jawline, and they’re caused by volume loss and skin laxity in the lower face rather than by any single muscle acting on its own. The name comes from the resemblance to the hinged mouth lines on a puppet or marionette doll. They tend to sit alongside, and interact with, the nasolabial folds above them and the pre-jowl sulcus just below, which is why I never look at them in isolation.
Why Do Marionette Lines Form?
Marionette lines form mainly because of volume loss in the deeper fat compartments of the face combined with a downward pull from the muscle around the mouth. As we age, we lose fat and bone support in the mid and lower face, the skin loses elasticity, and gravity does the rest. On top of that, the muscle that pulls the corners of the mouth down, the DAO, keeps working away at full strength the whole time, and that constant pull deepens the crease further. It’s a combination problem, not a one-cause problem, which is exactly why a one-technique fix rarely gives a good result.
How Do You Know If You’ve Got Marionette Lines Forming?
You’ll usually notice marionette lines first as a shadow or crease at rest, even when your face isn’t moving. Early on it might just show up in photos or under certain lighting. As it progresses, you’ll get an actual fold that stays visible when you’re not smiling or talking, and some people also notice a slightly downturned look at the corners of the mouth, like the face has settled into a sadder or sterner expression than they actually feel. If you’re seeing that in the mirror or in photos more than you used to, that’s your cue to get it assessed rather than wait, if it’s something that is bothering you.
Can You Prevent Marionette Lines?
You can’t stop marionette lines from forming altogether, but you can slow them down. Good sun protection, not smoking, and keeping your skin’s collagen in reasonable shape all help delay the volume and elasticity loss that drives this. Realistically though, most people are dealing with some degree of established lines by the time they come to see me, so prevention is only part of the conversation, and treatment is where most of my time goes.
What Are the Treatment Options for Marionette Lines?
The right treatment for marionette lines depends on how much volume loss and skin laxity is involved, and I generally work from the least invasive option up.
Anti-wrinkle injections. In milder cases, or as part of a combination approach, a small amount of anti-wrinkle injection into the DAO reduces the strength of that downward pull, which on its own gives some lift at the corner of the mouth. It won’t fill the line, but it takes some of the tension off it.
Dermal filler, done with technique. This is where most of the correction happens for most people, and technique matters more than product here. The way I approach it is a fanning technique, entering a little to the outside of the line first, feeding into the line, then continuing a little further inside past it. Going in just on the inside edge of the line on its own tends to push the line further out rather than soften it, so the placement really does matter. I’ll often also treat the pre-jowl sulcus, the little hollow just below and to the side of the marionette line along the jaw, because supporting that area gives additional lift rather than just filling the crease in isolation. Combining careful filler placement with anti-wrinkle injection into the DAO tends to give a more natural result than treating the line as a single flat area to fill.
Fat transfer. For more established volume loss, using your own fat rather than filler can give longer-lasting correction, and it pairs particularly well with this same fanning approach to the marionette lines, nasolabial folds and pre-jowl sulcus. You can read more about how we approach fat transfer to the cheeks and lower face or explore our dermal filler treatments more generally.
Surgical options. Where skin laxity is the dominant issue rather than volume loss, a mini face lift or submental plication addresses the loose skin directly, which injectables alone can’t do. This is usually a later step, once non-surgical options have been tried or aren’t going to be enough on their own.
Frequently Asked Questions
What causes marionette lines?
Marionette lines are caused by a combination of volume loss in the lower face, reduced skin elasticity, and the ongoing pull of the DAO muscle at the corner of the mouth.
Can dermal filler make marionette lines worse?
Poorly placed filler can push the line further out rather than soften it, which is why the technique and entry point matter as much as the product used.
Do anti-wrinkle injections address marionette lines on their own?
Not fully. Anti-wrinkle injections reduce the downward pull of the DAO and give some lift, but they don’t restore lost volume, so they work best alongside filler or fat transfer for established lines.
How long does filler for marionette lines last?
Longevity varies by individual and by product, but most patients need a top-up treatment to maintain results over time.
Is surgery ever needed for marionette lines?
Yes, in cases where skin laxity rather than volume loss is the main driver, a mini face lift or submental application may give a better result than injectables alone.
Can marionette lines be prevented?
Not entirely, but sun protection, not smoking, and supporting your skin’s collagen can slow their progression.
If you’re noticing marionette lines forming and want an honest assessment of what will actually help in your case, get in touch with our team for a consultation.
General disclaimer: All cosmetic treatments carry potential risks, including bruising, swelling and, rarely, more significant complications. Individual results vary depending on factors including anatomy, skin quality, age and overall health. This information is general in nature and does not constitute medical advice or establish a doctor-patient relationship. A consultation with a qualified practitioner is required to determine your suitability for any treatment discussed.