How to Get Rid of Marionette Lines

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lines are the vertical that run downward from the corners of the mouth toward the . They’re named after the lines on a puppet’s mouth — and they’re one of the most commonly cited say their face looks "sad" or "tired" even when they’re not.

What’s clinically important: marionette lines are primarily a volume problem, not a problem. The line itself is real, but the cause sits above and around it — in the descended cheek tissue, the loss of jawline structure, and the corner of the mouth that gravity and age produce .

This guide the anatomy, what drives the change, and the treatment options at each stage — from filler to when is .

The anatomy

factors contribute to line formation:

Descended tissue. As the cheek fat thin and with age, weight above the jawline. This tissue forms what we call jowls. The line where descended cheek tissue meets the relatively immobile chin and lower lip area is the marionette line.

Loss of the depressor anguli oris support. The depressor anguli oris (DAO) is a small muscle that runs from the side of the chin upward to the corner of the mouth. Its job is to pull the corner of the mouth down — when it more strongly than the muscles the mouth corner, the result is a permanently mouth.

Loss of bone . The mandible (jawbone) actually changes shape with age — it becomes slightly and less projected. The skin and soft tissue that previously sat on a fuller bony now sit on a smaller one, contributing to descent.

Skin laxity. The skin itself loses elasticity, can no longer recoil over the structure, and develops static creases along the natural lines of .

The implication: just the line itself, in isolation, often doesn’t the result want. The cause of the line involves several different structures, and the that works best the structural context rather than just masking the .

For context on how facial ageing progresses, see our guide on .

What makes marionette lines worse

Volume loss is the primary driver. fat compartment thinning starts in the mid-30s and progresses over decades. Patients who lose weight often notice marionette lines becoming more because the volume loss is .

Sun exposure degrades dermal and elastin, reducing the skin’s to bounce back over the underlying .

Smoking compounds the problem in multiple ways: direct collagen damage, vascular impairment, and the action of smoking adding mechanical wear.

Genetics set how the lines become and how early. Some patients see lines in their early 40s; others develop them only in their 60s.

Repetitive facial expressions — particularly downturning of the mouth (frowning, sadness, concentration) — etch the lines deeper over time.

Sleep position. side-sleeping to line development on the side that presses into the pillow.

Treatment options — by stage

Skincare doesn’t lines but slows their progression and any other you have:

Daily SPF is the single .

Topical retinoids build dermal and improve skin over time.

Vitamin C provides antioxidant .

Stopping smoking matters substantially if you’re a current smoker.

Maintaining stable weight prevents the rapid volume changes that exaggerate marionette lines.

For most patients, is the most effective non-surgical . As with nasolabial folds, the most natural-looking results come from a structural approach rather than just filling the line itself.

Cheek and restoration first. Restoring volume to the mid-face and supporting the lifts the tissue that’s to the line. placed in the lateral and zygomatic cheek areas creates the support that’s been lost.

Mouth corner support. A small amount of filler placed at the corner of the mouth lifts the downturned corner and reduces the "sad" appearance.

Direct line filling — as a secondary step. After the work, any marionette line can be with a small amount of filler placed within the line itself. Often, addressing the cheek and mouth corner first reduces how much direct line filling is needed.

Why the approach is preferred. Filling marionette lines without addressing the tissue above them can produce a heavy, sausage-like below the mouth — the line is filled but the face still looks aged. the structural context produces a far more result.

Filler longevity in this area is typically 9 to 18 months, depending on the product and . The is reversible with if needed.

The is the same one used for — the being that the lower face works as an unit, and it that way produces the most natural results.

have a small but useful role for marionette lines. A small dose into the anguli oris (the muscle pulling the mouth corner down) its activity. With the DAO weakened, the mouth corner to a more neutral or slightly lifted position, which the appearance of the marionette line indirectly.

This is a technically — the dose must be small and the . Too much, and the lower lip function is affected; the wrong placement, and the smile becomes . The should only be performed by injectors familiar with this anatomical area.

AWI for the DAO is usually combined with filler treatment rather than used alone.

For patients whose skin is also a concern, energy-based treatments stimulate and overall texture:

— microneedling reaches deep into the dermis. Particularly useful for the lower face where skin laxity is starting to appear.

— combines four laser modes including an intra-oral pass that delivers heat to the deeper from inside the mouth. Useful for the lower face and jawline.

These don’t replace filler or surgery for marionette lines but the overall context — better skin quality and modest tightening complement the work.

and improve dermal quality from within. Useful as preparation before filler work in patients with poor skin quality, or as maintenance between filler .

For patients with significant tissue descent — jowling, sagging along the jawline, mid-face — surgical treatment is more effective than continuing non-surgical .

repositions the descended SMAS (the deeper structural layer of the face) and tissue. The lifts the descended cheek tissue off the jawline, restores jaw definition, and reduces marionette line . The result is long-lasting — 7 to 12 years before significant recurrence.

on the lower cheek and jawline. Useful for patients with moderate jowling and of the marionette area but not yet enough descent to warrant a full facelift.

is often with facelift because the neck and lower face age together. one without the other can leave a visible .

— the patient’s own fat is harvested from another body area, processed, and into the and mouth corner area. Unlike HA filler, the result is for the that survives transfer ( 50-70%). Often combined with facelift for a more complete result.

A with our team — including — which matches your anatomy.

How to decide which treatment fits

Mild marionette lines, minimal descent: filler with cheek and mouth corner support. Add daily SPF and good .

lines with early jowling: filler combined with AWI to the DAO, plus energy-based skin . Sometimes this is enough; sometimes it’s the stage at which patients start thinking about surgery.

Established lines with visible jowling and mid-face descent: surgical becomes appropriate. Continued work at this stage diminishing and heavy from accumulated filler. The honest answer is that a facelift what filler can’t.

Significant lower-face and neck descent: with neck lift, often with fat .

For most patients in their 40s and 50s, over time the best result — moving through the stages as the underlying anatomy changes.

Cost

Filler treatment is priced per . Most patients need 1 to 2 for cheek/mouth corner work plus a smaller amount for the line itself if after that. Surgical vary substantially. , including 0% APR, are available.

What we don’t recommend

PDO thread lifts. The Centre for does not offer Thread lifts (https://www.theaestheticbox.co.uk). The evidence for sustained benefit is weak, the rate (visible threads, threads, thread extrusion, infection) is higher than alternatives, and the cost is comparable to filler that has more reliable outcomes. seeking a non-surgical lift get better, more consistent results from comprehensive filler treatment.

marionette lines without addressing the cheek. For the discussed above, isolated line treatment often an result. Comprehensive treatment is more expensive in the short term but produces a more and tends to last longer.

Continued filler when surgery is the right answer. who have to the point where lifting would their concerns more effectively sometimes continue filler year after year, with diminishing returns and a unnatural appearance. An honest should this point and recommend surgery when appropriate.

Common questions

The of descended mouth and visible lines produces a face at rest that reads as sad to others — even when the person isn’t feeling that way. The goal is usually to a more neutral at rest, not to make the face look happy. Subtle in mouth corner position is enough to change the .

The change is immediately. Mild swelling for 2 to 5 days . The "final" result is what you see at the 2-week mark.

No — the face returns to whatever state it was in before treatment. Hyalase dissolves only the filler, not your underlying tissue.

It improves them but doesn’t them entirely — some line is anatomical rather than purely age-related, and complete would produce an look. The aim is a youthful balance, not making the face flat.

A useful self-test: lift the skin in front of your ears upward and slightly back with your . If the result is what you’re hoping for, surgery is likely to give you something close. If the result is too dramatic for what you want, is probably the right next step. A provides a more definitive .

Centre for Surgery · · GMC surgeons · · · ·

Medically reviewed by , GMC .

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