Marionette lines are the creases that run down from the corners of the mouth toward the chin. Even when they are shallow, they change how a face reads at rest: the mouth looks turned down, and people may assume you are tired, stern or unhappy when you are not. That is often what bothers people most about them.
They are also easy to treat badly. Marionette lines rarely have a single cause, and a treatment that targets only the crease can leave the area around the mouth looking heavy. The useful question is not how to fill the line, but what is creating it.
What causes marionette lines
Several changes usually work together:
- Volume loss. The fat around the mouth, chin and lower cheek thins with age, and the support beside the corners of the mouth goes with it.
- Descent along the jaw. As skin and supporting tissue loosen, the lower face slides downward. Jowls form along the jawline, and the line from the mouth to the chin sharpens where the moving tissue meets the firmer chin.
- Muscle pull. A small muscle below each corner of the mouth pulls it downward. In some people it is strong enough to deepen the line and the downturned look.
- Skin quality. Thinner skin with less collagen creases more easily and holds a line once it forms.
Genetics, sun exposure, smoking and weight changes all play a part. Weight loss can make the lines more visible by removing volume from the lower face.
Not every line around the mouth is a marionette line
Three different features often get grouped together. Nasolabial folds run from the nose to the corners of the mouth, above them. Smokers lines are fine vertical lines on the lips. Marionette lines run down from the mouth to the chin. Each responds to different treatment, so it is worth knowing which one you are looking at before deciding what to do.
Filler: supporting the area, not just filling the crease
Hyaluronic acid filler is the most common treatment. Used well, it restores some of the support that has been lost beside the corners of the mouth and along the front of the jaw and chin, so the line softens and the mouth looks less turned down.
The common mistake is placing filler only in the crease and adding more each time it reappears. The area beside the mouth moves constantly and should stay relatively slim, so too much filler there can look heavy or puffy and can make a smile look less natural. Often a small amount in the line works best alongside support at the chin or jawline. Jawline filler explains how that structure is restored, and dermal fillers in Beverly Hills covers the products themselves.
Botox for a downturned mouth
When the muscle below the corner of the mouth is pulling it down, a small amount of Botox placed in that muscle can let the corners rise slightly. It does not fill the line, but it can soften the sad look the line creates. Doses are small, because the muscles around the mouth are needed to speak, eat and smile, and too much can make the mouth feel or look stiff. It is usually combined with filler rather than used alone. Botox in Beverly Hills covers how it works elsewhere on the face.
What treatment involves
A consultation comes first, looking at the face at rest, in conversation and when smiling. If injectables are right for you, the skin is cleaned and often numbed, and filler is placed with a fine needle or a blunt cannula. The appointment is usually short. Most people return to normal activities the same day, with some swelling, tenderness or bruising that settles over several days. Conservative amounts, reviewed once the swelling has gone down, give a more natural result than trying to remove the line entirely.
Risks worth knowing about
Bruising and swelling are the most common and usually temporary.
Lumps, unevenness or asymmetry can occur and can often be massaged or corrected.
Over-correction, a heavy look beside the mouth, tends to build up over repeated treatments.
A stiff or uneven smile can follow Botox near the mouth if too much is used or it spreads to a neighbouring muscle. It wears off, but it can take weeks.
Blockage of a blood vessel is rare but serious. Sudden pain, blanching, mottled or darkening skin, or any change in vision after an injection needs immediate medical attention. Hyaluronic acid filler can usually be dissolved with an enzyme called hyaluronidase.
When surgery is the better answer
If the lines are mainly caused by sagging along the jaw, usually with visible jowls, injectables cannot lift what has descended. Adding more filler to compensate tends to make the lower face look heavy. In that case a facelift, which repositions the deeper tissue of the lower face, addresses the cause rather than the shadow it creates. How to get rid of jowls covers that decision, and deep plane facelift explains how the tissue is repositioned. For some people, longer-acting volume from Sculptra or fat transfer is another option.
The short version
Marionette lines usually come from a mix of volume loss, descent along the jaw, muscle pull and skin changes. Filler can soften them, especially when it supports the chin and jawline rather than only filling the crease, and a small amount of Botox can help a downturned mouth. Keep the amounts conservative, choose an experienced injector who assesses the whole lower face, and consider a facelift when sagging along the jaw is the main cause.
Find out what is behind the lines
A consultation looks at whether your marionette lines come from lost volume, muscle pull, skin quality or sagging along the jaw, and whether filler, a small amount of Botox, or surgery is the right answer for you.
Request a ConsultationRelated reading: nasolabial fold filler, jawline filler, smokers lines, how to get rid of jowls, and dermal fillers in Beverly Hills.