What Are Marionette Lines? Causes and Treatment Options

Marionette lines are the lines that run downwards from the corners of the mouth towards the chin. They take their name from their resemblance to the lines on puppets whose jaw moves separately. These lines can make the corners of the mouth look turned down and give the face a tired or sad expression. This article explains why marionette lines form and what the treatment options are.

Why Do Marionette Lines Form?

Several factors play a role in the formation of these lines:

• Volume loss in the lower part of the face and around the mouth with age
• Reduced skin elasticity and the downward shift of the cheek tissues
• The effect of the muscle that pulls the corner of the mouth downwards
• Genetics, sun exposure, smoking and rapid weight loss

Treatment With Filler

The most commonly used method for marionette lines is supporting the volume loss around the corners of the mouth and the chin with fillers containing hyaluronic acid. The procedure is usually performed with an anaesthetic cream or local anaesthesia; some filler materials also contain a local anaesthetic. The filler is placed in small amounts with a fine needle or cannula. Deep lines may not disappear completely, but they can look softer.

Other Options

In some people in whom the effect of the muscle pulling the corner of the mouth downwards is marked, the doctor may consider botulinum toxin to reduce the effect of this muscle, together with filler. If there is marked skin sagging or sagging along the jawline, filler may not be enough; in this case, surgical methods such as a facelift may come into consideration. Treatments aimed at skin quality play only a supporting role. Which method is suitable is decided at the examination.

Recovery and How Long It Lasts

• Swelling, redness and bruising may occur in the first days; these usually decrease within a few days.
• Avoid pressing on or massaging the area.
• Wait for the period recommended by your doctor before intense exercise, saunas and very hot environments.
• The filler is broken down by the body over time, so the result is temporary; how long it lasts depends on the filler used, the amount and the person.

Possible Risks

Swelling, bruising and tenderness are usually temporary. Less commonly, infection, lumps or asymmetry, an allergic reaction and the filler material blocking a blood vessel may occur. With botulinum toxin, temporary asymmetry of the smile or weakness of mouth movements may occur. If increasing pain, whitening or purplish discolouration of the skin is noticed, a doctor should be contacted immediately. For more information, see our face filler and facelift pages.

Author: Op. Dr. Yücel Sarıaltın