Concerns with Marionette Lines - 71

Marionette Lines

Deep, noticeable marionette lines can cause cosmetic problems for both men and women. Marionette lines essentially give a person a permanent frown and can also make them look much older than they actually are. The good news is that there are ways to effectively erase these lines and to prevent them from appearing in the first place, starting with a consultation with a reputable dermatologist or cosmetic surgeon.

The Skinny

Content Reviewed by AEDIT Medical Advisory Board


If you have never heard of marionette lines on the face and are unsure what they are, it is likely you would still be able to recognize them on sight. Marionette lines, also known as puppet lines, are vertical lines that run straight down from the corners of the mouth towards the direction of the chin. For those with deep marionette lines, it is common to seek solutions to reduce or eliminate the appearance of these wrinkles—as they’re generally considered to be an undesirable side effect of the aging process.

This article will go over everything you need to know about marionette lines and why they form in the first place. Continue reading to discover what the initial signs and symptoms are when marionette lines begin to appear, what you can expect when receiving an official diagnosis for marionette lines from a medical professional, existing treatment options, and how to proceed with a cosmetic solution once you are ready to do something about them.


Marionette lines are deep, heavy wrinkles on the face, located below the nasolabial folds, starting at the corners of the mouth and running in a downward direction as far as the outer corners of the chin or the jawline. When people get older, we begin to experience depletion of skin tissue and facial volume loss that often results in deep creases around the mouth area. Aging is the primary reason why most people get marionette lines and is a natural reaction to the loss of collagen and hyaluronic acids within the skin.

However, there are some lifestyle habits and also varying genetic factors that can cause a person to have a predisposition for marionette lines. If older family members have marionette lines or are prone to early or otherwise significant wrinkling around the mouth, then you may be more likely to develop marionette lines than others. Also, people with very pronounced and animated facial expressions or movements, and those that smoke or have spent excessive amounts of time in the sun are generally at a greater risk for developing marionette lines due to the harsh side effects that these lifestyle habits have on the skin.

While some treatments and procedures can help to reduce and eliminate marionette lines after they’ve already developed, doing what you can to prevent them or to reduce their eventual appearance before they form is important. Knowing which signs and symptoms to watch out for can help you improve your skin and avoid or prolong the appearance of marionette lines before they’re a problem.

The Specifics

The Signs and Symptoms of Marionette Lines

Most patients experience signs and symptoms of aging skin, which will often prompt them to visit their dermatologist for treatment or advice. Paying attention to changes in the skin will help you to stay ahead of your skin’s natural tendency to develop problems like marionette lines, and will help your dermatologist decide how to proceed with the treatment of the issues you’re experiencing with your skin.

This is true for marionette lines as well. Deep grooves and wrinkles can have numerous causes, and these symptoms usually become apparent as we age. Once people are in their 40’s and older, the lines begin to appear or become even more intense or visible. However, premature marionette lines can occur in people much younger than 40 who have skin damage due to excessive sun exposure, or for those that smoke, drink, or do drugs.

These are some other early signs that can help you tell if you might already have or are developing marionette lines:

  • 40 years of age or older
  • Changes in your skin tone and its overall condition
  • Dry skin on the face and around the corners of the mouth
  • Reduced skin elasticity or looser, droopy skin and jowls
  • Frequently asked why you look angry or sad even when you are not
  • Faint, barely visible lines running down from the corners of the mouth

If you are experiencing these signs and symptoms, it may be time to consult a board-certified dermatologist or plastic surgeon for diagnosis and treatment.

The Diagnosis of Melomental Folds

Marionette lines have a distinct visual appearance, which helps in achieving a correct diagnosis for most patients. However, the official diagnosis of skin issues including marionette lines should be made by a qualified doctor or plastic surgeon. Potential patients should consult a dermatologist or plastic surgery specialist for their options. Your doctor will determine how far the aging process has progressed, how deep and severe your marionette lines are, and will also discuss your options to find the right treatment for you.

One way that a patient and doctor will determine the severity of marionette lines is to use the 5‐point photonumeric scale, which is a grading scale designed to objectively measure the severity of the melomental folds.

Choosing the Right Treatment Option for You

When it comes to choosing the right treatment options, the first step is to identify exactly what your goals are. Some treatment options are designed for the earlier stages of marionette lines, while others are for patients with more serious and advanced cases of melomental folds. Matching up the treatment to your actual needs and goals can mean the difference between a successful treatment and a failed one.

When evaluating your case for treatment, your medical professional will consider your aesthetic goals, any specific health concerns, complications (like allergies), and other needs into account when determining the right treatment for you. We have provided an overview of the most popular options for reducing/eliminating marionette lines below for your review.

Face Lift Surgery: One of the most well-known cosmetic procedures, as well as one of the most popular in the United States, is the facelift procedure. A facelift is an invasive surgery designed to treat advanced signs of aging, including marionette lines, crow’s feet, sagging skin, and other skin aging symptoms. Facelifts are frequently performed along with brow lifts, eyelid surgery, neck lifts, and other cosmetic treatments to dramatically improve the appearance of aging skin.

Dermal Fillers: By the method of injection, injectable facial fillers like Restylane®, Radiesse®, or Juvederm® plump up skin in areas that have experienced a loss of volume. As a result, wrinkles are reduced or eliminated, paving the way for smoother and younger looking skin.

Botox®: Botox® is a derivative of botulinum toxin type A. This option is used for both cosmetic and medical reasons, although it is more likely known for its aesthetic uses in preventing wrinkled, aging skin in the upper face. While Botox® alone is not likely to be a suitable treatment for marionette lines, some studies have shown that a combination of Botox and other injectables (hyaluronic dermal acid and synthetic deoxycholic acid fillers) can work as a safe, effective treatment and less-invasive alternative to cosmetic surgical procedures.

Laser Resurfacing: Laser resurfacing is a relatively new and increasingly popular treatment for rejuvenating wrinkled and aging skin. This technique uses an ablative or non-ablative laser tool depending on the severity of the marionette lines and other skin issues being resolved. For deeper lines, an ablative laser tool is used, while a non-ablative laser tool is used to eliminate or reduce minor flaws. For both techniques, the laser works to remove the damaged skin layer by layer, to reveal new, younger skin cells beneath. This method also improves collagen production and encourages a general improvement in the health of the skin over time.

Light Therapy: Light therapy is a non-invasive treatment used to treat various skin conditions through the use of differently colored wavelengths of an LED light. This treatment is used as a supplement to enhance the effectiveness of other techniques and should not be used as a standalone treatment. The effectiveness of light therapy will also depend on the color used in treatment, which will most likely involve red LED light therapy (which is the option that penetrates the skin the deepest, while promoting new cell regeneration).

Chemical Peels: Designed to improve the skin’s appearance, a chemical peel is a resurfacing technique used to remove damaged layers of the skin. This procedure is performed by applying a solution to the patient’s face, which causes light, medium, or deep exfoliation depending on the severity of the marionette lines. Once the exfoliation is complete, the solution and exfoliated skin are sloughed away. The exfoliation process encourages cell turnover which creates younger and smoother skin.

Microneedling: Microneedling, also known as collagen induction therapy, is a technique used to treat very fine wrinkles, scars, large pores, and to promote smoother and healthier looking skin. In microneedling, the patient’s skin is repeatedly punctured with a fine needle. This process helps to generate new skin cells and encourage collagen growth, plumping up deep wrinkles and reducing fine marionette lines.


Skincare: The best treatment is preventative treatment. It is a lot easier for the body to protect against something than to recover after the condition has happened. Some of the best skin care options for prevention involve a proper skin care regimen and makeup removal routine that is catered to your skin type. The earlier you start your skincare routine, the better protected you are against marionette lines.

Keep in mind that anti-aging creams, face washes, and other skin care treatments are used for prevention and validation purposes only. Once you have developed marionette lines, taking care of your skin or using anti-aging products will not be enough. However, continuing your skincare routine can help stave off additional wrinkling when combined with proper restorative procedures like the ones mentioned previously.

Facial Exercises: Exercises like “facial yoga” and other programs have recently become popular for preventing or delaying the aging process. In theory, these exercises can be used to help keep the skin firm and taut, and to prevent the sagging jowls and loose skin that can cause marionette lines to form or worsen. In reality, the effectiveness of facial yoga and other facial anti-aging exercises has not yet been proven in studies. Still, many people that use these systems regularly claim to achieve dramatic results after practicing these low-risk programs.

One clear thing is that the earlier you start your prevention the better your chances. Some exercises you can do are face and neck stretches, jaw strengthening, and other movements designed to strengthen and tone the facial muscles. Remember, that results are not guaranteed, and so far only show signs of helping with prevention—not restoration.

The Takeaway


For those with marionette lines, there are many treatment options to consider that can significantly reduce or eliminate these wrinkles for a more attractive, younger-looking appearance. From laser resurfacing and chemical peels to light therapy and fillers, there are many types of procedures and combinations of procedures that can help you dramatically improve your skin and relieve you of the symptoms of melomental folds.

However, seeing a qualified board-certified doctor is crucial to your success. Only a cosmetic surgeon or dermatologist is qualified to evaluate your marionette lines and other issues and to determine the proper route to take to improve your skin’s appearance and overall health. A reputable doctor will be able to handle all aspects of your treatment from the official diagnosis of your skin’s condition to the procedure itself, as well as any follow-up visits or other treatments necessary to achieve your short-term and long-term skin goals.

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AEDIT uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. American Academy of Dermatology Many Ways to Firm Sagging Skin
  2. The American Board of Cosmetic Surgery Skin Tightening
  3. Uwe Wollina Treatment of Facial Skin Laxity by a New Monopolar Radiofrequency Device


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