- Marionette lines are a common and natural sign of aging that appear around the mouth and chin.
- A healthy lifestyle combined with preventative antiaging skin care treatments can help keep marionette lines from forming.
- Cosmetic treatments which range from toxins to fillers can soften the appearance of marionette lines.
As we age, we experience volume loss in the tissues underlying the skin, as well as reduced skin elasticity, which leads to the formation of wrinkles.
While wrinkles and fine lines may be inevitable, the same biological processes that cause these conditions can help to hide and reverse them as well.
What Are Marionette Lines?
To imagine what marionette lines look like, picture a marionette puppet. It has lines that run from the edges of the mouth to the chin so that the puppet’s jaw can open up and down to imitate talking.
Marionette lines look similar on a human face. They are creases or folds that start at the outer corners of the mouth and run down to the outside edges of the chin. In some cases they run straight down while in others they curve outwards.
Marionette lines are very subtle, so much so that it may be impossible to trace the exact line. However, they have a negative impact on the face because they create a shadow between the chin and cheek creating the look of a droopy jowl.
Vertical lines at the corners of the mouth can also make it appear as if you are frowning or scowling even when you’re happy.
People typically begin developing marionette lines in their late 30s or early 40s. In the early stages, marionette lines are barely visible. When they become noticeable is different for everyone and is dependent on race and ethnicity, in addition to other factors.
Marionette lines vs. nasolabial folds
The two are often confused, but they are distinct features of the lower face.
Marionette lines run from the mouth to the chin, while nasolabial folds run from the nose to the outside of the mouth and are commonly known as smile lines.
Both are wrinkles and both have many of the same causes and treatments, yet they are not connected in any way. Having deep lines in one area does not mean deep lines will form in the other.
What Causes Marionette Lines to Form?
Your appearance is a result of many factors, including bone structure, the amount of fat and collagen (an important protein in skin and connective tissue) in your face and your skin type.
Facial volume loss caused by the depletion of collagen means less support for the facial skin, causing it to droop, fold, crease and develop marionette lines and other wrinkles.
All people experience this process to some degree or another. However, certain people develop deep marionette lines for reasons they have little to no control over.
Persistent facial expressions
If you’re someone who frequently purses their lips, it may be creating more wrinkles around the mouth and chin.
How much lip pursing is “too much”? This is difficult to pinpoint, but if you purse your lips habitually or if you smoke (thereby pursing your lips while drawing smoke from the cigarette), you may be at greater risk of developing marionette lines.
Some people are more likely to get marionette lines simply because of genetics. If your parents or grandparents had marionette lines, you may be predisposed to develop them as well, but the complex relationship between genetics and skin quality is still being studied.
The genetic basis of marionette lines means some people will develop these wrinkles despite taking preventative measures. However, despite this genetic predisposition, treatment is still possible.
The same external factors that cause marionette lines also tend to be bad for the skin in general: smoking, stress and sun exposure. All of these factors can cause lasting damage to the skin’s surface and the underlying structure.
Less permanent factors, but still problematic ones are lack of sleep, improper skin care, poor nutrition, and not maintaining proper hydration. Develop smart practices to maintain a healthy lifestyle that focuses on the overall health of your body to contribute to better-looking skin with diminished visible signs of aging.
Marionette Line Treatments
There are multiple antiaging treatment options to restore the volume and elasticity of the skin and reduce signs of aging such as fine lines, wrinkles and folds.
The first step is to determine what type of marionette lines you have – shallow or deep. Both have similar causes and they express themselves in similar ways, however they are treated differently.
Best Treatments for Shallow Marionette Lines
Shallow marionette lines typically appear as fine lines that don’t create much crease or cast a shadow. Treating these lines early is important, as they will otherwise get progressively worse.
Some of the most effective antiaging treatments for facial rejuvenation include:
Botox and other neurotoxin-based brands injected around marionette lines help relax the facial muscles and smooth out the skin. The results from most of these treatments last several months before requiring reinjection.
Injections alone cannot stop the skin from aging, but they can slow down the formation of wrinkles by relaxing the dynamic surfaces of the face.
Topical creams containing Retin-A (retinoids) help promote the production of collagen in the skin. Regularly using a retinoid cream restores facial skin elasticity, smooths out existing wrinkles and prevents them from becoming worse.
Some laser resurfacing treatments remove the damaged outer layers of skin to reveal the smoother, healthier skin underneath. Other types promote collagen production under the skin. Both treatments can diminish the appearance of shallow lines and wrinkles.
This process makes tiny punctures in the skin around the marionette lines. These punctures stimulate collagen production, which heals the skin and softens the look of wrinkles.
During this treatment, a chemical solution is applied to the skin to make it blister and eventually peel off, exposing a fresh layer of skin underneath. Following the chemical peel, the skin will appear smoother and less wrinkled.
The extent of the results depends on the percentage of acid used in the solution. Deeper marionette lines will require a deep chemical peel, which can remove skin cells both from the epidermis and lower layers of the skin.
Best Treatments for Deep Marionette Lines
Deep marionette lines occur after the skin loses significant amounts of fat and collagen, creating a sunken appearance. Since the problem is with the underlying structure of skin rather than the surface, a different type of treatment is necessary:
Facial fillers made from hyaluronic acid (HA) are injected into the area around the marionette lines. They give lift and volume to the areas under these wrinkles, smoothing out deep lines and restoring a youthful appearance to the surface of the skin.
The volume boost from filler products loses effectiveness over time, and not all of them are appropriate for treating marionette lines. While Juvederm, Radiesse and Restylane are generally used to treat marionette lines, you should consult with a professional to determine the most effective filler for your situation.
A facelift is a surgical procedure used to tighten facial skin by repositioning the deep tissues underneath it. In some cases, fillers and fat grafts are used after the surgery to give contour to the restored skin.
Medical advances have turned facelift surgery into a minimally-invasive procedure that requires little downtime, while producing natural-looking results.
How Do I Prevent Marionette Lines?
While avoiding the facial expressions that cause marionette lines may be impossible, there are preventative measures that will ensure they take longer to appear.
Get enough sleep
Sleep is an important factor for multiple physiological processes, including skin regeneration. Chronic poor sleep quality has a negative effect on skin health, and is associated with accelerated intrinsic aging, as well as decreased function of the skin barrier, the outermost layer of the skin’s surface.
Smoking accelerates skin aging, causing wrinkles to form faster than they would naturally.
Apply a high SPF broad-spectrum sunscreen before any amount of sun exposure, not just at the beach. Day-to-day exposure to UV rays may damage the skin in small increments, but it damages it nonetheless, and the results will eventually become visible.
You can apply sunscreen as a standalone product, or use a moisturizer with a sunscreen factor in your daily skin care routine.
Skin care routine
A daily skin care regimen that includes cleansing and moisturizing helps prevent wrinkles from forming by supplying the skin with the vitamins and minerals it needs to preserve elasticity.
Marionette lines are caused by a combination of internal and external factors, as well as genetic predisposition. Although these lines are natural and common, they are avoidable and reversible.
A healthy lifestyle and regular preventative skin care can delay marionette lines from forming and limit their appearance once they do form.
Alternatively, corrective treatments ranging from dermal fillers to toxin injections can minimize the appearance of existing marionette lines by addressing the underlying causes – facial volume loss and diminished skin elasticity.
- Flament, F., Bazin, R., Laquieze, S., Rubert, V., Simonpietri, E., & Piot, B. (2013). Effect of the sun on visible clinical signs of aging in Caucasian skin. Clinical, cosmetic and investigational dermatology, 6, 221–232. doi:10.2147/CCID.S44686
- Wollina U. (2013). Perioral rejuvenation: restoration of attractiveness in aging females by minimally invasive procedures. Clinical interventions in aging, 8, 1149–1155. doi:10.2147/CIA.S48102
- Sood, V., & Nanda, S. (2011). Patient Satisfaction with Hyaluronic Acid Fillers for Improvement of the Nasolabial Folds in Type IV & V Skin. Journal of maxillofacial and oral surgery, 11(1), 78–81. doi:10.1007/s12663-011-0256-3
- Hara, Y. , Hirao, T. and Iwai, I. (2017), Facial expression under stiff stratum corneum leads to strain concentrations, followed by residual wrinkle formation. Int J Cosmet Sci, 39: 66-71. doi:10.1111/ics.12349
- Makrantonaki, E., Bekou, V., & Zouboulis, C. C. (2012). Genetics and skin aging. Dermato-endocrinology, 4(3), 280–284. doi:10.4161/derm.22372
- Small R. (2014) Botulinum toxin injection for facial wrinkles. ncbi.nlm.nih.gov/pubmed/25077722
- Kligman, AM. (1989) Guidelines for the use of topical tretinoin (Retin-A) for photoaged skin. ncbi.nlm.nih.gov/pubmed/2778128
- American Board of Cosmetic Surgery. (n.d.) Skin Resurfacing Guide. americanboardcosmeticsurgery.org/procedure-learning-center/non-surgical/skin-resurfacing-guide/#laser
- Singh, A., & Yadav, S. (2016). Microneedling: Advances and widening horizons. Indian dermatology online journal, 7(4), 244–254. doi:10.4103/2229-5178.185468
- Brandt, F. S., & Cazzaniga, A. (2008). Hyaluronic acid gel fillers in the management of facial aging. Clinical interventions in aging, 3(1), 153–159. ncbi.nlm.nih.gov/pmc/articles/PMC2544360/