Marionette lines conjure images of puppets. It is an unfortunate term for those folds running from the outer corners of the mouth to their respective sides of the chin. Add downward turned mouth corners to the situation, and it becomes a sad looking one. Of course, there are treatments to quickly improve the appearance of marionettes.

Causes and Treatments

Marionettes are a result of the general facial aging process: volume loss and loss of structural support from shrinking facial fat pads, bone and mineral loss (particularly the bony resorption of the mandible), decrease in collagen and elastin production and hormonal changes that thin and weaken skin. Movement, genetics and bad habits also contribute to development and severity of marionettes.

In regards to movement, a lifetime of opening and closing our mouths with smiling, laughing, frowning, talking, eating, kissing, singing, cheering keeps the depressor anguli oris (DAO) muscles perpetually activated. DAO muscles control mouth corners, pulling them downward with the everyday actions of our mouths and lower faces. Weakening the DAO’s with a little Botox relaxes them and lifts mouth corners.

In regards to movement, a lifetime of opening and closing our mouths with smiling, laughing, frowning, talking, eating, kissing, singing, cheering keeps the depressor anguli oris (DAO) muscles perpetually activated. DAO muscles control mouth corners, pulling them downward with the everyday actions of our mouths and lower faces. Weakening the DAO’s with a little Botox relaxes them and lifts mouth corners.

In regards to lifestyle, bad habits like smoking and foregoing sunscreen take their toll on skin visibly and at cellular levels. Both weaken skin on every level as they cause oxidative stress, inflammation, the breakdown of collagen and elastin and your body’s ability to produce them. Wearing sunscreen everyday and not smoking are significant ways to show your skin a little love, keeping skin strong, bouncy, smooth and tight.

Other lifestyle habits that help keep skin strong, resilient and smooth include getting enough sleep, staying hydrated, eating well, exercising and using effective skin care products (particularly, potent antioxidants and retinoids).  Reminder: It is never too late to start good habits and use good products.

As for genetics, well, you can blame your parents.

Besides lifestyle tweaks and changes, the right products and a bit of Botox in the DAO’s, other treatments to address and improve marionettes include:

Dermal Fillers

Judicious use of dermal fillers can improve marionettes. Generally, improving mouth corners and jawline contours with fillers is enough to alleviate the appearance of marionettes.

While some filler injected directly into marionette creases can help the issue, too much can distort the overall face shape. Over-filling or continuously addressing marionette creases with fillers eventually make faces look bottom heavy and flat. A full lower face is quite the opposite of the desired goals of an attractive face: full, lifted cheeks and a sharp, angular jawline. 

Secret RF

Secret RF combines radiofrequency with microneedling to tighten and smooth skin. The microneedles work as conduits to carry RF energy deep into the skin layers, deeper than basically any other laer can go. It is in the deepest layers that collagen and elastin are produced and tissue is regenerated. Heating up these layers with controlled energy kicks production into high gear, tightening and remodeling skin.

truSculpt 3D 

truSculpt 3D uses radiofrequency to reduce fat and tighten skin. Oftentimes, reducing jowls and skin tightening can help reduce marionette creases.

Surgical Facelift

For deep marionettes, a lower facelift may be the only option. Brutal as it may be, we’ll give you the truth.