Marionette lines are the lines that extend from the corner of the mouth downwards. They’re not to be confused with nasolabial folds, which are the lines from the bottom of the nose to the corner of the mouth – although it is common for both to develop at around the same time. Marionette lines are an extremely common concern that can profoundly impact confidence and self-esteem. I see many men and women presenting with this concern, and they feel it makes them appear tired and sad, even if that’s not how they’re feeling on the inside. Thankfully, marionette lines can be significantly improved with the right treatment approach. Read on for everything you need to know.

What are marionette lines?

As we age, the collagen production in our skin cells naturally starts to reduce, and our skin loses elasticity. The skin around the sides of your mouth is thinner than most other areas of your face, so you may notice deep lines and shadows running down the sides of your mouth, either side of your chin – these are marionette lines. They get their name because if you imagine a wooden puppet or ventriloquist’s dummy, those are the lines where the mouth block would drop when it is ‘talking’.

What causes marionette lines?

Marionette lines develop due to various factors including gravity, volume loss and declining collagen levels. The face contains many fatty layers deep under the skin. When we’re young, these layers are in well-defined areas and give the face its youthful shape and curvature. Over time, however, these layers tend to decrease in volume or atrophy. As well as this, our face also loses bone, and without the structural support of the bone, there are noticeable changes in the other layers of overlying soft tissue and skin, leading to these ageing signs.

Another cause is when the depressor muscles of your mouth corners are constantly activated. When the depressor anguli oris (DAO) muscle is constantly activated, it creates a ‘sad face’ look over time. Many people use this muscle unintentionally, causing their mouth corners to pull down.

What are the best treatments for marionette lines?


Rather than injecting directly into the line, which can often look unnatural and overfilled, we see betters results by restoring the structure and support which has been lost over time. When the jawline shape is improved and contoured, and volume is restored in the midface, it will help to soften the appearance of the folds by improving the condition of the area and giving the face the supportive structure that it needs. We can also inject the lips to create a more upturned mouth corner.


Botox works differently to fillers. Rather than adding volume and definition, it blocks the nerve signals that lead to muscle contraction. We have a muscle at the corner of the mouth, which is responsible for causing the downturn of the mouth and a sad or dissatisfied expression. When Botox is delivered into this muscle, it will help reduce the activity, which causes the lip elevators (the muscles responsible for curing the lip upwards) to work harder, creating a subtle lift.

Non-Surgical Skin Tightening

My favourite skin-tightening devices are Profound RF and Sofwave. Both offer a safe and effective solution to lift and tighten skin sagging and deep lines and folds. Known as the ‘non-surgical face lift’, Profound RF is a microneedling radiofrequency treatment that tightens, smoothens, hydrates and melts fat. I use it to treat the skin on the lower face and neck, as well as smoothing marionette lines, it can also tighten jowls, firm the neck and destroy stubborn under-the-chin fat. Sofwave also works to tighten and lift the skin, except it uses ultrasound waves to fill wrinkles from the inside out by increasing collagen stores.

The best treatment for you will depend on how deep your marionette lines are, and often, a combination approach is required for the best results.

If you’d like to discuss the treatment options available, click here to enquire or book a consultation.