Marionette Lines

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Marionette Lines

Marionette lines start at the corner of the mouth and extend downwards and outwards towards the jaw.

Initially they may just affect the area around the corner of the mouth but over time the extend downwards and form jowls along the jawline.

They are called marionette lines in reference to puppets that have a separate mouth to the rest of the face, which gives the appearance of a crease running down from the corner of the mouth.

Marionette lines form due to volume loss in the area and often people are genetically predisposed to developing them. Volume loss in the mid face can exacerbate this problem as the mid face is partially responsible for support in the lower face. As volume in this area depletes the corners of the mouth tend to fall downwards creating an appearance of sadness or disapproval. This is often referred to as a "mouth frown".

In addition, some people have a strong muscle joining the corner of the mouth to the jaw and this can exacerbate the mouth frown.


Generally dermal fillers are used to treat marionette lines. These substances replace volume loss that occur as we age.

It is important not to over correct marionette lines as this can lead to an unnatural puffy appearance. Furthermore, the skilled injector realises that facial shape and proportion is crucial to achieving a natural, youthful look and it is important not to overfill the lower face as this can increase facial squareness. Facial squareness creates an aged appearance as opposed to the more youthful triangular shape with a wide midface and a narrower lower face.

Marionette Lines cosmetic treatment - beforeMarionette Lines cosmetic treatment - after

Dermal Filler injections to the marionette can provide good results. Appropriate patient selection, good product choice and skilful injection technique are all required to produce good results. It is usually best to have smaller treatments more regularly to avoid overfilling this area. Filler in the cheek area is often required as well for optimum results.

Longevity / Treatment Regime

Generally 1-2ml of medium or thick dermal filler is needed to treat the marionette lines. It is recommended that the client return every 6 months for further assessment and treatment until adequate or complete correction is achieved. At this point, treatment will only be required every year or so. 

Marionette Lines

Marionette Lines in a 57 yo lady. Volume loss extends downwards from the mouth corners towards the jawline. In this example, there is also some jowl formation.

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