Marionette Lines: What They Are, Causes, Filler, & Treatments

Locations:

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Marionette lines are wrinkles at the corners of your mouth. These lines are the result of aging and other causes. You can minimize marionette lines and create a more youthful appearance with cosmetic treatments.

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Marionette lines, also called melomental folds, are creases that extend from the corners of your mouth to your chin. The name comes from marionette string puppets, which have pronounced vertical lines in the same place.

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Marionette lines may be mild, moderate or severe.

Marionette lines and nasolabial folds are in different locations on your face. Nasolabial folds are known as smile lines and extend from the nose to the mouth. Marionette lines appear below nasolabial folds.

Most people will get marionette lines as they age. However, some people may be more prone to developing these lines sooner or have more visible, deeper lines. For example, people who smoke and don’t use sun protection may form marionette lines early or have more prominent wrinkles.

Marionette lines typically appear around age 40. But you may see faint or subtle lines at the corners of your mouth in your 20s and 30s.

Yes, marionette lines are a sign of aging. These wrinkles can make you look older than you are.

Marionette lines may develop due to:

• Aging and naturally losing collagen and elastin in your skin.
• Having parents or grandparents with marionette lines.
• Not wearing sunscreen on your face.
• Pursing your lips frequently.
• Severe stress.
• Smoking.
• Sun exposure, which can lead to sun damage.

Marionette lines can be subtle or deep lines, traveling from your mouth’s outer corners to your chin. They can make you look like you’re constantly frowning.

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Your dermatologist or cosmetic surgeon may use a five-point rating scale to diagnose the severity of the marionette lines. The rating scale can help your surgeon determine the best treatment option.

The best way to treat marionette lines differs for each person. Together with your healthcare provider, you’ll decide which option is best for you based on your:

• Current health.
• Desire for any additional skin changes.
• Goals and expectations.
• Severity of marionette lines.

You can minimize marionette lines with various cosmetic procedures and treatments. Most of these options don’t require surgery or incisions.

Instead, healthcare providers use injections, peels, lasers and threads to minimize marionette lines. But these cosmetic treatments are temporary. The effects will wear off, and you’ll require additional sessions.

Treatment options include:

• Botox.
• Chemical peels.
• Dermal fillers.
• Laser skin resurfacing.
• Microneedling (collagen induction therapy), which increases the production of collagen to add volume and improve lines.
• Thread lift.

Dermal fillers temporarily add volume to your face to smooth out lines and wrinkles. There isn’t one filler that’s best for marionette lines. In general, dermal fillers may help with mild to moderate marionette lines. But they might also create an unnatural look.

If you have deeper marionette lines, your healthcare provider may recommend a full or mini-facelift (rhytidectomy). During a full or mini-facelift, your surgeon makes incisions to remove and lift your skin. This surgery requires a longer recovery than the other options for marionette lines, such as fillers or injections.

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Various cosmetic treatments can reduce the severity of marionette lines and improve the look of your skin. Surgery is the only long-lasting solution for marionette lines.

Marionette lines last forever. These lines become deeper as you age. With treatment, you can temporarily minimize the appearance of marionette lines.

You can’t completely prevent marionette lines from forming, as they naturally occur with age.

However, you can prevent marionette lines and other wrinkles from worsening by following healthy living tips:

• Drink water to stay hydrated.
• Eat foods with nutrients, such as fruits and vegetables.
• Get enough sleep.
• Quit smoking.
• Manage stress.
• Minimize caffeine.
• Use a face moisturizer.
• Wear sunscreen with SPF 30 daily.

If you have marionette lines, ask your healthcare provider:

• Are my marionette lines mild, moderate or severe?
• What are the best treatments for the type of marionette lines I have?
• Am I a candidate for surgery to treat marionette lines?
• What skin creams can minimize marionette lines?

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Marionette lines are wrinkles that extend from the corners of your mouth to your chin. Cosmetic treatments, such as dermal fillers, cosmetic peels and laser resurfacing, may temporarily get rid of or minimize marionette lines. Healthy habits can prevent these lines from worsening. Talk to your dermatologist or cosmetic surgeon about the best treatment and prevention options for you.

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Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.

Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.

• Carruthers A, Carruthers J, Hardas B, et al. A validated grading scale for marionette lines (https://pubmed.ncbi.nlm.nih.gov/19021675/). Dermatol Surg. 2008;34 Suppl 2:S167-S172. Accessed 5/18/2022.
• Galadari H, Galadari I, Smit R, Prygova I, Redaelli A. Use of AbobotulinumtoxinA for Cosmetic Treatments in the Neck, and Middle and Lower Areas of the Face: A Systematic Review (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926328/). Toxins (Basel). 2021;13(2):169. Published 2021 Feb 22. Accessed 5/18/2022.
• Mess SA. Lower Face Rejuvenation with Injections: Botox, Juvederm, and Kybella for Marionette Lines and Jowls (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732664/). Plast Reconstr Surg Glob Open. 2017;5(11):e1551. Published 2017 Nov 9. Accessed 5/18/2022.
• Solish N, Bertucci V, Percec I, Wagner T, Nogueira A, Mashburn J. Dynamics of hyaluronic acid fillers formulated to maintain natural facial expression (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850461/). J Cosmet Dermatol. 2019;18(3):738-746. Accessed 5/18/2022.

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