Marionette lines run downward from the corners of the mouth towards the chin, named after the hinged jaw of a puppet. They form as the cheek and jowl tissue descends, the lower face loses volume and the muscle that pulls the mouth corners down becomes more dominant. Mild lines can be softened with filler; where jowls are the main cause, a facelift is usually more effective.
Why marionette lines appear
Along the jaw, a firm ligament tethers the skin to the bone just in front of the jowl. As the tissues above loosen and slide down with age, they pile up on either side of this anchor point, creating a groove that runs from the mouth corner to the chin. At the same time, fat beneath the lower lip and chin thins, and the depressor muscle that pulls the corners of the mouth downward can make the mouth look downturned, even at rest. Genetics, sun damage, smoking and weight loss can all make the lines appear earlier.
Marionette lines or nasolabial folds?
The two are often confused. Nasolabial folds run from the side of the nose to the corners of the mouth, whereas marionette lines continue below, from the mouth corner towards the jaw. Both are caused by similar processes of descent and volume loss, and many people develop both. Treating one without the other can leave the lower face looking unbalanced, so both are assessed together, along with the jawline and neck.
How they affect expression
Because they draw the corners of the mouth down, marionette lines can give a sad, stern or tired look that does not match how a person feels. Many people notice this first in photographs or on video calls, and friends may ask whether something is wrong. Lipstick may bleed into the lines, and the chin can look less defined as the jowl develops beside it. Small vertical lines around the lips often appear at a similar stage.
Non-surgical options
- Dermal filler: hyaluronic acid filler can support the mouth corners and soften the groove. Small amounts are used, often combined with subtle support in the cheek, to avoid a heavy lower face.
- Anti-wrinkle injections: a qualified prescriber can relax the muscle that pulls the mouth corners down, giving a slightly lifted look.
- Skin treatments: sun protection and skin care improve texture but cannot reverse the fold itself.
Non-surgical treatments are temporary and work best for early lines without significant jowling. Overfilling the area can make the chin look wide or bulky, and repeated large volumes of filler can stretch the tissues over time.
Surgical options
When the lines are driven by descended jowls, repositioning the tissues surgically is usually the most effective approach. A facelift or deep plane facelift lifts the cheek and jowl back up over the jawline, which can soften marionette lines significantly and restore a cleaner jaw contour. A mini facelift can help earlier jowling. Fat grafting may be used alongside to restore lost volume near the mouth. Mr Nassab will explain which parts of the line are likely to improve, as a small residual crease often remains.
Recovery and risks
After filler, mild swelling and bruising usually settle within a few days; rare complications include lumps and blood vessel blockage, which requires urgent treatment, so contact your practitioner immediately if the skin becomes pale, mottled or very painful. After a facelift, most people need two to three weeks before they feel comfortable socially, with swelling settling over several months. Surgical risks include bleeding, infection, scarring, numbness and, uncommonly, facial nerve injury, which is usually temporary.
Cost
Filler and anti-wrinkle injections are quoted at consultation. A facelift costs from £14,500. A deep plane face and neck lift costs from £18,500 and a mini facelift from £8,000. The consultation fee of £150 is separate. Treatments are provided to adults aged 18 and over.
Frequently Asked Questions
What age do marionette lines appear?
They commonly become noticeable in the forties or fifties, though genetics and weight loss can bring them on earlier.
Is filler good for marionette lines?
Filler can soften early lines effectively. Deeper lines caused by jowling usually respond better to a surgical lift.
Can a facelift remove marionette lines completely?
A facelift can soften them considerably by lifting the jowls, but a faint crease may remain.
Will marionette lines get worse?
Without treatment they tend to deepen slowly with age, as the lower face continues to lose support.
Can marionette lines be prevented?
You cannot prevent them entirely, but sun protection, not smoking and a stable weight help slow their development.
Do marionette lines affect both sides equally?
Not always. Natural asymmetry and differences in jowling can make one side deeper, which is considered when planning treatment.
