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The lines on either side of the mouth are so noticeable, and “marionette lines,” the culprit that makes you look older, are a real nuisance! What causes marionette lines? Are they really that hard to improve? You may simply be using the wrong approach! To treat marionette lines effectively, first understand your type. This article analyzes three main categories: laxity and sagging, volume loss and hollowing, and muscle pull, and tells you how to improve each.
Marionette Line Type 1: Laxity and Sagging
When the cheeks age and become lax, or baby fat is pronounced and jowls sag, lines are pressed into both sides of the mouth, which are commonly known as “marionette lines.” Sagging jowls fall into 3 types, and to effectively treat marionette lines caused by jowls, you first need to identify which type of jowls you have:
1. Laxity of the Superficial Skin
The first type of jowl looks like a check-mark-shaped strip of flesh hanging at the corner of the mouth. It is caused by laxity of the superficial skin and fat sliding forward, which pushes out marionette lines.
2. Laxity of the Middle Fascia Layer
The fascia layer lies in the middle of the skin and connects the layers above and below. As the facial fascia layer ages, the whole layer shifts downward, and the skin sags with it, forming jowls and in turn marionette lines.
3. Sagging of the Deep Fat Pad
The deep buccal fat pad is naturally round. When it sags, the jowls take on two round shapes, like holding a braised egg in the mouth, and they also push out marionette lines. In addition, people with pronounced baby fat when young are more likely to develop this, which can noticeably change the face shape.
Learn more:
Marionette Lines When You Smile Bothering You? Ways to Get Rid of Them
How to Improve Marionette Lines Caused by Jowls
1. RF and Ultrasound Lifting: Improves Skin Laxity
Thermage FLX uses monopolar radiofrequency and 3D volumetric heating to deliver heat from the outside in to the deep dermis and subcutaneous tissue, stimulating more collagen remodeling and triggering natural repair, which improves marionette lines, tightens the contour, and restores skin elasticity.
4th-Generation Ultraformer MPT heats with focused points, delivering thermal energy deep into the skin to stimulate more new collagen. Using ultrasound principles, it creates thermal coagulation points from the inside out, triggering immediate contraction from the dermis to the fascia layer, which lifts the facial skin upward and softens marionette lines.
2. Thread Lift: Repositions the Fat Pad and Fascia
Absorbable threads with barbs on the lower half hook onto the fascia or deep fat pad and lift it upward, shrinking the jowls. Besides improving marionette lines, this can also adjust the face shape.
Learn more:
The Complete Thermage FLX Guide: Treatment Details and Key Pre- and Post-Treatment Points
The New Generation Ultraformer MPT: Three Types of People Who Should Not Miss It!
Thermage FLX vs. 4th-Generation Ultraformer MPT: Differences Compared at a Glance
Marionette Line Cause 2: Volume Loss and Hollowing
Loss and hollowing of skin tissue creates a height difference, which in turn forms lines. Taking the spot where marionette lines appear as a reference, the skin and fat on the outer cheek are thicker, while the skin and fat on the inner side toward the chin are thinner. If fat is lost through weight loss or aging, the height difference becomes more obvious, and marionette lines show up. If a lifting treatment has slightly improved your marionette lines but they cannot be fully eliminated, you may also have this hollowing type.
How to Improve Marionette Lines Caused by Volume Loss and Hollowing
Collagen Stimulators
Collagen stimulators, such as Sculptra, Ellansé, AestheFill, and others, stimulate collagen growth to fill in hollows, and can also tighten the skin and support the contour.
Learn more:
The Secret of the “Youth Needle” (Sculptra): How to Regain Youthful, Elastic Skin
Gradual Results, Remarkable Beauty! A Must-Read Guide Before Discovering the Secrets of Sculptra
Dynamic Hyaluronic Acid Filler
Marionette lines sit at the corners of the mouth, an area that moves constantly. If ordinary hyaluronic acid filler is used, it may not last long and can easily migrate. In that case you can choose Restylane Goddess dynamic hyaluronic acid filler, which will work better.
Marionette lines cannot be solved simply by filling them in. If volume loss and hollowing are combined with laxity and sagging, the tissue must first be repositioned and then filled, in order to improve marionette lines more comprehensively.
Learn more:
Hyaluronic Acid Brands Compared! Which One Is Best for Me?
How Do Hyaluronic Acid Molecule Sizes Differ? Recommended CC Amounts for Popular Areas!
Marionette Line Cause 3: Muscle Pull
Long-term muscle contraction damages the skin and creates muscle-type lines. The muscles around the mouth are complex and allow many expressions. The muscle most related to marionette lines is the depressor anguli oris, which pulls the corners of the mouth downward. Some people, because of long-term use of the depressor anguli oris, end up with marionette lines that gradually become more severe. When muscle is the cause, lifting and filling alone have limited effect.
How to Improve Muscle-Pull Marionette Lines
Botulinum Toxin Injections
The idea of using botulinum toxin for marionette lines is to relax the muscle so it does not become over-tense and pull, by inhibiting the release of neurotransmitters from nerve endings so the muscle does not move too strongly and the lines do not become too deep. It plays a supporting and softening role and can be combined with the treatments described above for a more complete result.
Recommended botulinum toxin brands: Neuronox, Botox
Learn more:
Are Wrinkles Dynamic or Static? How Botox Keeps Dynamic Lines From Becoming Static Lines
Why Is Botox from the US So Popular? A Quick Guide
Marionette lines are in fact more complex than they look and are usually caused by a combination of factors. So if you want to improve them, we recommend visiting a clinic for evaluation by a professional doctor to find out which type you have, then choosing a suitable treatment for the problem.
This article is for general information only. Results vary from person to person; please consult a doctor in person before deciding on any treatment.
