What are Marionette Lines on the Face? Causes & Treatment

What are marionette lines?

Marionette lines are the deep vertical creases extending from the corner of the mouth to the chin. Some patients may experience extreme cases of these lines when it joins the nasolabial folds at the corners of the nose. Marionette lines can make your patients look permanently angry, sad, or exhausted.


What are the causes of marionette lines?

Marionette lines are caused by a combination of elements, including chronological ageing and external skin-damaging influences. Prolonged exposure to sunlight, unintentional weight loss and even smoking can speed up the ageing process.

Skin is made of 3 layers:

  1. epidermis
  2. dermis
  3. subcutaneous

When the skin ages due to genetic signaling, these 2 layers are affected. The epidermal layer becomes thinner and drier. In addition, the body is not as efficient in producing structural collagen and elastic fibres to maintain the firmness of the skin. Some patients experience ageing in the form of subcutaneous fat loss, resulting in sunken and loose skin.

Extrinsic ageing, on the other hand, is defined as external factors that promote ageing by introducing free radicals into the skin. Free radicals are reactive toxins that interfere with normal cell regeneration and repair. They worsen skin ageing by bombarding and altering DNA molecules in cells. Consequently, the bodily system becomes sluggish in maintaining the integrity, health, and functionality of the skin. The skin loses its elasticity, resulting in deeper and more pronounced marionette lines.



Skin ageing can be easily controlled with proper skincare regimens. Skincare routines ensure that dead and keratinized cells, as well as impurities like makeup and excessive sebum, are continuously sloughed off to make way for healthy new cells. Adequate sun protection like applying broad spectrum sunscreen or wearing protective clothing shields the skin from harmful UV rays. In addition, adopting a healthy lifestyle like giving up smoking and excessive indulgence in alcoholic beverages reduce unwanted free radicals in the body. So, skin remains healthy from the inside out and more skin imperfections can be cured. But, some patients may benefit from aesthetic treatments if the skin depressions are too severe. The most common method is injecting dermal fillers composed of materials like hyaluronic acid and collagen. The temporary fillers deliver volumising and lifting actions on marionette lines. Patients can also opt for face lifts—a surgical procedure also known as rhytidectomy—to subtly yet effectively tighten the loose tissues. As a result, creases are lifted for a younger-looking visage.