Concerns We Treat
Marionette Lines
The lines that travel down from the corners of the mouth toward the chin, lending the face a downturned cast at rest.
The lines that travel down from the corners of the mouth toward the chin, lending the face a downturned cast at rest.
Marionette lines are the creases that run downward from the corners of the mouth toward the chin, named for the puppet-mouth appearance they give the face at rest. They are not expression lines; they are the visible front of a structural shift in the lower face, where the skin has begun to descend slightly off the bone beneath it.
The lines are most often noticed not by the patient but by the camera. The face in motion may look much as it always has. The face at rest, in photographs, begins to look subtly downturned or somber even when the patient feels neither.
Treatment for marionette lines suits patients whose lower face has begun to read more somber than they wish, and whose jawline and cheek have visibly thinned compared with earlier years. The work is conservative: small amounts of filler placed precisely, often paired with treatment of the surrounding midface for a balanced result.
It also suits those willing to plan across visits rather than seeking a single dramatic correction. Marionette lines are best met patiently.
The principal cause is loss of structural support along the jawline and at the lower cheek, the same forces that deepen nasolabial folds at the midface. As the supporting bone of the jaw resorbs and the fat pads of the lower face thin, the skin that runs from mouth to chin loses its taut hold and begins to crease at the corners of the mouth.
The supporting causes include sun exposure that thins the skin, weight fluctuations that pull fat from this area, smoking that accelerates collagen loss, and the natural decline in skin elasticity that begins in the late twenties and continues across the decades.
You may notice:
Marionette lines often arrive in the mid-forties, slightly later than nasolabial folds, and deepen across the fifties as the structural changes of the lower face accumulate. Patients with strong jawline definition into their forties often notice marionette lines later than patients with naturally softer lower-face contour.
The arc can be accelerated by significant weight loss, by chronic sun exposure, and by the years immediately surrounding menopause, when estrogen-driven collagen support begins to decline more steeply.
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