
Are marionette lines making you look old when you still feel young? Or sad when you’re actually OK? Marionette lines are a very common sign of facial aging. According to The Cleveland Clinic, they usually start to appear around age 40. But for some, these lines can begin in their 30s – or even their 20s. What causes marionette lines? Can you get rid of them – or at least substantially soften them? What are the best ways to do it?
What causes marionette lines?
There are several factors that cause marionette lines. One is the Depressor Anguli Oris muscles that run from your chin to the corners of your mouth. You use these muscles to express emotions like anger and sadness. If they are particularly strong, you may find marionette lines forming in your 20s and 30s. Life today gives us too many reasons to use these muscles. Early marionette lines can be a sign that they’re a little too strong.
Another factor is sagging skin. Young, healthy skin has plenty of collagen, its building block, and elastin, which keeps it firm and elastic. Once you’re past your 20s, your collagen and elastin production decline every year. Too much sun or alcohol, or regular smoking or vaping makes the situation even worse. As these vital skin proteins decline, lines and wrinkles begin to appear somewhere on your face. Heredity or your facial expressions can make it show up as nasolabial folds and marionette lines around your mouth.
Volume loss is another factor in marionette lines. As you age, the fat pads that kept your face full and your skin firm melt away. Weight gain followed by dieting can make this worse. As those fat pads thin out, lines and wrinkles can appear on the surface. Sometimes they’re marionette lines.
Finally, there is the ongoing effect of gravity. It prevents us from flying off into space. But it also constantly pulls your facial muscles and skin downward. In time, your mid-cheeks will drape themselves over their anchor point above your mouth, causing nasolabial folds. And the tissues near your mouth may sag into marionette lines. If this happened to you, what can you do about it?
Are there marionette lines fillers or non-invasive treatments that work?
If you’re in your 20s or 30s and marionette lines are just beginning, there are some non-invasive treatments that can help. If your Depressor Anguli Oris muscles are the primary cause of the problem and your skin is still firm and elastic, Botox injections may work.
However, often the problem also involves a loss of volume under the skin. If this is the case, and you’re no older than middle-aged, filler injections could help. However, you’ll have to get additional shots on schedule or your marionette lines will be back, perhaps to stay.
There are generally two types of fillers for marionette lines. Hyaluronic acid fillers will provide volume that will last about a year. Fillers like Sculptra and Bellafill not only fill the area but stimulate collagen production, which helps them last longer. Bellafill lasts up to 5 years or longer, often making it the best value. You can read more about this in “Best Filler for Nasolabial Folds?”

However, filler injections in this area must be done carefully. One facial plastic surgeon reported many new patients coming to him after receiving too much filler in their lower cheeks and complaining, “I look like a chipmunk!”
Another doctor wrote on his website regarding marionette lines, “In the past, we used dermal fillers to treat them, but we don’t recommend this anymore, simply because it doesn’t work.” I’m sure that depends on the patient, but it’s interesting to note what The Cleveland Clinic published:
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.
Eliminate marionette lines for years!
I agree with The Cleveland Clinic – while noninvasive treatments can reduce marionette lines, the only way to eliminate or substantially improve them for years is a facelift. What kind of facelift is best? That answer depends on your age, the condition of your facial skin and muscles, and the degree of facial aging you have. Here are some options:
Mini Lift
Some plastic and facial plastic surgeons heavily advertise their Mini Lift. What is it and what does it accomplish? A mini facelift uses shorter incisions than a regular facelift. The surgeon places these in front of the ears from the hairline to the earlobe. Through these, they will gently pull your skin and facial tissues diagonally toward your ears. They will suture these in place and remove any excess tissue.
A mini lift can eliminate minor jowls and reduce larger ones. It will tighten loose skin around your mouth and jawline. It can help soften nasolabial folds, and smooth marionette lines and wrinkles. As I brought out in “Is the Mini Lift or Mini Facelift Cost Really a Bargain?” while the mini lift is less invasive, it accomplishes substantially less than a full facelift.
That can present a problem you might not expect. Because the mini lift is limited in scope, facial aging in areas not covered by the procedure will remain and may become even more noticeable. Thus, if you have more pronounced nasolabial folds, a sagging mid-face, or an aging neck, a mini facelift is not your best option.
SMAS Facelift
The SMAS procedure is the most widely used facelift in America. Your surgeon will cut out or fold a quarter-inch strip from the SMAS membrane that lies just above your facial muscles. Suturing it tight lifts muscles and skin up to one-third of an inch. He or she will then remove excess skin.

The SMAS facelift eliminates marionette lines and jowls. It softens but does not eliminate nasolabial folds. It provides good, natural-looking results for your lower face that can last 10 years. But if you have sagging cheeks, a turkey neck, or other signs of neck aging, you’ll need an additional procedure.
Deep Plane Facelift CONTACT Dr. Machida Inland Empire, CA

The Deep Plane facelift is today’s state-of-the-art facial rejuvenation procedure. It can help you look younger in more ways than any other facelift. Your surgeon will release key ligaments under your face and reposition the tissues to the level where they were years ago. The result is a face that looks years younger and far more attractive.
A deep plane facelift can get rid of marionette lines and jowls. It improves nasolabial folds far more than any other procedure. It firms sagging lower and mid-cheeks, restoring a younger look. And it can eliminate a turkey neck and substantially smooth an aging neck without a separate neck lift.
Not every plastic or facial plastic surgeon can successfully perform a full deep plane facelift. Those that can give their patients a great new look that will last for years.
A highly experienced board-certified plastic or facial plastic surgeon can help you choose the procedure that will effectively treat or eliminate your marionette lines. If you’re in Inland Empire, California, feel free to contact me at STC Plastic Surgery in Ontario for a free evaluation.