Marionette lines are facial wrinkles that occur with natural aging. The lines run vertically between the mouth and chin, which can also create sagging in the lower half of your face.
Marionette lines get their name from marionette string puppets, which are known for having split jaws so puppeteers can help them talk. The skin around your mouth is particularly prone to wrinkling because it’s thinner compared with the rest of your face.
These types of wrinkles tend to develop by your 40s, but you may start seeing signs of them in your 20s and 30s. Learn more about their causes and possible treatment options if you wish to help minimize their appearance.
Like other types of facial wrinkles, marionette lines are caused by natural collagen losses that occur with age. Collagen itself is a protein that naturally plumps up your skin. Gravity also plays a role in sagging skin around the chin, making marionette lines more noticeable.
As early as your 20s, your skin starts losing elasticity as well as hydration, which increases your risk for fine lines and wrinkles. Long-term sun exposure, stress, and poor nutrition may also contribute to facial wrinkles by prematurely breaking down collagen and elastin.
Despite the overall causes of wrinkles, you may only get certain types while other people may develop others. It’s not clear exactly what causes marionette lines in some individuals, but genetics are thought to play a role.
While wrinkles like marionette lines are a part of the natural aging process, it’s possible to temporarily reduce their appearance. There are no medical treatments besides surgery that’ll remove wrinkles permanently, but certain options like injections and dermal fillers may last longer than others.
Wrinkle treatments aren’t considered a medical necessity, so insurance won’t cover them.
Surgery for marionette lines
The only wrinkle treatment considered permanent is surgery. For significant wrinkles, a dermatologic surgeon might recommend a rhytidectomy (facelift). With this type of surgery, incisions are made to remove or transfer fat, while underlying tissues are lifted upward to help tighten your face.
Since a facelift is a major surgery, it’s typically only recommended once other wrinkle methods have failed. For the treatment of marionette lines only, a surgeon might recommend a partial rhytidectomy (mini facelift).
Due to the significance of the procedure, you’ll need to take 1 to 2 weeks off work to recover. Weight fluctuations and excessive sun exposure could undo the results of your procedure, so it’s important to talk to your surgeon about adopting healthy lifestyle habits ahead of time. See below for suggestions.
Laser resurfacing
While also considered an invasive therapy for wrinkles, laser treatments don’t require the incisions that facelifts do. Laser resurfacing works by removing the top layers of your skin via lasers.
While an effective treatment for some, laser resurfacing carries the risk of scarring and hyperpigmentation. The results are long lasting but not permanent — you’ll likely need repeat treatments every few months.
Botox for marionette lines
Botulinum toxin type A (Botox) injections are popular solutions for facial wrinkles around the mouth and eyes. These work by relaxing the facial muscles underneath the injection site. In turn, your skin will become smoother with a reduced appearance in wrinkles.
Botox may cause minor bruising and irritation at the injection site. In order for Botox injections to treat marionette lines, you’ll need to repeat the treatment every 3 to 4 months. This treatment method works best if you’re just starting to develop these types of wrinkles.
Dermal fillers
Like Botox, dermal fillers are temporary injectables that can help treat marionette lines in their earlier stages. Unlike Botox, fillers don’t relax muscles. Instead, they help plump your skin with either poly-L-lactic or hyaluronic acid. This is designed to mimic the effects of collagen and elastin to help smooth fine lines and wrinkles.
Hyaluronic acid dermal filler results in an immediate change, while poly-L-lactic takes several months to see results, as it’s a stimulatory filler that stimulates the production of collagen over time.
Dermal fillers may also help address sagginess caused by marionette lines, but they might inadvertently worsen these effects if too much is used. There’s also concern that injecting these fillers into the cheek area can create an unnatural appearance.
Chemical peels
Chemical peels are applied by an aesthetician or dermatologist and, depending on the type of peel, are designed to remove the outer layer of skin (epidermis) as well as parts of the middle layer (dermis). The process reduces the appearance of facial wrinkles and age spots, and the new skin cells that generate are stronger.
Before getting a chemical peel, tell your provider if you use retinoids or face acids, as these could make your skin too sensitive for this treatment option. To maintain your results, you’ll likely need a chemical peel every month.
Microneedling
Microneedling, or collagen induction therapy, is a treatment that creates very small holes in the skin to help generate stronger skin cells. A dermatologist uses a derma roller or microneedling pen, a tool that contains small needles to create these small holes in the target area of the skin.
When applied to deep marionette lines, microneedling may help generate more collagen to essentially fill in these deeper facial wrinkles. Depending on the results you’re looking to achieve, you’ll need to repeat microneedling several times.
Retinoids
Retinoids are types of synthetic vitamin A derivatives used for wrinkles, acne, and photoaging. The most common over-the-counter form is retinol, but stronger retinoids are available by prescription.
Retinoids aren’t recommended for pregnant women, and these types of products may increase your sensitivity to the sun.
For marionette lines, retinoids may help by getting deep beneath the epidermis to stimulate collagen. These products aren’t intended to be used on the mouth due to sensitivity concerns, though they may be applied near the mouth.
Hyaluronic acid
Hyaluronic acid is a substance that’s naturally available in skin tissues. Like collagen, hyaluronic acid can diminish with age. This substance is found in certain dermal fillers, serums, and skin care products. When applied to wrinkles, it’s thought to smooth the skin.
Topical treatment
If you don’t already use an anti-aging serum, you should consider adding one to your daily skin care routine. Ideally, you’ll want to start using serums at the earliest stages of facial wrinkles.
Best serum for marionette lines
Marionette lines may benefit from a serum that contains a combination of the following ingredients:
- antioxidants, such as vitamins C and E to help fight free radicals that can further aging skin
- vitamin A derivatives, such as retinoids
- hyaluronic acid
- niacinamide (vitamin B3), which are thought to help increase collagen production and improve elasticity
- peptides, which are proteins that have firming effects on your skin
Another option that doesn’t involve any dermatologist treatment is makeup. If you wish to cover up your wrinkles, consider the following steps:
- Apply your foundation first.
- Next, apply cream concealer after applying your foundation.
- Gently dab the concealer onto your skin with your ring finger or a concealer brush until the product is absorbed. Don’t rub in the concealer.
- Apply setting powder with a large makeup brush.
Focusing on eye makeup can also help divert attention away from the lower half of your face if you wish to do so. But remember: Everyone gets wrinkles. They’re a natural part of aging, and many consider them beautiful!
While there’s no way to entirely prevent skin aging, there are preventive measures that may slow down the development of marionette lines. Consider the following health and lifestyle tips.
Daily skin care
Wrinkle treatments won’t go far if you don’t take care of your skin on a regular basis. Wash your face twice per day, and remove makeup before bedtime. Use your desired anti-aging serum as well as facial moisturizer to keep your skin hydrated.
Weight management
Weight fluctuations can increase the risk for sagging skin. This includes under the jawline, which may also make marionette lines more noticeable. If you need to lose weight for medical reasons, be sure to do so gradually and work with a doctor so you can maintain it.
Reduce sun exposure
Over time, unprotected sun exposure can damage both the epidermis and dermis, which may increase your risk for fine lines, wrinkles, and sagging skin. You can help protect your skin by wearing SPF 30 sunscreen every day and hats to shade your face.
Also, avoid being in direct sunlight between the late morning and early afternoon hours — this is when UV rays are strongest.
Adopt a skin-friendly diet
Drinking lots of water can keep your skin hydrated, but eating the right foods can also help keep your skin healthy in the long term. Anti-inflammatory foods, such as colorful fruits and vegetables, fish, and unprocessed grains, may be especially beneficial.
Other lifestyle considerations
Other lifestyle habits may contribute to marionette lines and other facial wrinkles, including:
- alcohol consumption
- drinking too much caffeine
- not drinking enough water
- smoking
- excessive stress
- inadequate sleep
Marionette lines occur naturally with age, just as other facial wrinkles do. Your genes, lifestyle, and overall health may play a role, but there’s no way to completely prevent them. If you’re concerned about your marionette lines, talk to a dermatologist about treatment options and tips for long-term skin care.