MARIONETTE LINES: WHAT THEY ARE AND HOW TO TREAT THEM
By Shetha Naji, Consultant Plastic Surgeon – Sept 1, 2025
Are you noticing lines forming around your mouth as you age? You’re not alone. One of the most common concerns I hear about are marionette lines — the vertical creases that run from the corners of the mouth down towards the chin.
Named after the strings of a puppet, these lines can sometimes give the impression of sadness or tiredness, even when you feel perfectly happy. While they’re a completely natural part of ageing, there are effective ways to soften them and restore a refreshed, youthful appearance.
In this article, I’ll explain what marionette lines are, how they differ from other facial lines such as nasolabial folds, what causes them, and the best treatment options available today.
WHAT ARE MARIONETTE LINES?
Marionette lines — also known as mentolabial folds — are deep vertical lines that extend from the corners of the mouth toward the chin. They usually begin to appear in your late 30s or 40s and can deepen with age, making the lower face look heavier or droopy.
Unlike fine lines that affect only the surface of the skin, marionette lines form due to changes in deeper facial structures such as muscle, fat, and bone.
MARIONETTE LINES VS. NASOLABIAL FOLDS: WHAT’S THE DIFFERENCE?
It’s easy to confuse marionette lines with nasolabial folds (sometimes called “smile lines” or “laugh lines”). Here’s the distinction:
• Nasolabial folds run from the sides of the nose down to the corners of the mouth. They typically appear earlier, often from your 30s, and are linked to volume loss and or descent in the cheeks and mid-face.
• Marionette lines extend downward from the mouth corners to the chin. They tend to appear later and are caused more by sagging in the lower face.
Understanding the difference is important, because the right treatment plan will often vary between the two.
WHAT CAUSES MARIONETTE LINES?
Several factors contribute to the development of marionette lines:
1. Age-related collagen loss – From your mid-20s, collagen and elastin production declines by 1–2% each year, reducing skin firmness and elasticity.
2. Facial fat redistribution – With age, fat pads shift downward, leading to sagging in the lower third of the face.
3. Bone resorption – The jaw and chin gradually lose bone density, reducing structural support for the skin.
4. Muscle activity – Repeated expressions (frowning, speaking, pursing lips) activate muscles that pull the mouth corners downward.
5. Lifestyle factors – Sun exposure, smoking, and pollution accelerate collagen breakdown.
6. Genetics – People with thinner skin or a family history of early wrinkles are more prone to marionette lines.
WHEN DO MARIONETTE LINES APPEAR?
While everyone ages differently, marionette lines typically become noticeable in your 40s. However, they can appear earlier — sometimes in your 30s — if you smoke, have high sun exposure, or naturally thinner skin.
TREATMENT OPTIONS FOR MARIONETTE LINES
The good news is that several **non-surgical treatments** can effectively soften marionette lines and rejuvenate the lower face. The best approach is often a personalised plan that combines techniques.
1. Dermal Fillers
Hyaluronic acid-based fillers restore lost volume and smooth deep creases around the mouth and chin. Results are immediate and typically last up to 12 months.
2. Injectables
Targeted injections can relax overactive muscles (such as the depressor anguli oris) that pull the mouth corners down, helping lift and refresh your expression.
3. Skin Boosters & Polynucleotides
Skin-quality treatments improve hydration, elasticity, and cellular repair. They don’t just smooth the surface — they actually help restore healthier skin over time.
4. Collagen-Stimulating Treatments
Options like microneedling or Sofwave use controlled stimulation to trigger your skin’s natural healing response, boosting collagen and gradually improving skin texture.
CHOOSING THE RIGHT TREATMENT
The ideal treatment depends on:
• The depth of your marionette lines
• Whether you also have nasolabial folds or volume loss in the mid-face
• Your personal goals — whether you’d like subtle softening or more dramatic rejuvenation
In many cases, combining therapies provides the most natural and long-lasting results.
PREVENTION TIPS
While you can’t stop ageing, there are steps you can take to delay or minimise marionette lines:
• Protect your skin from UV damage with daily sunscreen including blue light protection
• Avoid smoking, which accelerates collagen breakdown and reduces collagen synthesis.
• Maintain a stable, healthy weight to reduce excessive facial fat shifts.
• Invest in a good skincare routine with antioxidants and retinoids to support skin health.
FINAL THOUGHTS
Marionette lines are a completely natural part of ageing, but if they make you feel less confident, treatments are available to help you look refreshed without changing who you are.
My goal as a Consultant Plastic Surgeon is not to erase character, but to restore balance, softness, and confidence.
If you’re considering treatment for marionette lines or nasolabial folds, I’d be delighted to guide you through your options.
Tel: +44 (0) 7903 159640
Email: contact@shethanaji.com
Take the first step towards a fresher, more radiant you today.