Marionette Lines: What Causes Them and How to Get Rid of Them

On this page

1. Marionette line treatments compared at a glance
2. What are marionette lines?
3. What causes marionette lines?
4. How do you get rid of marionette lines?
5. Does filler work for marionette lines?
6. Is filler for marionette lines safe?
7. Does Botox work for marionette lines?
8. What do marionette lines before and after results look like?
9. Can you soften marionette lines without filler?
10. Is there a needle-free way to work on marionette lines at home?
11. Your next step

Quick answer: Marionette lines are the creases that run from the corners of your mouth down toward your chin. They come from bone and fat loss, a muscle that pulls the mouth corners down, and collagen loss with age and sun. Hyaluronic acid filler is the most common fix, Botox can lift the downturn, and only surgery lasts long-term.

We read 19 studies and sources on marionette lines, from a 2008 paper that built a 5-point grading scale for them to a 2024 filler study that followed 83 people for a year, so every claim below links to where it came from. (I also bought a secondhand marionette puppet at a flea market, purely for research. His name is Gerald. His strings were tangled within four minutes, and so, frankly, was I.)

Marionette line treatments compared at a glance

Option	Best for	What the evidence shows	Worth knowing
Daily sunscreen, SPF 30+	Everyone	903 adults: the daily group showed no detectable increase in skin aging over 4.5 years	Slows new damage. Won’t fill an existing fold
Retinoid at night	Fine lines around the mouth	Boosts collagen and softens fine lines. No trial on marionette lines found	Can irritate at first. Not for use in pregnancy
Hyaluronic acid filler	The fold itself	83 adults: 69.9% improved by 1+ grade at 1 month, 51.3% at 6 months	Lasts about 4 to 12 months. Average cost $715
Botox in the corner muscle	Mouth corners that turn down	10 people vs 10 on saline: lasted at least 12 weeks in most	Off-label. Lasts about 3 to 4 months
Filler plus Botox	A fold plus a downturned mouth	90 women: filler groups improved more than Botox alone on most measures	Often done in one visit
Thread lift	Mild to moderate sagging	Reviews and case photos. No large trials found	Suits leaner faces with good skin quality
Facelift	Deep folds with jowls	Cleveland Clinic calls surgery the only long-lasting option	1 to 2 weeks off work
At-home needle-free RF	Upkeep between clinic visits	33 women, 12 weeks: lower-face sagging improved more than with a cream	Marionette lines not measured. One small trial

Sources: Hughes 2013, AAD on retinoids, Ruiz Del Cueto 2024, AAD fillers FAQ, ASPS, Moradi 2023, AAD on Botox, Carruthers 2010, Hong 2024, Cleveland Clinic, Healthline, Shu 2022.

What are marionette lines?

Marionette lines are creases that run from the corners of your mouth down to your chin, also called melomental folds. They sit below the nasolabial folds, the smile lines that run from your nose to your mouth. Cleveland Clinic says they typically appear around age 40, with faint lines possible in your 20s and 30s.

“Marionette lines, also called melomental folds, are creases that extend from the corners of your mouth to your chin.”

Cleveland Clinic

The name comes from marionette string puppets, whose jaws are split so a puppeteer can make them talk (Healthline). Gerald, my flea-market research assistant, has exactly that hinge. He has never once complained about it, mostly because his mouth is currently tied to his left elbow.

Doctors grade the lines on a 5-point photo scale, built in 2008 when nine experts rated photos of 35 people (Carruthers 2008). Nine experts agreed on one crease. I can’t get three friends to agree on a pizza topping. Your grade matters, because a mild line and a deep fold with jowls need different fixes.

A line from the side of your nose to the edge of your mouth is a nasolabial fold, the neighbor upstairs, and our guide to nasolabial fold treatments covers those. [Points at own face in the mirror like a lost tour guide.]

What causes marionette lines?

Marionette lines form when several aging changes stack up around the mouth. The jaw bone thins, deep fat pads shrink while jowl fat drops, a muscle called the depressor anguli oris pulls the mouth corners down, and skin loses collagen. Sun, smoking and family history can make them show earlier or deeper.

A 2024 anatomy review lists seven causes, from jaw bone loss and gravity to a ligament that tethers skin to the jaw and drooping jowl fat (Hong et al. 2024). Seven causes for one crease. It’s the only group project in history where everybody showed up.

The bone part surprised me most. A review of how the facial skeleton ages describes “the prejowl region of the mandible that develops into an area of relative concavity” (Mendelson and Wong 2012), so the soft tissue above has less to sit on. I had assumed bones were the one part of me that stayed put. Apparently not even the bones are committed.

Then the skin joins in. Cleveland Clinic says you “lose about 1% of your collagen each year starting in your 30s” (Cleveland Clinic), and lists sun, smoking, stress, family history and pursing your lips as things that bring marionette lines on sooner (Cleveland Clinic). Pursing my lips is my entire thinking face. Gerald does all his thinking behind a painted-on smile, and he looks extremely rested.

How do you get rid of marionette lines?

No cream or exercise removes marionette lines. The proven fixes happen in a clinic: hyaluronic acid filler to fill the fold, Botox to relax the muscle pulling the mouth corners down, and threads or a facelift for deep folds with jowls. Sunscreen and a retinoid slow new damage. Cleveland Clinic says only surgery lasts long-term.

Cleveland Clinic warns that all the non-surgical options are temporary (Cleveland Clinic), the same word I once used about my gym membership freeze. The trick is matching the fix to the cause. Filler adds back lost volume. Botox relaxes the muscle that tugs the corners down, which is basically snipping one of Gerald’s strings. Most people have more than one cause, so injectors often combine them.

Does filler work for marionette lines?

Yes, for most people. Hyaluronic acid filler fills the fold and gives an immediate result. In a 2024 study of 83 adults, 69.9% improved by at least one grade on a marionette line scale after a month, and 51.3% still had that improvement at six months. Results typically last about 4 to 12 months.

“Treatment of the marionette lines via dermal fillers is the most common approach despite the lack of published clinical data specific to this indication.”

Ruiz Del Cueto et al., Journal of Cosmetic Dermatology

That’s the authors admitting the most popular fix had little paperwork behind it, which is refreshingly honest and a tiny bit alarming. So they ran one, at a single clinic in France, with an average age of 59 (Ruiz Del Cueto 2024). AbbVie, which makes the filler tested, funded it, so read it as a solid start, not the final word. I’d also love to grade my own homework. Nobody lets me.

The FDA approves temporary fillers for “moderate to severe facial wrinkles and skin folds” (FDA). Hyaluronic acid gel lasts about 4 to 12 months (AAD) and costs $715 on average (ASPS). Since it wears off, that’s a repeat bill, like a streaming service for your chin.

Cleveland Clinic adds a fair warning: “There isn’t one filler that’s best for marionette lines,” and fillers “might also create an unnatural look” (Cleveland Clinic). So skill beats brand. Pick your injector the way I should have picked my last haircut: slowly, and not from a coupon.

Is filler for marionette lines safe?

Filler is generally safe in trained hands, but it carries real risks. Bruising, swelling and tenderness are common and usually fade within days. The rare serious risk is filler entering a blood vessel, which the FDA says can cause tissue death, vision problems including blindness, or stroke. Choose a board-certified dermatologist or plastic surgeon.

“While the chances of this happening are low, if it does happen, the resulting complications can be serious and may be permanent.”

U.S. Food and Drug Administration

[Takes off the funny hat.] The FDA says to get medical help right away for unusual pain, vision changes, or skin near the injection site that turns white, gray or blue. It also warns: “Do not purchase dermal filler products online, because they could be counterfeit products or products that are not approved for use in the U.S.” (FDA). No bits in this paragraph. Straight face, fully on.

In the 2024 study, 80% of people reported some pain or tenderness, and most reactions were mild or moderate and cleared within 8 days (Ruiz Del Cueto 2024). [Puts the funny hat back on. Checks it for strings.]

Does Botox work for marionette lines?

Botox can help, but it works on the downturn, not the fold. It relaxes the depressor anguli oris, the muscle that pulls the corners of your mouth down. In a small 2023 trial of 20 people, the effect lasted at least 12 weeks in most. This use is off-label: Botox is not FDA approved for marionette lines.

A plastic surgeon’s 2017 case report says it plainly: “Botulinum toxin has been used off-label for relaxation of the depressor anguli oris (DAO) muscle” (Mess 2017). Off-label means a doctor uses an approved drug in a way its label doesn’t cover. It’s legal and common, and it’s also exactly how I use my stand mixer (doorstop).

The best trial we found is small: ten people got onabotulinumtoxinA, the Botox ingredient, ten got saline, and the authors concluded: “Treatment was well tolerated and in most individuals lasted at least 12 weeks” (Moradi 2023). Twenty people is a dinner party, not a verdict. Botox Cosmetic does have full FDA approval for other lines, which our guides to crow’s feet and forehead wrinkles cover.

Botox alone rarely fills the crease, though. In a randomized trial of 90 women aged 35 to 55 who got filler, Botox or both, “For all measures and most time points, the 24-mg/mL cohesive gel treatment groups experienced greater improvements than onabotulinumtoxinA alone” (Carruthers 2010). The gel is the filler, so filler did the heavy lifting. Gerald would agree, if his jaw weren’t tangled in his left string again.

What do marionette lines before and after results look like?

Filler before and after photos show the biggest change at about one month, then a slow fade. In the 2024 study, the study doctors rated 98.8% of people improved at one month, falling to 50% by month 12. Botox is different: results show in 3 to 7 days and last about 3 to 4 months.

Here’s the filler timeline from that study (Ruiz Del Cueto 2024), with Botox timing from the American Academy of Dermatology:

• Days 1 to 8: pain, swelling or bruising, settling within about a week for most people.
• Month 1: the peak. 69.9% improved by at least one grade.
• Months 3 and 6: 58.2%, then 51.3%, still improved.
• Month 12: the study doctors rated half of people improved.

So when a clinic shows you an after photo, ask how long after. I ask the same about my own haircut photos, and the answer is always the same day, in perfect light.

Can you soften marionette lines without filler?

At home, nothing is proven to remove marionette lines, but two habits protect the skin around them. Daily broad-spectrum sunscreen slowed visible skin aging in a 4.5-year trial, and a nightly retinoid builds collagen and softens fine lines. In a clinic, lasers, peels, microneedling, thread lifts and facelifts are the non-filler options.

In that trial, 903 Australian adults used sunscreen daily or whenever they felt like it, and “The daily sunscreen group showed no detectable increase in skin aging after 4.5 years” (Hughes 2013). Whenever I feel like it is also my approach to ironing. The shirts can tell.

The American Academy of Dermatology says a retinoid “reduces fine lines and wrinkles” (AAD), and our retinal vs retinol guide covers which one to start with. The honest catch: we found no retinoid trial on marionette lines, so expect softer fine lines around the mouth, not a filled fold. Mine lives on the nightstand, next to Gerald, who supervises.

In a clinic, thread lifts use dissolving threads to pull sagging tissue up, and a 2024 review says they suit people with “a low body mass index, minimal soft tissue fullness” and good skin (Hong et al. 2024). Strings lifting droopy things upward: somewhere on my bookshelf, Gerald feels very seen. RF microneedling such as Morpheus8 is another clinic route, covered in our guide to what Morpheus8 is.

For deep folds with jowls, Cleveland Clinic is blunt: “Surgery is the only long-lasting solution for marionette lines” (Cleveland Clinic). Long-lasting, yes. Quick, no.

Gerald finally got untangled this morning, by the way. He’s back on the shelf looking exactly like the day I bought him, the only one in this house with a truly permanent result. He’s made of wood, so I’ve decided not to be jealous. [Walks past. Tangles him again.]

Is there a needle-free way to work on marionette lines at home?

No at-home device is proven for marionette lines. The closest evidence is a 12-week split-face trial of 33 women aged 35 to 60, where an at-home radiofrequency device improved lower-face sagging more than an anti-aging cream. Marionette lines weren’t measured, so think of it as gentle upkeep, not a replacement for filler.

The researchers reported that “the experimental side had significantly greater improvement in forehead wrinkles, crow’s feet, nasolabial folds, facial pores and sagging of the lower part of the face than the control side at W12” (Shu 2022). The catches: sessions ran 5 days a week under supervision, and a company, Ecolite Wellbeing, paid the journal’s publishing fee. Five days a week. I can’t water a plant five days a week.

If you want that route, the VEAUTY Dot is a needle-free option: 144 electrodes that sit on the surface and never pierce the skin. It’s a cosmetic device, rated 4.8 out of 5 from 1,163 reviews on its own store. It wasn’t the device tested in that trial, and for marionette lines, filler and Botox have much stronger evidence. Think of it as the 15 minutes on the sofa that go with sunscreen and a retinoid, the only step on this list where you get to sit down. Our comparison of at-home skin rejuvenation devices puts it side by side with the alternatives.

Frequently asked questions

Sources

• Cleveland Clinic: Marionette lines
• Hong et al. 2024, why marionette lines appear (Skin Research and Technology)
• Mendelson and Wong 2012, changes in the facial skeleton with aging (Aesthetic Plastic Surgery)
• Carruthers et al. 2008, a validated grading scale for marionette lines (Dermatologic Surgery)
• Ruiz Del Cueto et al. 2024, VYC-17.5L filler for marionette lines (Journal of Cosmetic Dermatology)
• Carruthers et al. 2010, Botox and filler alone and combined for the lower face (Dermatologic Surgery)
• Moradi et al. 2023, onabotulinumtoxinA in the depressor anguli oris (Dermatologic Surgery)
• Mess 2017, Botox, Juvederm and Kybella for marionette lines and jowls (Plastic and Reconstructive Surgery Global Open)
• FDA: Dermal fillers (soft tissue fillers)
• American Academy of Dermatology: Fillers FAQs
• Hughes et al. 2013, sunscreen and prevention of skin aging (Annals of Internal Medicine)
• Shu et al. 2022, at-home radiofrequency split-face trial (Dermatology and Therapy)