Marionette lines｜Doctors explain causes, prevention, and how to remove them immediately.

I want to know how to get rid of marionette lines instantly."
The marionette lines are prominent and give the impression of being grumpy."
What causes marionette lines and what can be done about them?"

Do you have any of these questions or concerns about marionette lines?

Hello. I am a doctor of cosmetic dermatology and Smart Skin Clinic.

In this issue, we will provide an easy-to-understand explanation of marionette line problems, from causes to home care and treatment methods, from an expert's perspective.

If you want to know only specific treatment and care methods, you can jump to the appropriate section from the Table of Contents.

Table of Contents

What are marionette lines?

Marionette lines are wrinkles that extend downward from the corners of the mouth. They are so called because of the prominent lines and cracks around the mouth and chin area, similar to the mouth of a marionette doll that is manipulated with strings.
It is a symptom that appears with aging.

Causes of marionette lines

The main cause of marionette line formation,Structural changes in facial bones, muscles, fat, and skin with aging, ultraviolet rays, and lifestyleIt is.
This section describes how these factors affect

Muscle Changes

The most important factors affecting marionette lines are changes in the muscles. Loosening, tension, and hardening of these muscles lead to marionette lines.

Directly related muscles: orbicularis oris muscle and submucosa
Muscles indirectly affected: masseter muscle and broad cervical muscles

orbicularis oris muscle

These muscles extend from the corners of the mouth to the chin and are responsible for pulling up the corners of the mouth.
Due to weakened muscles and aging skin elasticity, the corners of the mouth become difficult to lift, resulting in deep furrows carved into the muscle borders, giving rise to marionette lines.

orbicularis oris muscle

The orbicularis oris muscle is a ring-shaped muscle that surrounds the lips and is used to close and purse the lips.
The orbicularis oris muscle does not function alone. It is connected to the surrounding muscles and skin by a thin tissue called fascia. The role of the fascia is to wrap around the orbicularis oris muscle and help it move smoothly.

As the orbicularis oris muscle deteriorates with age, the surrounding fascia is affected at the same time, weakening the support of the mouth. As a result, the skin tends to sag, leading to deep wrinkles such as marionette lines.

masseter muscle

The masseter muscle extends from below the ear to the gills and is responsible for moving the jaw when chewing. It has a significant impact on facial expression and contours.

Although the masseter muscle itself does not directly form marionette lines, the development and tension of the masseter muscle can affect facial sagging.

If the masseter muscle is strongly developed, the gills are more easily accentuated and the fat and skin around the chin is more likely to drop. This results in a more prominent marionette line, which should be noted.

broad neck muscle

The broad cervical muscles are thin membrane muscles located on the front of the neck. As the name implies, the broad cervical (neck) muscles extend from the jaw to the chest. Because the muscles of the face and neck are interlocked, the broad neck muscles also affect the muscles of the face.

The role of the broad cervical muscles is to pull up the skin from the neck to the chin and keep it taut. However, as the broad cervical muscles deteriorate with age, the skin of the neck and chin tends to sag. The skin of the entire face tends to droop, causing sagging around the mouth and chin, and marionette lines may become more prominent.

Aging is not the only cause of broad cervical muscle weakness. Poor posture is also a contributing factor. In particular, be careful not to lean forward when operating a smartphone or computer.

Skin Changes

The skin is composed of three layers: epidermis, dermis, and subcutaneous tissue. As aging progresses, the skin undergoes various changes.

Decreased firmness and elasticity
Decreased moisture retention

First is the decrease and degeneration of the components in the dermis that maintain skin firmness and elasticity, such as collagen and elastin. Skin sags and grooves form, and deep wrinkles, especially marionette lines, are more likely to occur.

You will also likely notice a decrease in the skin's ability to retain moisture and a tendency to dry out easily. When the stratum corneum on the skin's surface lacks moisture, the skin becomes hard and rough in texture, and the texture is disrupted. In this condition, light reflection becomes uneven, making wrinkles and marionette lines more visible.

Fat changes

Fat is located under the skin and above the muscles. Fat lumps exist in the cheeks, under the eyes, and around the mouth, forming the contours of the face. However, as we age, fat atrophies or drops in position, changing the contours of the face and causing it to sag.

Fat atrophy
Fat drooping

The fat mass that directly affects marionette lines is the thick bacal fat located on the cheeks. It plays an important role in rounding the face, but as it drops with age, the cheeks droop and marionette lines become more prominent.

In addition, high facial fat content is more likely to cause marionette lines.

bone atrophy

Bones are the foundation that supports skin and muscles, but bone density decreases and atrophies with age.

The smaller jaw and cheek bones involved in the marionette lines weaken the support of the skin and fat, resulting in excess and sagging skin. This makes it easier for marionette lines to form.

one's lifestyle

Lifestyle habits also tend to cause marionette lines.
Examples include.

Skin deterioration due to lack of UV protection
smart phone posture
expressionless
Habit of chewing on one side or cheekbones
Grinding and clenching of teeth
Poor dental alignment and bite

Skin deterioration due to lack of UV protection

Marionette lines are exacerbated by sagging, though,UV-A, which accounts for 90% of UV rays, causes saggingUV-A can penetrate glass and reach the dermis, denaturing collagen and elastin.
80% of aging is caused by ultraviolet raysThat being said, let us not forget that we are exposed to the causes of marionette lines even when we are indoors.

smart phone posture

Poor posture is also directly related to marionette lines. In particular, be careful not to use your phone too much. If the back is rounded and the face is slumped forward at an angle, it is difficult to apply strength to the broad cervical muscles from the mouth to the neck. As a result, the facial muscles sag.

Often expressionless

When anyone makes a straight face, the mouth naturally turns into a "he" shape. When we are expressionless, the muscles around the mouth and cheeks drop, leading to marionette lines. The corners of the mouth will only go down if we are not conscious of it.
Many of you have probably realized the importance of facial expressions in your masked lives.

Habit of chewing on one side or cheekbones.

The habit of chewing with one side of the mouth when eating causes an imbalance in the muscles of the left and right cheeks. In addition, people who are in the habit of chewing with their cheekbones will put more stress on one side of the cheek, resulting in a difference in muscle function. As a result, the skin on one side sags, causing marionette lines.

Grinding and clenching of teeth

Grinding or clenching of the teeth while sleeping causes the masseter muscles that move the jaw to contract and develop. The submucus muscles that lower the corners of the mouth also tense and stiffen.

As a result, the corners of the mouth drop, the skin around the mouth sags, and marionette lines become more visible.

set of teethPoor occlusion

When a person has a bad bite, the muscles around the mouth become unbalanced. The left-right difference in the muscles around the mouth causes the skin to sag, and marionette lines are more likely to appear.

Home care to improve and prevent marionette lines

To prevent marionette lines and maintain the effectiveness of treatment, the following methods are recommended

Maintain correct posture and use of muscles in the body
Moisturizing and UV protection
well-balanced diet

Because the effects of marionette lines are compounded, a multifaceted approach is required for improvement and prevention.

Correct posture and muscle usekeep in mind

The key to improving and preventing marionette lines is to develop proper posture and muscle use.

Difficult to improve deeply carved marionette lines with home careHowever, training the muscles involved in the marionette lines can help improve and prevent mild sagging. Muscles can be trained even as you age. Aim for beautiful facial lines and upturned corners of the mouth.

Posture when using a smartphone: Sit in a chair, hands at the base of the legs, chest out, and the smartphone screen at eye level.
Posture when using a computer: Sit deeply in a chair so that the entire sole of the foot is in contact with the floor. The display should be at the same height or slightly lower than the eye level, with a distance of at least 40 cm.
Rest: Take a break every hour to rest muscles.
Exercise for the mouth: Say "Aiueo" while looking in the mirror. Do it while checking that the corners of the mouth are properly raised.
Neck exercise: Slowly tilt and stretch the neck back and forth from side to side.

Moisturizing and UV protection

Moisturizing is the foundation of any skin care regimen. By replenishing moisture and oil and maintaining the suppleness of the skin's surface, the skin grooves caused by sagging become less noticeable.

To protect against ultraviolet rays, remember to use a parasol and sunglasses when going outside, and also remember to apply sunscreen even when you are inside the house. Although the effects of ultraviolet rays are difficult to see at the moment of exposure, they cause gradual changes inside the skin.

nutritiously balanced diet

Dietary habits also affect skin conditions. Nutritional imbalance can lead to a decline in the metabolism and repair of bones and muscles as well as skin, leading to sagging and swelling.

Don't forget to consume dietary fiber, minerals, and water intake, as well as protein and vitamin A, which are the building blocks of skin.

If you don't know what to eat, you can use a simple nutrition management app.

Makeup to camouflage marionette lines

Apply a concealer lighter than your skin under the corners of your mouth and gently blend it upward with your finger. If you apply it to the entire marionette line, the concealer will pool in the grooves and become more noticeable.

To avoid drawing the eye to the marionette line, it is best to place makeup points on the upper half of the face. For example, blush and highlighter can be placed high to naturally camouflage them.

Cosmetics to care for marionette lines

Marionette lines are a form of sagging. Since sagging is caused not only by skin but also involves muscles and bones, there is no cosmetic product that can fundamentally improve it.

For daily skin care, medicated cosmetics that are effective against deep wrinkles may be used.

Cosmetic ingredients that have been shown to improve deep wrinkles include Retinol, Niacinamide, Neil One®, and Rice Power® Extract N0.11.

Both are expected to stimulate collagen production.

Types of treatment for marionette lines

The following is a list of treatments to eliminate marionette lines.

(data) item	Jubeluk Volume (Renishna) Injection	shopping lift	GOURI Injection	profilo injection	PRPF injection	Incision lift (facelift)
Treatment Description	Injection of a formulation containing non-cross-linked hyaluronic acid and polylactic acid	Insertion of ultrafine, dissolvable threads made primarily of PDO (polydioxane-on)	PCL (polycaprolactone) liquefied formulation injected	Injection of a formulation containing high molecular weight and low molecular weight hyaluronic acid	Injection of PRP extracted from autologous blood plus growth factors	Skin incision is made and excess skin is removed
Effect	Promotes collagen production and improves firmness and luster	Promotes collagen and elastin production, natural lifting, and improvement of skin elasticity and luster	Promotes collagen production	Moisturizing, improved firmness and elasticity, natural volume increase	Promotes collagen and elastin production and improves skin thickness	Lifting and rejuvenation of the mouth and entire face including marionette lines
Time of onset of effect	2 to 3 weeks later	Gradually, immediately after the treatment.	Gradually after a few days	Days to weeks later, peak in a month.	2-4 weeks later, peak 3-6 months later	Immediately after treatment
Duration of effect	1-2 years	1 to 1.5 years	6 months to 1 year	6 months to 1 year	5 years	5 to 10 years
Down time	24 hours / Pain, redness, swelling, internal bleeding	A few days / mild swelling, redness, internal bleeding	24 hours / Redness, bumps, internal bleeding	24 hours / Puffiness, redness, swelling, internal bleeding	A few days / mild swelling, redness, internal bleeding	2-3 weeks / swelling, internal bleeding, sticking sensation

Jubeluk Volume (Renishna) Injection

JUVELUX Volume (RENISNA) is an injectable drug that combines non-cross-linked hyaluronic acid with polylactic acid (PDLLA).

Compared to JUVELUX, its particles are larger and work deeper into the skin to increase its volume. It promotes the production of collagen and elastin, and is effective for deep wrinkles such as marionette lines.