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

“I want to know how to get rid of marionette lines instantly.”
“My marionette lines are prominent and make me look 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 at the cosmetic dermatology practice Smart Skin Clinic.

In this article, we provide a clear, expert explanation of marionette line concerns, covering everything from their causes to home care and treatments.

If you only want to know about specific treatments and care methods, you can jump to the relevant section from the table of contents.

Supervisor Information

Group Chief Director, Smart Skin Clinic Group

IshiiIshii KotaKota

Career

Graduated from Juntendo University School of Medicine

Worked at Tokyo Women's Medical University Hospital and affiliated facilities

Worked at a major aesthetic clinic in Tokyo

Affiliations / Qualifications

Board-certified specialist, Japan Surgical Society

Board-certified specialist, Japanese Society of Anti-Aging Medicine

What are marionette lines?

Marionette lines are the wrinkles that extend downward from the corners of the mouth. They are named for their resemblance to the mouth of a string-controlled marionette puppet, with prominent lines and creases around the mouth and chin.
They are a symptom that appears with aging.

Causes of marionette lines

The main causes of marionette line formation are:Age-related structural changes in the facial bones, muscles, fat, and skin; ultraviolet exposure; and lifestyle habits.
Here we explain how each of these factors contributes.

Muscle changes

The factor with the greatest influence on marionette lines is changes in the muscles. Looseness, tension, and stiffening of these muscles lead to marionette lines.

depressor anguli 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.
As muscle strength declines and skin elasticity decreases with age, it becomes harder to lift the corners of the mouth, and deep grooves form along 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 them.
The orbicularis oris muscle does not function on its own. It is connected to the surrounding muscles and skin by a thin tissue called fascia. The role of the fascia is to envelop the orbicularis oris muscle and support its smooth movement.

As the orbicularis oris muscle weakens with age, the surrounding fascia is affected at the same time, weakening the support around 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 jaw angle 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, its development and tension can contribute to facial sagging.

If the masseter muscle is strongly developed, the jaw angles tend to be more pronounced, and the fat and skin around the chin are more prone to dropping. This ultimately makes marionette lines more prominent, so it warrants attention.

platysma muscle

The platysma is a thin, sheet-like muscle on the front of the neck. As its name (the broad neck muscle) suggests, it covers a wide area from the jaw to the chest. Because the facial and neck muscles work together, the platysma also affects the facial muscles.

The role of the platysma is to lift the skin from the neck to the chin and keep it taut. However, as the platysma weakens with age, the skin of the neck and chin tends to sag. The skin of the entire face is more prone to dropping, causing sagging around the mouth and chin and making marionette lines more prominent.

Aging is not the only cause of platysma weakening; poor posture is also a contributing factor. In particular, be mindful of leaning forward when using a smartphone or computer.

Skin changes

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

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

You may also readily notice a decline in the skin’s ability to retain moisture and a tendency to dry out. When the stratum corneum on the skin’s surface lacks moisture, the skin becomes hard and rough in texture and its fine texture is disrupted. In this state, light reflects unevenly, making wrinkles and marionette lines more noticeable.

Fat changes

Fat is located beneath the skin and above the muscles. Pads of fat exist in the cheeks, under the eyes, and around the mouth, shaping the contours of the face. However, as we age, this fat atrophies or drops in position, changing the facial contours and causing sagging.

The fat pad that directly affects marionette lines is the thick buccal fat located in the cheeks. It plays an important role in creating the roundness of the face, but as it drops with age, the cheeks sag and marionette lines become more prominent.

In addition, a high amount of facial fat makes marionette lines more likely to form.

bone atrophy

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

As the jaw and cheek bones involved in marionette lines shrink, they provide weaker support for the skin and fat, so the skin becomes excess and prone to sagging. This makes marionette lines more likely to form.

Lifestyle habits

Lifestyle habits also make marionette lines more likely to develop.
Examples include the following:

Skin deterioration due to insufficient UV protection

Marionette lines are worsened by sagging, andsagging is caused by UV-A, which accounts for 90% of ultraviolet rays.UV-A penetrates glass and reaches deep into the dermis, degrading collagen and elastin.
80% of aging is said to be caused by ultraviolet rays,so remember that even when you spend time indoors, you are still exposed to the causes of marionette lines.

Smartphone posture

Poor posture is also directly linked to marionette lines. Be especially careful about overusing your smartphone. When your back is rounded and your face is tilted forward at an angle, it becomes difficult to engage the platysma running from the mouth to the neck. As a result, the facial muscles sag.

Often expressionless

When anyone makes a straight face, the mouth naturally forms an inverted-V shape. Staying expressionless causes the muscles around the mouth and the cheeks to drop, leading to marionette lines. Without conscious effort, the corners of the mouth only continue to droop.
Many people have keenly felt the importance of facial expressions during life behind a mask.

Habit of chewing on one side, or resting your chin on your hand

If you have a habit of chewing on one side when eating, the muscles on the left and right cheeks become imbalanced. Likewise, people who habitually rest their chin on their hand put strain on one cheek, creating a difference in how the muscles work. As a result, the skin on one side sags, contributing to marionette lines.

Grinding and clenching of the teeth

Grinding or clenching your teeth while sleeping causes the masseter muscle that moves the jaw to contract and develop. The depressor anguli oris muscle, which lowers the corners of the mouth, also becomes tense and stiff.

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

Dental alignment・A poor bite

When your bite is poor, the muscles around the mouth become imbalanced. This left-right imbalance in the muscles around the mouth causes the skin to sag, making marionette lines more likely to appear.

Home care to improve and prevent marionette lines

To help prevent marionette lines and maintain the results of treatment, the following approaches are recommended:

Because the factors behind marionette lines interact with one another, a multifaceted approach is needed for improvement and prevention.

Correct posture and proper muscle usepractice

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

It is difficult to improve deeply etched marionette lines through home care.However, training the muscles involved in marionette lines can help improve and prevent mild sagging. Muscles can be trained even as you age. Aim for a beautiful facial line and upturned corners of the mouth.

Moisturizing and UV protection

Moisturizing is the foundation of any skincare routine. By replenishing moisture and oil and keeping the skin’s surface supple, the grooves caused by sagging become less noticeable.

For UV protection, use a parasol and sunglasses when going out, of course, and remember to apply sunscreen even when you are indoors. The effects of ultraviolet rays are hard to notice at the moment of exposure, but they gradually bring about changes within the skin.

A nutritionally balanced diet

Your diet also affects the condition of your skin. A nutritional imbalance weakens not only the skin but also the metabolism and repair capacity of the bones and muscles, leading to sagging and puffiness.

Be sure to get dietary fiber, minerals, and adequate water intake, as well as the protein and vitamin A that make up your skin.

If you’re not sure what to eat, using a simple nutrition-management app can be helpful.

Makeup to camouflage marionette lines

Apply a concealer lighter than your skin tone below the corners of your mouth and gently blend it upward with your finger. If you apply it over the entire marionette line, the concealer will pool in the groove and actually make it more noticeable.

To keep attention away from the marionette lines, it helps to place the focus of your makeup on the upper half of the face. For example, applying blush and highlighter higher up can create a natural camouflage.

Cosmetics to care for marionette lines

Marionette lines are a form of sagging. Because sagging is caused not only by the skin but also involves the muscles and bones, no cosmetic product can fundamentally correct it.

For daily skincare, you may want to use medicated cosmetics that are effective on deep wrinkles.

Cosmetic ingredients recognized for improving deep wrinkles include “retinol,” “niacinamide,” “NEI L1®,” and “Rice Power® Extract No.11.”

All of these can be expected to help stimulate collagen production.

Types of treatment for marionette lines

We have compiled the treatments for eliminating marionette lines in the table below.

Item	Juvelook Volume (Lenisna) Injection	Shopping Lift	Gouri Injection	profhilo injection	PRPF injection	Excision lift (facelift)
Treatment description	Injects a formulation combining non-cross-linked hyaluronic acid and polylactic acid	Insertion of ultra-fine dissolvable threads made primarily of PDO (polydioxanone)	Injects a liquefied formulation of PCL (polycaprolactone)	Injects a formulation combining high- and low-molecular-weight hyaluronic acid	Injection of PRP extracted from your own blood, combined with growth factors	The skin is incised and excess skin is removed
Effect	Promotes collagen production and improves firmness and radiance	Promotes collagen and elastin production, provides a natural lift, and improves skin firmness and radiance	Promoting collagen production	Moisturizes, improves firmness and elasticity, and adds natural volume	Promotes collagen and elastin production and improves skin thickness	Lifting and rejuvenation of the mouth area and the entire face, including marionette lines
When the effect appears	After 2 to 3 weeks	Gradually, starting immediately after the treatment	Gradually from a few days later	A few days to a few weeks later; peaks after about one month	2–4 weeks later, with a peak at 3–6 months	Immediately after treatment
Duration of effect	1 to 2 years	1 to 1.5 years	6 months to 1 year	6 months to 1 year	5 years	5 to 10 years
Downtime	24 hours / pain, redness, swelling, bruising	A few days / mild swelling, redness, and bruising	24 hours / redness, bumps, bruising	24 hours / puffiness, redness, swelling, bruising	A few days / mild swelling, redness, and bruising	2–3 weeks / swelling, bruising, and a sensation of tightness

Juvelook Volume (Lenisna) Injection

Juvelook Volume (Lenisna) is an injectable that combines non-cross-linked hyaluronic acid with polylactic acid (PDLLA).

Compared with Juvelook, its particles are larger and work in the deeper layers of the skin, which can help build volume. It promotes the production of collagen and elastin and is effective for deep wrinkles such as marionette lines.

Shopping Lift

The Shopping Lift is a non-surgical treatment that inserts dissolvable threads into the skin.
As the threads are absorbed, collagen is produced, improving marionette lines over the long term.

Gouri Injection

Gouri injection is a liquefied injectable containing PCL (polycaprolactone) that is effective for lifting and improving sagging, particularly marionette lines.

PCL is used as a medical suture material; as it gradually breaks down in the body, it promotes collagen production over an extended period, tightening sagging areas.

profhilo injection

It combines high concentrations of high- and low-molecular-weight hyaluronic acid, working in the deep layers of the skin to help restore elasticity.

It can help reduce the appearance of deep wrinkles and sagging around the mouth, as well as marionette lines.

 PRPF injection

This is a regenerative medicine treatment that uses PRP (platelet-rich plasma) derived from your own blood, to which FGF (fibroblast growth factor, which stimulates the fibroblasts that produce collagen and other substances) is added. It can offer long-term benefits for improving wrinkles such as marionette lines and nasolabial folds, as well as for skin rejuvenation.

Because it uses your own blood to promote the regeneration of your own tissue, it is recommended for those who are hesitant about injecting a foreign substance or undergoing surgery. At our clinic, we customize the concentration and injection volume of PRPF for each patient.

For more information on PRPF injections, please also see the following article:

Excision lift (facelift)

This is a surgery in which an incision is made in the skin to lift sagging tissue.
By removing excess skin and tightening the skin and muscles, it can deliver long-lasting results for severe marionette lines.

Points for avoiding disappointment in marionette line treatment

To avoid disappointment in marionette line treatment, preparation before treatment is important.

When choosing a clinic, check the fees and reviews. In the reviews, look not only at treatment results but also at whether a doctor provides the consultation, whether the treatment is explained appropriately beforehand, and whether there is any hard-selling.

Note that whether fees such as consultation, needle, anesthesia, and aftercare charges apply varies by clinic. It is a good idea to also confirm the total cost of one full course, including the second and subsequent sessions.

Frequently asked questions about marionette lines

Do marionette lines improve when you lose weight? Or do they get worse?

When the fat that is one cause of marionette lines shrinks, the lines will become less noticeable. However, if you lose weight rapidly, the reduced fat leaves excess skin, making marionette lines more likely to form. By losing weight gradually, the skin has time to contract accordingly and is less likely to be left slack.

How can I remove marionette lines instantly?

To remove marionette lines quickly, options include filling the wrinkle indentation with an injectable, or lifting the skin with a thread lift or excision lift. That said, choose a treatment based not only on efficacy but also on downtime, scarring, and how long the results last.

For marionette line concerns, turn to Smart Skin Clinic

Because marionette lines are linked to the deterioration of the skin and muscles, they become more likely to appear with age.

Cosmetic treatments are effective for improving marionette lines, but maintenance and self-care are also important to sustain the results. Choose a treatment suited to your condition and as easy to keep up as possible.

At our clinic, we do not use cosmetic counselors; instead, a doctor provides the consultation directly and proposes the optimal treatment. We keep costs down, offer carefully selected products, and never engage in aggressive sales.

If you are troubled by marionette lines, please come and consult with us.