Marionette lines: what they are and how to treat them

Marionette lines are the folds that run down from the corners of the mouth toward the chin, on both sides. The name comes from marionette puppets, whose mouth opens through a vertical slit in that position. They often come together with downturned mouth corners, which gives the face an expression of sadness or tiredness even at rest.

Why do they appear?

Several causes act together. Cheek fat loses volume and descends, the skin loses elasticity and the jawbone is resorbed. At the same time, the depressor anguli oris muscle pulls the corner of the mouth downward. The result is a fold that separates the cheek volume from the chin area and interrupts the jawline.

How does HOF usually approach this area?

The assessment looks for the predominant cause. The options discussed include:

• filler in the mouth corners and the fold area to provide support;
• botulinum toxin in the depressor anguli oris muscle, to reduce the downward pull;
• treatment of the jawline and chin, which can redraw the transition;
• biostimulators for skin quality.

The plan and dose are defined by the qualified professional, after assessment. As in the whole perioral area, hyaluronidase must be available when hyaluronic acid is used.

In Harmy

In the marking, the area corresponds to the Mouth Corner point. Combining it with the Jawline point in the same projection helps show the patient the effect of the whole.

Also called: marionette fold, labiomandibular fold, sadness lines.