Marionette Lines

Marionette lines are the folds or creases that run from the corners of the mouth toward the chin. They form part of the lower-face structure and are influenced by:

• Skin quality and elasticity which declines with age
• Subcutaneous fat pads in the cheeks and jowls, which provide support
• Underlying bone structure in the mandible and midface, which maintains facial projection

In younger faces, these lines are typically subtle or only visible during expression. Ageing and repeated facial movements gradually convert these dynamic lines into permanent creases.

Key factors that maintain youthful lower-face contours include:

• Strong collagen and elastin fibres for elasticity
• Full, well-positioned cheek and jowl fat pads for lift
• Stable mandible and maxilla structure for midface and lower-face support

With time, the following changes contribute to more pronounced marionette lines:

• Skin thinning due to reduced collagen and elastin
• Fat loss and descent in the cheeks, midface, and jowl area
• Bone resorption in the mandible and maxilla reducing support
• Repeated facial movements such as smiling and speaking
• Dehydration and loss of skin elasticity often due to declining hyaluronic acid levels

These combined changes make marionette lines visible even at rest and contribute to a downturned mouth appearance.

Marionette lines form and deepen due to a combination of intrinsic ageing, genetics, and lifestyle factors. Key contributors include:

1. Collagen and Elastin Decline: From the mid-twenties, collagen and elastin production decreases. The skin becomes thinner and less resilient, allowing creases to deepen over time.
2. Midface and Lower-Face Volume Loss: Ageing leads to the descent and loss of cheek, jowl, and perioral fat pads. Reduced support for the corners of the mouth allows marionette lines to become more pronounced.
3. Bone Changes: Gradual resorption in the mandible and maxilla reduces lower-face projection, contributing to sagging and crease formation.
4. Repetitive Facial Movement: Speaking, smiling, and other expressions create dynamic lines that can become permanent with repeated use.
5. Lifestyle and Environmental Stressors:

• UV exposure
• Smoking
• Poor nutrition
• Chronic stress

These factors accelerate collagen breakdown and loss of skin elasticity, exacerbating lower-face ageing.

While marionette lines cannot be completely erased, consistent care can maintain skin resilience, volume, and lower-face contour.

Skincare Essentials

Maintaining the skin’s structural integrity is central to slowing the progression of marionette lines. Focus on:

• Sun Protection: Daily broad-spectrum SPF preserves collagen and elastin, slowing line formation.
• Retinoids: Stimulate collagen and increase skin thickness to reduce early lines.
• Antioxidants: Vitamin C, niacinamide, and resveratrol protect against oxidative stress.
• Hyaluronic Acid and Moisturisers: Hydration plumps the skin and improves resilience.
• Peptides: Encourage collagen and elastin production for long-term firmness.

Lifestyle Optimisation

• Avoid Smoking: Smoking accelerates collagen breakdown and promotes sagging.
• Hydration: Adequate water intake maintains skin plumpness and elasticity.
• Nutrition: Antioxidant-rich diets support skin structure from within.
• Sleep and Stress Management: Quality rest and stress reduction help maintain collagen health.

Gentle Facial Massage

• Use light, upward movements around the cheeks and jawline.
• Avoid excessive pressure to prevent overstretching delicate tissue.
• Combine with hydrating creams or serums for added benefit.

Professional treatments can soften marionette lines, restore lower-face support, and enhance overall rejuvenation. The most effective approaches target volume loss, skin quality, and tissue support.

1. Marionette Filler and Non-Surgical Face Lifts

Marionette fillers provide a reliable solution for marionette lines by restoring support to the corners of the mouth and surrounding midface. Non-surgical face lifts combine multiple filler placements to lift, volumise, and harmonise the lower face.

Benefits include:

• Immediate softening of marionette lines
• Restoration of midface and lower-face volume
• Improved skin hydration and quality
• Subtle collagen stimulation for longer-term benefits

At Dr Hass Clinic, all treatments are performed by Dr Hasaneen Al Janabi, a Royal College of Surgeons member with expertise in advanced facial anatomy, ensuring natural, balanced results.

2. Lip Filler

Lip fillers can complement marionette line treatment by supporting perioral structure. Enhancing lip volume lifts the mouth corners and reduces tension on the surrounding skin, improving the appearance of creases.

3. Endolift® and Energy-Based Treatments

Endolift®, a minimally invasive laser, tightens the skin and stimulates deep collagen remodelling. It is effective for marionette lines when combined with filler or as part of a full-face rejuvenation plan. Standard laser and radiofrequency devices also improve skin elasticity, firmness, and texture.

By combining filler, lip treatments, and energy-based procedures, marionette lines can be addressed from multiple angles for a naturally lifted and rejuvenated appearance.

Marionette lines are a natural part of ageing but do not need to define your expression. With preventive skincare, lifestyle optimisation, and professional treatments, it is possible to soften lines, restore volume, and maintain a youthful lower-face contour.

Among available treatments, nasolabial filler, full face rejuvenation, Endolift®, and lip fillers offer immediate, effective, and long-lasting results. At Dr Hass Clinic, every treatment is performed with precision and personalised care to deliver natural, elegant, and harmonious outcomes.