Unfortunately during the natural ageing process a downturned mouth with lines and folds that make you look sad can appear. This can be especially annoying as it can make you look older than you are. Similar to a marionette puppet’s face these lines look like you are able to open and close your mouth without the rest of your face moving.

Marionette lines and folds are caused by three different things: gravity, loss of volume and the action of the depressor muscles at the corners of the mouth. Gravity affects your face every day. As time goes on the down and inward movement of the face can result in marionette folds and nasolabial lines. Volume loss is also a big factor that contributes to the development of lines and folds. Loss of skin elasticity and collagen depletion is the underlying cause. Where soft tissue is lost and where the bone of the mandible becomes thinner and reabsorbs (especially if the patient is missing teeth) it can become more evident. Finally, when the depressor muscles at the corner of the mouth are constantly activated these can contribute to the development of marionette lines and folds. As with any other sign of skin ageing, lifestyle factors can also have a negative impact. A good skincare routine, adequate sleep (preferably on your back) optimal nutrition, staying away from the sun or using SPFs daily and curbing weight fluctuations will have a preventative effect. 

How to treat marionette lines and folds

Hyaluronic acid fillers such as Juvéderm can be injected below the corners of the mouth to lift the smile and fill out small creases. Mr Ferrando is an expert at treating lines with Juvéderm as well as other fillers too. If there are very deep lines either a thread lifts or even face lift or lower lift surgery may be an option to pull the skin taut. 

Botox may also be used on depressor muscles to stop them activating and causing the lines in the first place.

An experienced plastic surgeon such as Mr Ferrando will be able to determine the best treatment option for you depending on your age and what your expectations are as some treatment options will only be suitable for the earlier stages of marionette lines while others are for patients with more advanced cases.