Here's How to Reduce Marionette Lines

By Dr. Stephen Cosentino

PRESIDENT OF EMPIRE MEDICAL TRAINING

Also known as melomental folds, marionette lines are vertical lines or creases that frame the chin, beginning at the corners of the mouth. They look like the creases that allow old-timey ventriloquist dolls to move their mouths, hence the name.

Marionette lines typically appear in early middle age and deepen as we get older. They’re graded by severity: mild, moderate, or severe. They’re an inevitable sign of aging for many people and can be exacerbated by factors like excessive sun exposure, smoking, weight swings, and genetics.

Marionette lines often appear alongside (or, rather, under) nasolabial folds (smile lines), which extend from the sides of the nose to the corners of the mouth. While there’s no guaranteed way to prevent marionette lines and nasolabial folds for life, reliable treatments exist when they do occur.

How to Reduce Marionette Lines: Minimally Invasive Treatment Options

There are several minimally invasive cosmetic procedures that can temporarily treat marionette lines and nasolabial folds. 

Most work best for mild marionette lines. Some work for moderate marionette lines as well.

Botulinum Toxin (Botox® or Alternatives)

Many patients get Botox for marionette lines, or one of several competing botulinum toxin treatments (Dysport®, Xeomin®). Botox injected at the correct part of the corner of the mouth can temporarily weaken the muscles underlying the marionette lines, softening their appearance. Botox effects generally last 3 to 6 months, after which repeat treatment is necessary.

Dermal Fillers (Hyaluronic Acid or PLLA)

Hyaluronic acid filler is another common marionette line treatment. It’s an anti-aging treatment that temporarily counteracts loss of volume in the skin by mimicking collagen, a naturally occurring volumizer. Its effects last 6 to 12 months.

PLLA filler is a longer-lasting filler option that stimulates collagen and elastin production, sustainably restoring volume and reducing marionette lines. Effects last at least two years, which makes it all the more important to work with a provider who has completed advanced Botox and dermal filler training.

Laser Treatments

Laser resurfacing uses lasers to remove super-thin layers of the skin, subtly reshaping the treated areas of the face and encouraging new skin cells to form. Effects last a few months, after which the area returns to its original shape.

Chemical Peels

Chemical peels also resurface the skin, reducing the appearance of facial wrinkles and fine lines. There’s a limit to what they can accomplish though; they’re best suited to mild marionette lines.

Plastic Surgery: A Permanent Solution for Marionette Lines?

All of the minimally invasive options to treat marionette lines have something in common: their results are temporary. 

True, some last longer than others. PLLA filler results can persist for several years, for example. But all eventually stop working, returning your face to the pre-intervention status quo. 

The exception to the “marionette line treatments are temporary” rule is proper plastic surgery. Specifically, a surgical facelift (either a full or mini-facelift). 

This procedure requires general anesthesia rather than local anesthetic. As such, it’s much riskier than minimally invasive alternatives. It has a much longer recovery time too. 

The upside is that a surgical facelift can permanently alter the appearance of the face, “writing over” marionette lines in a way that’s simply not possible otherwise. If you want a permanent solution, it’s your only real option.