One of the early signs of ageing shown on our face is marionette lines – the lines appearing at the corners of the mouth.
Marionette lines
Marionette lines are the lines that extend from the corner of mouth down to jawline as a result of ageing, genetics, or facial muscles. They are also known as puppet lines because of the shared feature of marionette string puppets.
Like nasolabial folds, marionette lines are common wrinkles appearing on faces. Some people may have deep marionette lines accompanied with deep arc-shaped depressions on the outside or below the corners of the mouth. These 2 deep lines may not be necessarily long, but they will make us look tired and older.
Causes
Marionette lines are caused by a decrease in soft tissue volume, loss of structural support, loss of collagen, etc. Let’s talk about them.
1、Repetitive facial movements:The facial movement that involves the rise of the corner of the mouth will encourage the formation of marionette lines due to the fact that there is increased pressure acted on the muscles located at the corner of the mouth and the cheekbone. Facial expression such as laughing, smiling, chewing food on one side, and smoking can deepen existing or creating new lines on the face.
2. Excessive weight loss/collagen loss: Losing weight too fast will cause a quick loss of skin collagen and supporting soft tissues, making the skin loose and sagging.
3. Natural facial profile: People with high cheekbones, prominent chin or sunken cheeks are prone to nasolabial folds and marionette lines.
4. Bone structure changes: As we age, we naturally lose the volume of the upper jawbone and cheekbones, accompanied with the volume loss of the upper jawbone and less prominent of the chin, resulting in losing facial structural support and causing the face to sag. The sagging tissues eventually accumulate on the lower face, forming marionette lines and fat pockets around the mouth.
Symptoms
There are dynamic and static types.
① Dynamic Marionette Lines
Dynamic lines are the lines that are only noticeable when you have facial muscles movement, otherwise they do not see them.
② Static Marionette Lines
Static marionette lines often appear in middle-aged and elderly people as they have significant loss of collagen/elasticity, fat depletion, and decreased volume of soft tissues. Therefore, treatment for marionette lines should be determined according to the individual’s situation.
Marionette lines, fat pockets around mouths and sagging skin on the mouth corners often appear together.
Affect People
Marionette lines often appear on people over 40, indicating the beginning of the third stage of skin ageing. Marionette lines do not appear alone, they come with sagging soft tissues at the midface, fat pockets around the mouth, fine lines around the mouth and sagging skin at the corners of the mouth. The appearance of marionette lines is telling us that ageing is happening in the body and that it requires our attention.
Asians often have a less supportive facial structure because of the relatively receded chin and receded inner side of the upper jaw. On top of the natural bone structure loss, they are more likely to develop marionette lines.
Treatment
For marionette lines caused by moderate to severe skin laxity, medical beauty and anti-ageing treatments are recommended. For marionette lines caused by fat pockets at the corners of the mouth and skin laxity, injection and anti-ageing treatments are suggested. Here are the treatments that Ai Beauty Clinic offers to get rid of your marionette lines.
Option 1: Reduce marionette lines by anti-ageing treatment around the mouth
Fotona 4D PRO is highly recommended. The device has a treatment mode called “SMOOTH” that specifically provides an anti-ageing effect to the areas around the mouth. During the treatment, a treatment head will contact the oral mucosa inside the mouth and heat up the skin. It results in tightening the skin and improving nasolabial folds, marionette lines, and fine lines around the mouth. Also, the equipped “PIANO” system can improve skin sagging problems such as double chin and fat pockets around the mouth. Recommended treatment courses are at least 3-6 times a year.
Option 2: Improve skin sagging by treating the loss of collagen around the moth
Treatment including deep structural support + volume addition at superficial layer + tightening skin around the mouth can be used to effectively reduce wrinkles/lines around the mouth.
Deep structural support: Injecting hyaluronic acid to rebuild lost collagen and replenish volume. Ligament injection to lift the sagging skin around the mouth.
Volume addition at superficial layer: Injecting high viscosity filler into the skin according to the direction of muscle movement to pump up the face naturally.
Loose skin around the mouth: Injection at the muscles at the corners of the mouth, neck muscle and superficial muscle in the neck to relax the ligaments and muscles caused by facial movement and to slow down the ageing process.
Option 3:It is better to recommend the scheme of photoelectric combined injection with the treatment scheme of comprehensive rejuvenation of the lower part of the mouth and radiation.
Step 1: Fotona 4D PRO “SMOOTH” mode + Enhanced PIANO – to reduce appearance of lines around the mouth and improve fat pockets at the corners of the mouth.
Step 2: To treat the collagen loss at the corners of mouth, it is recommended to have injections at the area from the corners of the mouth down to the lower jaw by using a layering technique. It can build structural support and pump-up superficial skin.
Step 3: Ligament laxity in the middle and lower face can make the sagging skin around the mouth look worse. Therefore, treatment of both the middle and lower face is more effective and shows better improvement than a treatment of skin around the mouth alone.
Matching treatment with the specific areas to achieve the most significant results. Using Thermage and Ultherapy to lift and tighten the middle and lower face. Injecting hyaluronic acid/regenerative fillers around the mouth to provide support and add volume. Micro-Botox injection at the area within the corner of the mouth, earlobe, and collarbone.
A. Hyaluronic Acid Dermal Fillers at the Nasal Base
What is it?
Hyaluronic acid (HA), also known as hyaluronate, is naturally found in tissues and cells. In aesthetic treatment, hyaluronic acid can act as a filler and is injected into the dermis layer to fill up the folds/depressions or plump certain areas such as lips, cheeks, nose and chin. The injected hyaluronic acid will smooth and fill lines and wrinkles, and add volume to the face naturally.
B. Wrinkles Removal by Botulinum Toxin
What is it?
Botulinum toxin is a protein that can block the signal communication between nerves and muscles, and hence paralyses/relaxes the muscles temporarily, resulting in releasing the muscles pressure at the nasolabial folds and smoothing the folds. It is only suitable for eliminating dynamic wrinkles.
C. MERZ ULTHERAPY
What is ULTHERAPY:
MERZ ULTHERAPY®is a non-surgical aesthetic treatment. It enables high-intensity ultrasound to precisely focus on the SMAS layer, stimulate the self-renewal mechanism of skin tissue, resulting in a series of rejuvenation effects such as tightening, increased elasticity, lifting, wrinkle reduction, whitening, and pigmentation reduction.
D. THERMAGE
What is THERMAGE:
Thermage uses radiofrequency technology to heat the dermis layer. The localised dermis layer will be damaged and hence stimulate the skin self-healing process. The healing process promotes the formation and remodeling of collagens that will tighten, smoothen and lift up the skin. Similar to ULTHERAPY, Thermage also has a face slimming effect, tightening drooping skin and restoring a better defined contour.
E. Facial Thread Lift
What is thread lift:
Thread lift is currently the most effective face lifting technique. By embedding threads (that can be absorbed and degraded in the body) to the dermis layer, which lifts the face according to the direction and interval of the threads, it stimulates the skin, and further activates fibroblasts to produce collagen. Thread lift is suitable for people who want to restore skin’s lifting ability, reduce signs of sagging, and stimulate regrowth of collagen.
F. Radiofrequency (RF) Microneedling
What is Radiofrequency (RF) Microneedling:
Radiofrequency (RF) Microneedling is an innovative technology integrating matrix application, microneedling, and radio frequency technology. During the treatment, a device with fine needles creates tiny punctures in the skin. The RF energy is then delivered via the small needles into the dermis to stimulate the production of new collagen and elastin. Results can include improved skin texture and firmness, as well as skin resurfacing.
Reduce Marionette Lines,come to Ai Beauty Clinic,
for safe and professional medical treatment.

Ai Beauty Clinic is a CQC accredited clinic based in London, and also is strongly supported by Cynosure(the owner of Ulthreapy) and Cynosure (the owner of PicoSure).
With rich experience of treating clients of various conditions, led by a famous British medical chief trainer, practiced by doctors and nurses who are GMC/NMC-registered and worked in NHS national hospitals, Ai Beauty provides certified and safe medical beauty treatments.
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