What Causes Marionette Lines Around the Mouth?

You may first notice them as faint shadows extending downward from the corners of your mouth.

Over time, those shadows can become deeper folds that make the mouth appear slightly downturned—even when your face is completely relaxed.

These are commonly known as marionette lines.

Also called melomental or labiomandibular folds, marionette lines extend from the corners of the mouth toward the chin or jawline. They become more noticeable with age, but some people develop them earlier because of genetics, facial anatomy, sun exposure, smoking or natural patterns of facial movement.

But marionette lines are not simply wrinkles in the skin.

They can develop through a combination of collagen and elasticity loss, changes in facial fat, bone remodelling, ligament support, muscle activity and sagging tissue around the lower face.

That is why treating marionette lines successfully often requires looking at the entire lower face rather than simply injecting the visible crease.

What Are Marionette Lines?

Marionette lines are folds or depressions extending downward from the corners of the mouth toward the chin.

The name comes from traditional marionette puppets, whose movable lower jaws create noticeable lines around the mouth.

They are different from nasolabial folds, which run from the sides of the nose toward the corners of the mouth.

In simple terms:

Nasolabial folds: nose → corners of mouth

Marionette lines: corners of mouth → chin/jawline

Cleveland Clinic describes marionette lines as wrinkles that extend from the mouth corners toward the chin and notes that they tend to become more noticeable with ageing.

They may begin as subtle creases and gradually develop into deeper folds.

Why Do Marionette Lines Form?

There is no single cause.

The lower face is anatomically complex. Skin, fat compartments, ligaments, muscles and bone all interact around the mouth and jawline.

Modern anatomical research suggests marionette lines can develop through several simultaneous processes, including:

A 2024 anatomical review specifically identified changes in the maxilla and mandible, deeper fat loss, muscle effects, ligament tethering, skin laxity and jowl tissue among the factors contributing to marionette-line formation.

Let’s look at these causes individually.

1. Loss of Collagen

Collagen provides strength and structural support to the skin.

As you age, the skin naturally contains less collagen and becomes less elastic.

Mayo Clinic notes that ageing skin becomes drier and less elastic and has less collagen and fat within its deeper layers, contributing to wrinkles and loose skin.

Around the mouth, this reduced support means the skin becomes less able to resist folding.

A faint line that once appeared only when speaking or smiling may eventually remain visible even when the face is relaxed.

This is one reason marionette lines usually become more noticeable with age.

2. Loss of Skin Elasticity

Collagen gives skin strength, while elastin helps it stretch and return toward its previous position.

As skin elasticity declines, facial movements leave increasingly visible impressions.

This is especially relevant around the mouth because this area is constantly moving when you:

Repeated facial movement is normal and not something you should try to avoid.

However, as ageing skin loses flexibility, the lines created during movement may remain visible for longer. Mayo Clinic identifies both declining skin elasticity and repetitive facial expressions as contributors to persistent wrinkles.

3. Facial Volume Loss

Ageing does not affect only the skin.

Facial fat is organised into different compartments, and these compartments can lose volume or change position differently over time.

Around the mouth and lower face, this can create areas of:

Research into facial ageing describes lower-face changes as involving both loss of support and redistribution of facial fat.

The result can be a clearer separation between tissues on either side of the marionette line.

This is why simply treating the skin surface may not fully correct a deeper marionette fold.

4. Changes in the Cheeks Can Affect the Lower Face

It may seem surprising, but marionette lines are not always just a mouth-area problem.

Changes higher in the face can influence what happens lower down.

Age-related loss of midface support can alter cheek projection and the way facial tissues sit over the lower face.

Research into facial ageing describes deep midface fat loss and reduced cheek support as contributors to descending facial tissues and increasing lower-face ageing.

This can make:

That is why a qualified practitioner should assess the whole face, not simply the line beside your mouth.

5. Jowls Can Make Marionette Lines Deeper

Jowls are sagging or fuller areas that develop along the lower jawline.

As jowl tissue becomes more prominent, it can accentuate the hollow or crease immediately in front of it.

Anatomical research suggests marionette lines can become more noticeable because fat and tissue accumulate on one side of the fold while volume is reduced on the other.

This creates a stronger contrast between:

The hollow marionette region
and
The fuller jowl beside it

The shadow between those areas can make the line appear much deeper.

This is why treating the crease alone may not always provide the most balanced result.

6. The Mandibular Ligament Can Define the Fold

The lower face contains ligaments that attach tissues to deeper structures.

One particularly important structure in marionette-line anatomy is the mandibular ligament.

Research indicates that this ligament acts as a structural fixation point near the lower part of the marionette line. As surrounding tissue changes with age, the ligament can create a relatively fixed boundary while nearby tissue becomes looser or fuller.

This helps explain why marionette lines can sometimes look sharply defined.

The problem is not simply a wrinkle sitting on top of the skin—it can involve how deeper tissues are attached.

7. Facial Muscles Influence Marionette Lines

Several muscles affect the lower face and corners of the mouth.

These include the:

The depressor anguli oris, or DAO, pulls the corners of the mouth downward.

Research examining facial ageing has linked activity of the DAO and platysma to the development and prominence of marionette lines and downturned mouth corners.

Some people naturally have stronger downward muscle activity than others.

This can contribute to an expression that looks:

even when they are not feeling that way.

This muscular component is one reason some treatment plans consider more than filler alone.

8. Facial Bone Changes With Age

The facial skeleton also changes throughout adulthood.

Age-related remodelling can affect both the upper and lower jaws.

The 2024 anatomical review of marionette lines identifies changes in the maxilla and mandible as contributors to the structural changes surrounding marionette folds.

Why does this matter?

Your bones form the framework supporting the tissues above them.

If that framework changes while facial fat and skin are also changing, support around the mouth and jaw can decrease.

This means what appears to be a “deep wrinkle” may partly reflect a much deeper structural ageing process.

9. Gravity Contributes—but It Isn’t the Only Cause

Gravity acts continuously on the facial tissues.

When you are younger, firm skin and strong structural support help resist these forces.

As collagen, elasticity and deeper support decline, gravity can have a greater visible effect.

However, the idea that marionette lines appear simply because gravity “pulls the face down” is an oversimplification.

Anatomical studies point to a combination of bone changes, fat distribution, ligaments, muscle activity, skin ageing and gravitational forces.

Facial ageing is a three-dimensional process.

10. Sun Damage Can Make Marionette Lines Develop Earlier

Ultraviolet exposure accelerates skin ageing.

UV radiation damages collagen and elastin—the connective tissues that help keep skin firm and flexible.

Mayo Clinic explains that repeated UV exposure breaks down these supporting fibres, reducing skin strength and flexibility.

Over many years, this can contribute to:

If the skin surrounding the mouth loses elasticity earlier, existing folds may become more visible.

Daily sun protection is therefore one of the most useful steps for slowing preventable skin ageing.

11. Smoking Can Make Lines Around the Mouth Worse

Smoking is another important contributor to premature facial ageing.

It damages collagen and elastin and reduces blood flow to the skin. Repeated lip pursing during smoking can also contribute to lines around the mouth.

Cleveland Clinic specifically lists smoking as a factor associated with earlier or more prominent marionette lines.

Stopping smoking will not completely remove established folds, but it can reduce continued exposure to a preventable cause of premature skin ageing.

12. Genetics

Some people develop deeper marionette lines earlier than others.

Genetics can influence:

Cleveland Clinic notes that having parents or grandparents with pronounced marionette lines can increase the likelihood of developing them.

This helps explain why one person may notice marionette lines in their thirties while another does not develop noticeable folds until considerably later.

At What Age Do Marionette Lines Appear?

There is no exact age.

Cleveland Clinic notes that marionette lines commonly become noticeable around the forties, although subtle lines can appear in the twenties or thirties.

When they become noticeable depends on:

A younger person with strong DAO muscles and a particular jaw structure may develop them relatively early.

Someone with stronger skin support may notice them much later.

Why Do the Corners of My Mouth Turn Down?

Downturned mouth corners and marionette lines often occur together.

Several factors may contribute.

Muscle activity

The depressor anguli oris pulls the mouth corners downward.

Loss of tissue support

Changes in facial fat and skin elasticity can provide less support around the mouth.

Jowl development

Increasing lower-face heaviness can strengthen the downward appearance.

Structural ageing

Changes in deeper facial anatomy may alter how the tissues around the mouth sit.

The result can be a facial expression that appears sad or stern even when you feel completely neutral.

Are Marionette Lines the Same as Smile Lines?

No.

These two terms refer to different areas.

Smile Lines or Nasolabial Folds

Run from the sides of the nose toward the corners of the mouth.

Marionette Lines

Run from the corners of the mouth downward toward the chin or jawline.

You can have either one without pronounced changes in the other, although both commonly become more noticeable with age.

Are Marionette Lines Wrinkles or Sagging?

They can involve both.

Early marionette lines may mainly involve:

Deeper marionette lines often involve additional factors such as:

This distinction matters when choosing treatment.

A superficial line may respond differently from a deep fold created partly by jowls and tissue descent.

Can Weight Loss Cause Marionette Lines?

Significant weight loss can reduce facial fullness.

If volume decreases around the cheeks or lower face, existing folds may become more obvious.

This is particularly noticeable if skin elasticity has already declined.

However, weight loss is not the only cause of marionette lines.

People who have maintained the same weight for decades can still develop them through normal facial ageing.

Can Dehydration Cause Marionette Lines?

Dehydration can make the skin temporarily look:

This may make existing marionette lines look somewhat more noticeable.

But dehydration does not usually cause the deeper structural changes responsible for established marionette folds.

Drinking more water cannot reverse:

Adequate hydration supports general health, but it is not a structural lifting treatment.

Can Skincare Get Rid of Marionette Lines?

Skincare can improve skin quality, but it cannot completely remove deeper structural marionette folds.

Useful skincare may improve:

Retinoids may support collagen and improve some visible signs of ageing over time.

However, a cream cannot:

Skincare is therefore most useful for prevention and mild surface changes.

Does Retinol Help Marionette Lines?

Retinol and prescription retinoids may help improve:

They may make early lines less noticeable over time.

However, they should not be expected to eliminate a deep marionette fold caused by volume change and tissue descent.

Retinol treats the skin.

Established marionette lines often involve structures much deeper than the skin.

Can Sunscreen Prevent Marionette Lines?

You cannot completely prevent marionette lines because natural ageing and genetics remain important.

However, sunscreen can reduce premature UV-related ageing.

Since UV exposure accelerates collagen and elastin breakdown, protecting your skin from the sun can help preserve skin quality for longer.

Daily broad-spectrum sunscreen should therefore form part of a long-term prevention strategy.

What Treatments Can Improve Marionette Lines?

The most appropriate treatment depends on why the lines are present.

Cleveland Clinic lists options including fillers, botulinum toxin, chemical peels, laser resurfacing, microneedling, thread procedures and surgery, depending on severity and individual needs.

A good treatment plan should assess the entire lower face rather than automatically injecting the crease.

Dermal Fillers

Dermal fillers can temporarily add volume and soften facial creases.

They may be useful for selected mild-to-moderate marionette folds. Cleveland Clinic includes fillers among commonly used treatments for this area.

However, there is an important nuance.

Sometimes the best approach is not simply injecting filler directly into the deepest part of the line.

A practitioner may need to evaluate:

because all can influence the marionette area.

Adding too much volume directly into the lower face can make it look heavier.

Are dermal fillers risk-free?

No.

Common filler reactions include swelling, bruising, redness and tenderness.

Rare but serious complications can occur if filler accidentally enters a blood vessel. The FDA warns that vascular injection can cause tissue death and, in rare cases, vision abnormalities, blindness or stroke.

Fillers should therefore be treated as medical procedures and performed by appropriately trained healthcare professionals.

Botulinum Toxin

For some people, strong downward pull from the depressor anguli oris contributes to downturned mouth corners.

Carefully selected botulinum toxin treatment may sometimes be used to reduce this downward muscular pull.

However, the lower face is highly functional.

The muscles around the mouth are involved in:

Treatment therefore requires careful dosing and anatomical knowledge.

Botulinum toxin also does not replace lost volume or remove loose skin.

It addresses the muscular component only.

Microneedling

Microneedling stimulates controlled skin repair and collagen production.

It may help improve:

Cleveland Clinic includes microneedling among possible treatments used to minimise marionette lines.

However, microneedling is primarily a skin-remodelling treatment.

It cannot reposition significant jowling or fully correct a deep structural fold.

Chemical Peels

Chemical peels may improve superficial ageing around the mouth by addressing:

The American Academy of Dermatology notes that appropriately selected chemical peels can produce smoother, brighter skin and fewer fine lines.

They are more suitable for surface skin quality than deep structural marionette lines.

Laser Resurfacing

Laser resurfacing can improve certain aspects of:

This can soften the appearance of early lines around the mouth.

As with chemical peels and microneedling, however, resurfacing primarily treats the skin.

Deep folds associated with facial volume changes and jowling may require a different or combined approach.

Radiofrequency and Ultrasound Treatments

Energy-based procedures may be considered when mild skin laxity contributes to the lower-face appearance.

Radiofrequency and ultrasound treatments work by heating selected tissue layers and stimulating collagen remodelling.

The American Academy of Dermatology notes that non-invasive tightening treatments can produce modest, gradual tightening, generally developing over several months.

They do not provide the same degree of tissue repositioning as surgery.

This distinction is especially important for deeper marionette lines accompanied by substantial jowling.

Thread Treatments

Thread lifting has been used to address lower-face tissue position and marionette lines.

Research into thread-based treatment describes possible improvement in selected patients, particularly when tissue descent contributes to the fold.

However, results and longevity vary, and thread procedures have their own potential complications.

They should not automatically be considered a substitute for surgery.

Surgical Treatment

When marionette lines are part of more advanced:

surgical facial rejuvenation may provide a greater degree of structural correction.

Cleveland Clinic notes that mini or full facelift procedures may be considered for deeper marionette lines, particularly where more substantial lower-face ageing is present.

Surgery involves greater recovery and additional risks, but it can address deeper tissue descent in a way that surface treatments cannot.

What Is the Best Treatment for Marionette Lines?

There is no universal best treatment.

The correct option depends on what is causing the lines.

If the main issue is fine surface wrinkling:

Skincare, retinoids, chemical peels, microneedling or resurfacing may be considered.

If the problem is volume loss:

Strategic volume restoration may be more appropriate.

If strong downward muscle activity is contributing:

Carefully selected neuromodulator treatment may be considered.

If mild skin laxity is present:

Energy-based tightening may offer modest improvement.

If pronounced jowling and tissue descent are present:

More structural treatments may be necessary.

The strongest treatment plan is therefore based on anatomy rather than simply the name of the wrinkle.

Why Treating Only the Line Can Sometimes Look Unnatural

This is one of the most important points about marionette-line treatment.

Imagine that the line is partly caused by:

A hollow beside the mouth + jowl tissue beside the hollow + reduced cheek support + downward muscle pull.

If treatment consists only of repeatedly filling the visible crease, the lower face can become bulky without correcting the actual ageing pattern.

A better assessment may consider:

The objective should be to improve facial balance, not simply erase one line.

Can Marionette Lines Be Completely Removed?

Usually, complete removal is not a realistic goal.

Even treatment cannot stop:

Mild lines may become considerably softer.

Deeper folds may be improved without disappearing entirely.

A natural-looking result should still allow normal movement and facial expression.

How Can You Help Prevent Marionette Lines From Getting Worse?

You cannot prevent normal facial ageing, but you can reduce several modifiable contributors.

Useful habits include:

Cleveland Clinic recommends sun protection, moisturisation, avoiding smoking and general healthy habits as ways to reduce worsening of marionette lines and other signs of ageing.

The largest benefit comes from long-term consistency rather than a single anti-ageing product.

Book a Consultation for Marionette Lines

If marionette lines, downturned mouth corners or lower-face ageing are bothering you, a personalised consultation can help determine what is actually causing the folds.

A qualified practitioner can assess:

From there, they can explain whether you may benefit from skincare, collagen-stimulating treatments, skin resurfacing, energy-based tightening, carefully selected injectables or another treatment approach.

Not everyone needs filler, and treating the visible line alone is not always the most appropriate strategy.

Book a consultation today for a personalised facial assessment and treatment plan based on your anatomy, degree of ageing and aesthetic goals.

Frequently Asked Questions About Marionette Lines

What is the main cause of marionette lines?

There is no single cause.

Marionette lines result from a combination of ageing-related changes involving skin, facial fat, muscles, ligaments, bone structure and tissue descent.

Why am I getting marionette lines in my 30s?

Genetics, facial anatomy, strong downward muscle activity, sun exposure, smoking and early changes in facial support may make marionette lines noticeable earlier.

Subtle lines can appear during the twenties and thirties even though they generally become more noticeable later.

Are marionette lines caused by smiling?

Normal facial movement can contribute to the development of wrinkles over time, but smiling alone does not explain marionette lines.

Structural changes involving skin, fat, ligaments and bone also play important roles.

Can losing weight cause marionette lines?

Significant facial fat loss can reduce support and make existing folds more noticeable.

However, normal ageing can produce marionette lines even without weight loss.

Does collagen loss cause marionette lines?

It contributes.

As collagen and elasticity decline, the skin becomes less able to resist creasing and tissue descent.

But deeper marionette lines often involve structures beyond the skin.

Can retinol remove marionette lines?

Retinoids may improve skin texture and fine lines, but they cannot replace lost facial volume or lift significant lower-face sagging.

Can filler get rid of marionette lines?

Dermal fillers may temporarily soften mild-to-moderate marionette lines in selected patients.

Whether direct filler treatment is appropriate depends on the anatomy of the entire lower face.

Is Botox good for marionette lines?

Botulinum toxin may sometimes be considered where downward muscle pull contributes to the appearance.

It does not directly restore volume or correct significant skin laxity.

Can microneedling improve marionette lines?

Microneedling may improve fine surface lines and skin quality by stimulating collagen production, but it is unlikely to fully correct deep folds associated with jowling or volume loss.

Can you prevent marionette lines?

You cannot completely prevent them because normal ageing and genetics play major roles.

Sun protection and avoiding smoking can help reduce preventable skin ageing.

Do marionette lines mean my face is sagging?

Not necessarily.

Early lines can occur without significant sagging.

More pronounced marionette folds, however, frequently coexist with lower-face laxity, jowling and changes in facial volume.

Final Thoughts: What Really Causes Marionette Lines?

Marionette lines are not simply wrinkles caused by smiling too much.

They form because the lower face changes at several anatomical levels.

The skin loses collagen and elasticity. Facial fat changes. Supporting ligaments influence how tissues move. Muscles pull around the mouth. Jowls may develop. The underlying facial skeleton also changes over time.

Sun exposure and smoking can accelerate some of these ageing changes.

That is why there is no single treatment that works for everyone.

Someone with early surface lines may benefit mainly from improving skin quality.

Someone with volume loss may need structural support.

Someone with strong downward muscle pull may require a different approach.

And someone with significant jowling and loose skin may need treatment that addresses deeper tissue laxity rather than repeatedly adding filler to the crease.

The most useful question is therefore not:

“How do I fill my marionette lines?”

It is:

“What is causing my marionette lines?”

Once the cause is clear, treatment can be chosen more precisely, conservatively and naturally.

The goal should not necessarily be to erase every fold.

It should be to create a balanced, refreshed lower face while preserving natural movement, expression and facial proportions.

This article is for general educational purposes and does not replace personalised medical advice, diagnosis or treatment from a qualified healthcare professional.