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Marionettes Lines and Folds

Marionette lines are facial wrinkles that run vertically between the mouth and chin, they can also create sagging in the lower half of your face. They are caused by loss of collagen that occurs with ageing. Gravity also plays a role in sagging skin around the chin, making marionette lines more noticeable.

The skin around your mouth is prone to developing lines because it’s much thinner compared to the rest of the face.

These types of wrinkles have the tendency to develop by your 40s, however, they may appear in your late 20s and 30s. Below you will find a list of possible treatment options if you wish to help minimise their appearance.

How To Treat Marionettes Lines

Marionette lines typically appear with the natural ageing process, it’s however possible to reduce their appearance. There are several options available to treat this problem, usually injections and dermal fillers are the first step to consider, however, when the jawline is totally compromised, a lower face lift surgery would be the only option to eliminate them permanently.

Botox for marionette lines

Botox (Botulinum toxin type A) injections are a very popular solutions for facial wrinkles around the eyes and the mouth. They work by relaxing the facial muscles, causing the skin to become smoother, which consequently eliminates the wrinkles in the areas treated.

Botox may occasionally cause minor bruising and irritation at the injection site which willl quickly subside. To successfully treat marionettes lines with Botox injections, one will need to repeat the treatment every three to four months. This treatment method is ideal if one is just starting to develop these wrinkles.

Dermal fillers

Similarly to Botox, dermal fillers are temporary injectables that can be used to treat marionette lines in their earlier stages. Fillers don’t relax muscles, they plump your skin with either poly-L-lactic or hyaluronic acid. This is designed to act like the effects of collagen and elastin to smooth wrinkles and fine lines.

Hyaluronic acid filler produces an instant result, while poly-L-lactic takes several months to show results, as it acts as a stimulatory filler which promotes the production of collagen over time.

Dermal fillers can also help to address sagging caused by marionette lines.

Chemical peels

Chemical peels are a treatment used to remove the outer layer of skin (epidermis)in addition to parts of the middle layer (dermis). This process reduces considerably the appearance of age spots and facial wrinkles, and the new skin cells that are generated are much stronger.

Before getting a chemical peel, one should inform Dr. Ferrando if using retinoids or face acids, as these could could cause your skin to be too sensitive for this treatment option. To maintain results with the treatment of marionettes lines, one will likely need a chemical peel once a month for a period of 4 to 6 months.


Microneedling, also known as collagen induction therapy, is a treatment that helps to generate stronger skin cells, by creating very small holes in the skin. A derma roller or microneedling pen, is used to create these small holes in the target area of the skin.

When used to treat to deep marionette lines, microneedling may be helpful to generate more collagen production, which will fill in these deeper facial wrinkles. Depending on the depth of marionettes and results one is looking to achieve, it will be necessary to repeat microneedling several times.


Retinoids are synthetic vitamin A derivatives used for the treatment of wrinkles, photoaging and acne. The most widely used over-the-counter form is retinol, however, stronger retinoids can be purchased with a doctor’s prescription. 

Retinoids aren’t advisable for pregnant women, and these types of products are likely to considerably increase one’s sensitivity to the sun.

When used to treat marionette lines, retinoids may help by getting deep into the epidermis to stimulate the production of collagen.

Hyaluronic acid

Hyaluronic acid is a substance that occurs naturally in skin tissues. Like collagen, hyaluronic acid production is effected by the natural ageing process. This substance is found in several dermal fillers, skin care products and serums. When applied to wrinkles, it helps to plump and to smooth the skin.

Laser resurfacing

Despite being considered an invasive treatment for wrinkles, laser treatments, unlike facelifts don’t require any incisions. Laser resurfacing, works by removing the top layers of one’s skin with lasers.

While it can be a very effective treatment for some, laser resurfacing could potentially cause hyperpigmentation and scarring. The results of this therapy are long lasting, however, not permanent and treatments may be repeated every few months.

Surgery for marionette lines

When the jawline is completely compromised, the only treatment available to permanently eliminate marionette lines is surgery. For significant wrinkles, Mr. Ferrando might recommend a rhytidectomy (facelift). With performing this type of surgery, incisions are made to transfer or remove fat, while underlying tissue is lifted upward to tighten one’s face.

Given the fact that facelift is a major surgery, it’s usually only recommended once other wrinkle treatments have failed. If wanting to eliminate marionette lines only, Dr. Ferrando might recommend a partial rhytidectomy (mini facelift).

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