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Changes around the mouth are among the most noticeable signs of lower-face aging\u2014and often some of the trickiest to treat. \u201cMarionette lines are often described as simple folds that run from the corners of the mouth downward, but in reality, they reflect a broader structural shift occurring in the lower face,\u201d says New York dermatologist Julie Russak, MD. \u201cBone support diminishes, soft tissue begins to descend, muscles that pull the mouth downward become more dominant and the skin itself loses elasticity and resilience.\u201d<\/p>\n
Because several factors are at play, treating the lines alone rarely produces the most natural-looking outcome. \u201cThe most effective approach is to restore balance across the lower face and support the skin\u2019s ability to withstand constant movement and mechanical strain,\u201d says Dr. Russak. Luckily, there are several in-office treatment options available, but the right one depends on the severity of your lines and your goals, which is why consulting a qualified provider is a must, adds Delray Beach, FL, dermatologist Dr. Janet Allenby.<\/p>\n
Ahead, we\u2019re breaking down some of the most common in-office treatments doctors use to soften marionette lines.<\/p>\n
Both hyaluronic acid and biostimulatory fillers are useful tools for combating marionette lines, but techniques vary depending on the patient\u2019s anatomy and needs. \u201cIn many patients, carefully placed hyaluronic acid filler can reestablish structural support in areas such as the chin, jawline and pre-jowl region. When these foundational structures are restored, the shadowing associated with marionette lines often softens without directly filling the line itself,\u201d explains Dr. Russak. Meanwhile, biostimulatory injectables, like Radiesse, work by \u201cstimulating collagen production and helping rebuild the skin\u2019s internal framework gradually, improving firmness and elasticity over time,\u201d she explains.<\/p>\n
Dr. Allenby also likes filler as a minimally invasive option for marionette lines. \u201cI usually will use sturdier fillers in the outer face or upper cheeks or even into the scalp because it\u2019s usually the skin hanging that\u2019s the problem,\u201d she says. \u201cI may use a filler to improve the shape of the chin, giving it a little more augmentation or projection, which will sometimes relieve the depth of the marionette lines. Or I fill in the marionette line directly if it\u2019s not too deep,\u201d notes Dr. Allenby.<\/p>\n
\u201cBeyond structural support, strengthening the skin itself is essential. Techniques such as the Fern Pattern Filler Technique, which distributes micro-supporting strands of hyaluronic acid within the dermis, help reinforce the skin\u2019s internal scaffolding,\u201d says Dr. Russak. \u201cRather than simply adding volume, this approach improves the skin\u2019s ability to resist repetitive folding caused by constant muscle movement around the mouth.\u201d<\/p>\n
Dr. Russak says neuromodulators can also help resolve certain patients\u2019 marionette lines. Dr. Allenby notes that a product like Botox can help relieve the frown-like appearance. \u201cRelaxing the depressor anguli oris muscle helps reduce the downward pull at the corners of the mouth, which contributes to the deepening of these lines over time,\u201d explains Dr. Russak.<\/p>\n
\u201cEnergy-based treatments such as radio-frequency with microneedling or ultrasound tightening can further support tissue remodeling,\u201d which may be beneficial for marionette lines, says Dr. Russak. \u201cIf I am considering using a device, it may be a standalone device or a combination of devices,\u201d says Dr. Allenby. For example, Dr. Allenby would consider combining \u201cEllacor to remove the excess skin and the Helix CO2 laser to penetrate deeper into the tissue to tighten up the area.\u201d She notes that she\u2019s also seen improvements with Morpheus8 and EVERESSE Monopolar RF.<\/p>\n
Dr. Russak says PDO threads may be an option to help lift the tissue up and out. PDO threads are dissolvable sutures that help tighten the skin while stimulating collagen production.<\/p>\n
\u201cRegenerative therapies, including platelet-rich plasma, exosomes and peptide-based treatments, may enhance the skin\u2019s repair capacity and overall quality,\u201d says Dr. Russak. It\u2019s best to discuss with your doctor whether any of these regenerative approaches may be appropriate for addressing your specific concerns.<\/p>\n<\/p><\/div>\n