How to Get Rid of Marionette Lines: A Surgeon's Guide to the Best Treatments

Do people ask if you're upset or sad, even when you're perfectly happy? The cause might be the lines running down from the corners of your mouth: marionette lines.

These deep creases, often accompanied by sagging skin along the jawline known as jowls, can create a permanent downturned, grumpy, or aged expression. They are one of the most common and frustrating signs of facial aging.

In this article, we'll dive into the real anatomical reason why these lines form and explore the most effective treatments—from simple injections to definitive surgical solutions—to restore a happier, more youthful appearance.

The Unwanted Duo: Understanding Marionette Lines and Jowls

It's crucial to understand that marionette lines and jowls are two sides of the same coin.

• Jowls: This is the sagging flesh and fat that droops below the jawline, creating a loss of definition.
• Marionette Lines: These are the creases or folds that form between the sagging jowl and the chin.

Essentially, the formation of jowls causes marionette lines to appear or deepen. Therefore, the most effective treatments must address both issues simultaneously.

The Real Cause of Marionette Lines: It's Not Just Aging

While aging is a major factor, the true root cause of marionette lines is anatomical: a strong facial structure called the mandibular retaining ligament.

1. The Anatomic Foundation: The Retaining Ligament

Think of retaining ligaments as pillars that anchor your facial skin and soft tissue to the underlying bone. In the area where marionette lines form, this specific ligament is very strong and dense.

As we age, the surrounding tissues (like our cheeks and jowls) that are not tethered by ligaments begin to sag due to gravity and volume loss. However, the skin along the ligament line stays firmly anchored. This difference in movement creates a "valley" or a deep crease—the marionette line.

These retaining ligaments exist to maintain the shape of the face, but in younger individuals, sagging doesn’t occur, so they aren’t noticeable. 
However, their presence becomes evident when the face sags under gravity while running. If you capture that moment in motion, you’ll notice that some areas of the face droop and jiggle, while others stay firmly in place—creating visible grooves. This is the evidence of the retaining ligaments.

2. Aggravating Factors: Aging and Jaw Structure

The retaining ligaments themselves do not directly cause wrinkles around the mouth. It is aging and the structural characteristics of the jaw that deepen the lines around the mouth.

• The Aging Process: As skin loses collagen and fat pads descend, the jowls become heavier and sag more dramatically, making the anchored ligament line even more prominent.
• Jaw Structure: Individuals with a smaller or recessed chin have less bony support for the lower face. This can cause the soft tissues to sag earlier in life, leading to the premature appearance of marionette lines.

How to Get Rid of Marionette Lines: Your Treatment Options

An effective plan must address the root cause. This often means a combination of lifting the sagging tissue, filling the crease, and, most importantly, addressing the ligament.

1. Non-Surgical Treatments

Dermal Fillers & Fat Grafting (Filling the Crease)

Injecting hyaluronic acid filler or your own fat into the sunken crease is a common way to camouflage the line.

• Best For: Patients with early-stage marionette lines and minimal jowling.
• Important Note: This is a temporary fix. If significant sagging is the main issue, using filler for marionette lines can sometimes make the lower face look heavy or puffy.

Thread Lifts (Lifting the Jowls)

This is one of the most effective non-surgical methods for lifting jowls. PDO threads are inserted under the skin at a 45-degree angle to grip and elevate the sagging tissue, which in turn softens the marionette lines.

• Best For: Individuals with mild to moderate jowling who desire a noticeable lift without the downtime of surgery.

2. The Definitive Surgical Solution

Lower Facelift or Mini facelift

For moderate to severe sagging and deep-set lines, surgery offers the most powerful and long-lasting improvement. A facelift is the only treatment that directly addresses the root cause: the retaining ligament.

During a lower facelift, the surgeon carefully releases this ligament. Then, the deeper foundational layer of the face (the SMAS) and the descended jowl tissue are lifted and repositioned back to their youthful location.

This procedure doesn't just stretch the skin; it fundamentally rebuilds the support structure of the lower face, providing the most natural and durable result. This is the gold standard for marionette lines surgery.

Conclusion: Finding the Best Treatment for You

As you can see, there is no single "best" way to get rid of marionette lines. The ideal solution is a personalized plan based on a careful analysis of your unique anatomy—the strength of your ligaments, the degree of sagging, and your facial structure.

At Noonopi Plastic Surgery, we specialize in this kind of detailed facial analysis. By understanding why your marionette lines have formed, we can design the most effective combination of treatments to achieve your goals.

If you're tired of looking sad or angry when you're not, it's time to explore a real solution. Contact us today to begin your journey toward a brighter, more refreshed you.

If you have more questions, don't hesitate to contact us via 🔗WhatsApp