POSTED: 3 May 2022

Best Treatment For Marionette Lines, According To Doctors

We get a lot of questions from people looking for ways to treat marionette lines. These are also called puppet lines and are deep lines at the corner of the mouth and extend down to the chin. These facial wrinkles are caused by volume loss in the face and are part of the natural ageing process. 

Depending on the severity of the marionette lines, we offer a range of treatments to help with this. In this blog, our doctors will discuss both surgical and non-surgical procedures that you can undergo. Our expert doctors will share their experience and address some common questions that you may have, such as what are marionette lines? What causes them? How can you treat them?

What Are Marionette Lines?

Marionette lines are vertical lines that appear on the lower face with drooping skin due to ageing. You may commonly know them as puppet lines or jowls. Marionette lines run from the outer corner of the lips to the outer corners of the chin and naturally develop over time. Many of our clients want to correct these lines and find treatment to help them achieve a youthful-looking appearance, as marionette lines can cause the face to look saggy. Although marionette lines can not be treated using conservative approaches like skincare, there are a number of both surgical and non-surgical professional treatments available. 

What Causes Marionette Lines?

Marionette lines are naturally caused by ageing. As we age, gravity influences the movement of our skin, stretching smooth skin in a downward and inward pattern towards the ground. Ageing also reduces the natural fat pads and thins the connective tissues in our face which provides structure and lifts up our facial features.

Accompanying, degradation of proteins like collagen and elastin leads to skin thinning and sagging. This combined effect causes the skin to sit on our chin, creating lines down either side of the face.  Whilst ageing is the primary cause of wrinkles, genetic factors and lifestyle factors like smoking and excess sun exposure also contribute to the appearance of marionette lines. 

How To Get Rid Of Marionette Lines

If you are looking for a permanent solution for marionette lines, surgical procedures are your only option. This usually involves a facelift and maybe in combination with a neck lift to remove excess skin and lift tissue upwards and outwards. In some cases, surgeons may also combine this with fat grafting which helps replenish the fat pads and volume loss hence avoiding an overstretched look giving a more youthful and natural-looking result.

This is by far the definitive treatment but it is a major surgical procedure with significant potential risks and requires at least 1-2 weeks of downtime afterwards. Since a facelift is a big undertaking many people with marionette lines, initially opt for non-surgical options which are quicker, safer and require less or no downtime. Let’s take a look at them below.

Dermal Fillers

Dermal fillers are a popular facial aesthetic treatment administered through an injection. The filler is usually made from a colourless hyaluronic acid gel. At City Skin Clinic, we use dermal fillers for wrinkles to enhance specific areas of the face and reduce the appearance of deep marionette lines. They can also define and create volume in the face which is particularly useful in rejuvenating areas where there is volume loss. Time and time again, our clients have praised dermal fillers for revitalising their skin and helping them achieve a more youthful-looking appearance. 

There are a few ways in which dermal fillers can treat marionette lines. One is by filling the areas which have lost volume which helps better support the skin and reduce the appearance of sagging. Dermal fillers can also be directly injected into the deep lines to fill them and hence reduce the appearance of marionette lines. 

You can combine dermal fillers with Botox injections to reduce the pull of the depressor muscles which pull down on the corners of the mouth and worsen the appearance of the marionette lines. This not only helps improve the appearance of the marionette lines but prevents them from getting deeper. 

There are many pros to this treatment that certainly outweigh the cons. Clients can enjoy more permanent, natural-looking results and noticeably minimised appearance of marionette lines. The procedure itself also has minimal risks involved compared to surgical procedures like facelifts.

Chemical Peeling

Whilst chemical peels can’t treat deep marionette lines, they can help soften the appearance of early lines around the mouth and improve the skin in that area. If you want to refresh tired-looking skin and achieve smoother skin with a youthful glow, a chemical peel could be your desired procedure. 

The process involves removing the outer layers of the skin (epidermis) and the middle layer (dermis) the extent of which will depend on the type of chemical peel. Newer skin is revealed and a course of treatment can reduce the appearance of fine facial wrinkles, age spots and texture. 


This is also called collagen induction therapy. During this procedure, your doctor will use a derma roller or a microneedling pen. These are small devices that contain tiny needles. The needles create small holes in the target area of the skin which stimulates skin cells to generate new collagen and elastin.

These then improve the texture, quality and elasticity of the skin which in turn treats moderate lines and wrinkles. Again, whilst this treatment can not get rid of deep marionette lines,  it can help improve the appearance of early lines and helps clients achieve a smoother bouncier complexion. RF microneedling is an advanced form of this treatment that combines microneedling with radiofrequency energy to enhance the results.


One of the most popular skin boosters is Profhilo injectable moisturiser. Like micro-needling, this treatment promotes skin regeneration by increasing collagen and elastin production. The treatment leaves skin feeling thicker, plumper and better hydrated. It only requires 4 treatments every year.

Whilst it can not get rid of deep folds, it is excellent at treating crepey or sagging skin on the face which exacerbates the appearance and severity of marionette lines. Using treatments like Profhilo before the appearance of these lines can help prevent or slow down their formation as these skin-boosting injections work to improve the quality of your skin.

Can You Get Rid Of Marionette Lines Without Surgery Or Injectables?

You can get rid of marionette lines without surgery using treatments like dermal fillers if they are moderate in severity otherwise, if severe, you can only improve their appearance. As mentioned above, there are some professional skin treatments like Profhilo that can help improve the condition of your skin but these can only help with early or very mild marionette lines.  

Skincare wise, products like sunscreen and vitamins protect your skin from sun damage which causes skin ageing. However, these methods are preventative. At the moment, there is no topical treatment that will remove marionette lines. That being said, regardless of your skin type or age, you can reduce, slow down and prevent the appearance of fine lines and wrinkles with the right skincare products. In our opinion, your anti-ageing skincare routine should include products with the following ingredients.


Sun Damage is the biggest cause of skin ageing and is probably the easiest to treat. It is absolutely essential to use sunscreen of at least SPF 30 every day even if it’s not sunny. Don’t forget to use it even if you’re staying indoors as UV rays get through the window glass!  Sunscreen will also help protect you from skin cancer.

Vitamin C

Also known as ascorbic acid, Vitamin C is a potent antioxidant. It protects your skin from sun damage (you still have to use Sunscreen though) and helps increase collagen production. Vitamin C is also great at fading hyperpigmentation or sun spots and helps to give a more radiant brighter complexion.

Hyaluronic Acid

You are most likely familiar with this skin-boosting ingredient as it is found in most premium beauty products. Hyaluronic acid is a natural product found in our skin matrix which helps skin with its structure and hold moisture. Although there is doubt as to how far hyaluronic acid creams can penetrate the skin, even when working at a superficial level they can boost the hydration of the surface of the skin and hence reduce the  appearance of fine lines and dry skin., 


These are Vitamin A derivatives and are the only skincare ingredients that have been shown to reduce the appearance of fine lines and wrinkles in clinical trials. Retinoids, like Tretinoin,  exfoliate the surface of the skin, combat acne and hyperpigmentation as well as improve vascularization and collagen as well as elastic production by skin cells. Taken together, this improves skin quality over time. Whilst they can’t get rid of established marionette lines, Retinoids can make the skin smoother, bouncier and tighter over time. 

Marionette Lines Before And After

Before treatment, marionette lines can make your skin appear dull and tired. Many of our patients also complain that these lines make them look sad or grumpy and since these lines are prominent, some people report that it makes them feel self-conscious and even damages their self-esteem. After marionette lines treatment, the folds and wrinkles should reduce in appearance with overlying skin appearing smoother, giving you a youthful and rejuvenated complexion. There are many physical and mental benefits that treatment can offer, such as:

  • Improved self-esteem and confidence
  • Smooth, firmer skin
  • Natural-looking results
  • Little downtime
  • Minimises the appearance of fine lines and wrinkles in the surrounding areas of the face and neck

How much improvement you see and how quickly you see it will depend on the severity of your marionette lines and which treatment you choose.

Marionette Lines Treatment In London

We offer a range of dermal filler treatments at City Skin Clinic to help treat marionette lines. By far our best treatment for marionette lines is dermal fillers. These help to restore volume in your face and smooth deep lines. Dermal filler is injected into the problem area using a needle or microcannula by one of our aesthetic doctors. is not painful and is quick, only taking a few minutes to complete. There is generally very little downtime other than waiting for bruising or swelling to settle.  

The effects of dermal filler last up to 6 months although advanced fillers like Juvederm Voluma can last up to 12 months and Juvederm Volux up to 24 months. The type and amount of filler needed largely depend on the severity of your marionette lines, treatment goals and budget. We may also combine dermal fillers with Botox anti-wrinkle injections to rejuvenate the skin and treat deep marionette lines. Click here to find out more about our botox injections. 


Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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