Jowls & Marionette Lines

Jowls and marionette lines are two of the most recognisable signs of lower-face ageing. They tend to co-exist. Jowls are the soft, sagging tissue that forms along and just below the jawline. Marionette lines are the creases that run down from the corners of the mouth towards the chin. Both blur the clean contour of the lower face and can leave you looking tired or downturned even when you feel perfectly well. The key thing to understand is that they share the same root cause. The skin, fat and bone of the face all change with age and the face gradually loses support. This is why treating them properly means addressing more than the skin alone. This page is a complete guide to jowls and marionette lines. We explain what they are, why they form and every treatment option, from over-the-counter skincare through to surgery.

City Skin Clinic is an online skincare clinic. We provide and prescribe medical skincare and do not offer injectable treatments (dermal fillers or anti-wrinkle injections), energy-based devices or surgery. However, we have explained all the options below because we believe the public deserve clear, evidence-led information without commercial bias.

What’s the Difference Between Jowls and Marionette Lines?

Jowls and marionette lines are closely related but they’re not the same thing. Jowls are the loose skin and displaced fat that sit along and just below the jawline. They break-up the sharp line between the jaw and the neck. The small dip that often forms just in front of a jowl is called the pre-jowl sulcus. Marionette lines are the vertical folds that run from each corner of the mouth down to the chin. They frame the chin and can pull the mouth corners down. You can have one without the other. However, because both come from the same loss of support, most people develop them together over time.

What Causes Jowls & Marionette Lines?

Facial ageing isn’t only a skin problem. Four changes happen at the same time, and together they produce jowls and marionette lines. The key ageing processes that give rise to jowls and marionette lines are:

• Collagen & elastin loss: From the mid-twenties, the skin makes around 1% less collagen each year. This means it becomes thinner and less able to hold its shape.
• Volume loss & fat descent: The deep fat pads that support the midface shrink, whilst the more superficial fat slides downwards. Higher up, the face loses support, and the excess settles along the jaw to form jowls. The same loss of facial volume around the mouth also deepens marionette lines.
• Bone resorption: The facial skeleton also remodels with age. The jaw and the bone around the mouth lose projection. This removes some of the scaffolding the tissues above rely on for support.
• Ligament laxity: The ligaments that anchor the skin to the deeper structures loosen, letting tissue drift down.

Whilst ageing is a natural process, several things speed it up. Sun exposure is the single biggest accelerator and is thought to drive up to 80% of visible facial ageing. Smoking, big swings in weight and your genetics are also big contributors to premature skin ageing. In fact, genetics largely decide when and how heavily jowls appear.

How Are Jowls & Marionette Lines Treated?

Because jowls and marionette lines have several causes, the most effective plans combine treatments rather than relying on any single one. The right combination depends on your age, how advanced the changes are and which cause dominates. It helps to think of the options as a ladder. At the bottom is skincare, which improves the quality of the skin itself, gently with over-the-counter products and more powerfully with prescription ones. Above that sit non-surgical procedures such as fillers and energy devices, which address lost volume and laxity directly. At the top is surgery, which resets the deeper structures when the sagging is significant. We discuss each in detail below, starting with what you can do at home.

Can Over-the-Counter Skincare Smooth Jowls & Marionette Lines?

Over-the-counter skincare can’t lift sagging tissue but it does improve the quality of the skin. Better-quality skin holds its shape for longer. Used consistently, the right products soften fine lines, even out tone and give a firmer surface. The actives worth looking out for are:

• Retinol: The most useful over-the-counter ingredient and a milder cousin of prescription tretinoin. The skin converts it into retinoic acid, though less efficiently, so it works more slowly. A 2025 network meta-analysis of topical anti-ageing treatments found that retinol, tretinoin and isotretinoin all improved fine wrinkles, with the prescription retinoids ranking highest. Retinol usually comes in strengths of between 0.1% to 1%.
• Vitamin C: This antioxidant typically comes at 10% to 20% strength in its most common form. It supports collagen production and brightens the skin.
• Niacinamide & peptides: These two ingredients help support the skin barrier and maintain firmness over time.
• Exfoliating acids: Agents like glycolic acid can help smooth surface texture and even out tone.
• Bakuchiol: This is a plant-derived compound for anyone who can’t tolerate retinoids or strong actives.

Above all, a daily broad-spectrum sunscreen with at least SPF 30 is the most important anti-ageing product. This is because it prevents the very damage the others are working to repair.

What Prescription Skincare Can Help Treat Jowls & Marionette Lines?

Prescription skincare is the strongest skin-quality treatment you can use at home. For suitable patients, it sits at the centre of most anti-ageing protocols. The key ingredient is tretinoin, a vitamin A derivative and the most studied topical anti-ageing treatment in dermatology. It speeds up skin-cell turnover, boosts collagen and thickens the skin, which together smooth fine lines and improve tone. The evidence is strong and shows that topical tretinoin consistently improved wrinkling, pigmentation and skin texture. Because it is already in its active form, prescription tretinoin is also more effective than over-the-counter retinol. This of course means that it carries a greater risk of side effects including irritation and burns which is why it is a prescription only medicine.

However, tretinoin works on skin quality rather than structure. This means it will firm the skin and soften the fine creasing around the mouth, but it can’t lift an established jowl or replace lost volume. As such, it works best started early as a foundation or alongside the procedures below when the sagging is more advanced. Tretinoin is usually prescribed in strengths from 0.01% to 0.1% either as a stand-alone product or combined with ingredients such as hydroquinone or niacinamide if there is hyperpigmentation or large pores alongside the lines.

Which Non-Surgical Treatments are Best for Jowls & Marionette Lines?

Jowls and marionette lines are driven by lost volume or laxity and a number of non-surgical procedures can help with things that skincare alone can’t. Below are the best non-surgical treatments for jowls and marionette lines:

• Dermal fillers: Hyaluronic acid fillers can help replace lost volume in the midface and directly fill in wrinkles. This can soften the jawline and marionette lines directly. Results are immediate and usually last 6 to 24 months depending on the type of filler and your metabolism.
• Botulinum toxin: Relaxing the platysma muscle of the neck can sharpen the jawline. Similarly, relaxing the muscle that turns the mouth corners down can lift a downturned mouth. The effect of these injections is temporary and typically lasts 3 to 4 months.
• Energy-based devices: These tighten the skin by heating the deeper layers to stimulate new collagen. Microfocused ultrasound (sometimes called HIFU) and radiofrequency are the most common. A 2023 systematic review of microfocused ultrasound found that around 92% of patients showed mild tightening that continued for up to a year.
• Microneedling & thread lifts: Microneedling and radiofrequency microneedling stimulate collagen in a similar way, whilst thread lifts give a modest mechanical lift. Both suit milder laxity and the results build gradually.

All these non-surgical jowl and marionette line treatments work best for mild to moderate concerns. It is often best to pair them with good skincare for optimal outcomes.

When is Surgery the Best Option for Jowls & Marionette Lines?

When jowls are heavy and the skin is significantly loose, surgery becomes the most effective and longest-lasting option. A facelift (rhytidectomy) and neck lift reposition the deeper tissues, tighten the supporting layer (the SMAS) and remove excess skin. This addresses the sagging directly rather than improving the skin around it and provides longer-lasting results. Research shows that the jowl, nasolabial and marionette areas stay well corrected even after 5 years. Surgeons often combine the lift with fat grafting. This transfers some of your own fat into the cheek to replace the volume the face loses as jowls form. Roughly half of that fat lasts, so a second session is sometimes needed.

That said, surgery carries more risks than skincare and non-surgical treatments. It also needs a longer recovery period and the results will diminish with time as you continue to age. As such, surgery is usually reserved for advanced sagging or for those who want the most dramatic change. It is a decision to make carefully with a qualified plastic surgeon.

Can You Prevent Jowls & Marionette Lines?

You can’t stop facial ageing but you can slow it down considerably. Daily broad-spectrum sunscreen (at least SPF 30) matters most, and it is the one step with the strongest evidence. Research shows that people who use sunscreen daily show no detectable increase in skin ageing compared with those that don’t. A retinoid, ideally prescription tretinoin, can also help build collagen over the years. Of course, lifestyle measures like avoiding smoking and keeping your weight stable as well as eating a nutritious collagen rich diet helps. Ultimately, a consistent routine started early on can do far more than any treatment begun once jowls have set in.

At City Skin Clinic, our doctors create personalised skincare to target skin ageing using actives like tretinoin where appropriate. Every plan begins with an online consultation and we build it around your skin and the concerns you most want to treat. Start your online consultation today. The journey towards great skin starts here.

This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.