Jowls & Marionette Lines

Jowls are loose skin and flesh that hang beneath the lower jawline. Marionette lines or “puppet lines” are lines that run from the corners of the mouth to the chin.


Jowls are loose skin and flesh that hang beneath the lower jawline. Marionette lines or “puppet lines” are lines that run from the corners of the mouth to the chin. Both are a sign of ageing and volume loss in the face. One of the most commonly cited reasons for wanting to get rid of them is because they give the appearance of being grumpy or sad.


The main cause of both jowls and marionette lines is ageing. As we get older our skin becomes thinner and less pliable. This is due to loss of collagen and elastin. At the same time, we also lose volume in the face (particularly in the midface area) which provides scaffolding and shape. Both these processes result in sagging of the skin and tissues which gives rise to jowls and marionette lines in the lower face. Other factors which exacerbate skin ageing are smoking, sun-damage and genetics.


There are a number of treatment options for jowls and marionette lines. Firstly, it is very important to ensure that you follow a regular skincare routine tailored to your skin type. Two highly effective and non-surgical options that we offer at City Skin Clinic are Botox® and hyaluronic acid dermal fillers. Which of these (if any) is suitable for you will depend on your expectations and the severity of the lines.

Botox® For Jowls & Marionette Lines

For moderate jowls, we offer jawline tightening with Botox® as part of our non-surgical neck lift. This treatment can soften the appearance of early jowling and provide a more defined jawline and sculpted neck. Although it is possible to soften the appearance of marionette lines with Botox®, we do not think that this is the most effective treatment on its own. However, in some circumstances, we combine Botox with dermal fillers for treating marionette lines.

Dermal Fillers For Jowls & Marionette Lines

Both Jowls and Marionette lines are caused by volume loss and sagging skin in the face. As such, dermal fillers can provide the opportunity to treat the underlying problem. For moderate or severe lines, we can directly inject hyaluronic acid dermal filler into and around these creases. This is done to soften and minimise their appearance. For more severe jowling and marionette lines, hyaluronic acid dermal fillers can also be added to the cheeks. This can help to lift the face in addition to adding filler to the areas themselves. However, this might not be enough if you have both jowls and marionette lines. In this case, the best treatment might be a combination of Botox® and dermal fillers. This is often known as “liquid facelift“. It is a custom treatment and can help address other signs of ageing like upper face wrinkles.

Skin Ageing Prescription Skincare

Prescription skincare for skin ageing is a good choice to reduce th appearance of lines and wrinkles though it obviously won’t resolve the volume loss that causes jowling and folds. Tretinoin remains the gold-standard in topical anti-ageing treatments. It has been around for decades and clinically proven to reduce the appearance of lines and wrinkles. If you also have other signs of photo-ageing such as age spots and melasma then skin transformation systems like Obagi Nu Derm and Obagi-C can build on the results of Tretinoin.

At City Skin Clinic, we’re devotees of personalised skincare. We offer a variety of skincare treatments that can help rejuvenate your skin. Check out our online skin clinic which offers prescription-strength skincare products for skin ageing which you can access form the comfort of your home. Book a virtual appointment or use our online consultation form consultation to take your first step towards better skin.

For more info:

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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