Jowls & Marionette Lines cityskinclinic


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. First of all, 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. Whilst its 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

Since both Jowls and Marionette lines are caused by volume loss and sagging skin in the face, dermal fillers provide the opportunity to treat the underlying problem. For moderately severe lines, we can directly inject hyaluronic acid dermal filler into and around these creases to soften and minimize their appearance. For more severe jowling and marionette lines, we recommend hyaluronic acid dermal fillers to the cheeks to lift the face in addition to adding filler to the areas themselves.

If you have both jowls and marionette lines as well as other signs of ageing such as upper face wrinkles, then you can opt for a combination of Botox® and dermal fillers as part of our liquid facelift package.

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Frequently Asked Questions

This depends on a number of factors including whether you have a genetic predisposition and how well you've looked after your skin. As a general rule, volume loss in the face starts around age 30 onwards. By the time you reach 40 it is likely that jowls and marionette lines start to appear and continue to increase in prominence in your 50s.
This depends on how apparent they are. If you have only begun to notice them then a small amount of dermal filler can help lift and tighten the skin to minimise their appearance. If they are very apparent and have been there for a while then you may have to consider a larger amount of dermal filler and possibly Botox® to lift, volumise and tighten the skin. In some cases, if there is a lot of loose skin and sagging then you may need to consider that surgery will give the desired result. Of course, before you do anything make sure that you've covered the basics by following a regular skincare routine to cleanse nourish and protect your face. Also eliminate smoking and sun exposure to prevent worsening of skin ageing.
It is not possible to completely stop ageing but there are somethings that you can do to slow down the process and minimise the impact. Looking after your skin by hydrating it as well as using anti-wrinkle products containing Vitamin C and Retinol as part of a regular skincare routine will help. As will stopping smoking and sun damage. You can also ensure that you help stimulate collagen and elastin production with regular professional skin treatments like collagen induction therapy.
In general, we prefer to use dermal filler either alone or in combination with Botox®. This is because the main cause of jowls and marionette lines is volume loss and reduction in skin elasticity which can be corrected with dermal fillers.
This depends on the severity of the jowls and marionette lines, type of filler used and your expectations. Which is why we perform a thorough assessment and provide you with a bespoke treatment plan. As a general rule, for moderate jowls or marionette lines, we recommend at least 1ml of Juvederm Ultra 4 dermal filler to start with.