What Can I Do About Lines Coming Down from Each Side of my Mouth?

I look like a puppet and hate them, what can I do do remove them permanently. and how much will it cost. I'm 69 years old but look 50 (so I'm told).

Doctor Answers 7

Treating puppet (marionette) lines

To get the very best and most effective treatment of marionette lines, we take a multipronged approach, and perform each procedure to the maximal degree without inducing artifact or a done look.

1.  Place fat-fascial grafts into the lines (LiveFill)

2.  Augment the lips, particularly the corners of the lips (LiveFIll)

3.  Divide the DAO (depressor anguli oris) muscle tethering the corner of the mouth down into a frown

4.  Perform a volume sparing and elevating facelift if necessary

Of course it is possible for patients who want a minimal or quick recovery intervention to have temporary hyaluronic acid fillers alone, but the above paradigm will give the best and most comprehensive result.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 103 reviews

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Marionette Lines

These are called marionette lines. They develop by forming certain facial expressions repeatedly, such as frowning. With time, they become permanently etched on your face. These can be smoothed away with fillers.

Treatment for the down turning corner of the mouth

I refer to this area as the maintenance area of the face. It is caused by several factors;

  • The vertical height of the teeth shorten as we age
  • The cheek tissues relax
  • We lose tissue from years of the muscles working as we chew, frown, grind or clench our teeth.
  • The skin begins to thin revealing the underlying structures

Treatments will vary depending on the degree of each of these above components.

  • Botox to the small muscle that pulls the corner down
  • Fillers to help restore the lost volume
  • A facelift may help to decrease some of the tissue on the outer part of the fold
  • Laser resurfacing has been helpful to restore collagen in the skin and help hide some of the underlying changes

Brian Maloney, MD, FACS
Atlanta Facial Plastic Surgeon
4.5 out of 5 stars 16 reviews

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Sagging around mouth and jaw

The facial skin is attached to deeper structures via ligaments. As we age facial expression movements create creases or lines and together with gravity stretch the skin which sags. At the attachement points of these ligaments deeper folds appear like the marionette lines and nasolabial folds. The best way to treat these is some combination of excess skin removal by surgery, skin shrinkage by laser and filler injection. Which modality or combination of modalities is best varies from patient to patient.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Best way to Smooth Puppet (Marionette, Drool) Lines

Regarding: "What Can I Do About Lines Coming Down from Each Side of my Mouth?
I look like a puppet and hate them, what can I do do remove them permanently. and how much will it cost. I'm 69 years old but look 50 (so I'm told

The lines you are referring to as Puppet Lines are also called Marionette (French string puppet) or Drool lines. These lines are caused by a sagging of the cheek which also causes a deepening of the nose to corner of mouth (Nasolabial fold) lines.

To correct it we would need to EITHER:
- lift and reposition the cheek back in its youthful position with one of several cheek lifting Facelift techniques
OR if you would accept a lesser Puppet line smoothing (and cost) by
- applying certain deep fillers to the folds (Fat, Perlane etc).

The results of these two options are NOT the same . The fillers are a much cheaper, simpler but less effective method than a Cheek Lift Facelift.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 69 reviews

Marionette lines

I  think that you are talking about marioinette lines and these lines can be treated with fillers and a facelift. The facelift  will get rid of most of the problem in most cases.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Injectable Fillers work well for marionette grooves.

I read your concern: In my practice, I will favor a non-surgical approach whenever feasible. You can have your marionette grooves filled with little or no downtime. I prefer Silikon-1000, an off-label filler, for permanent results. In my practice, the fee for a marionette-groove treatment with Silikon-1000 is $750.

I've attached a link to a photo from my RealSelf gallery demonstrating rejuvenation of the marionette grooves in one of my patients.

All the best from NJ

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 302 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.