What is the best way to get rid of marionette lines? (photos)

I'm 50 and deep marionette lines have come up along with jowls and double chin. I have been told lipo to the jowls and neck will take better care of the marionette lines than fillers say in cheeks or in the lines themselves. Any thoughts?

Doctor Answers 11

Marionette line corrections

The indisputably best way to fix marionette lines long term and restore anatomy is face lifting.  The cheek needs to be re-suspended and this will lift the tissue.  This will also correct a double chin and jowls.  A less expensive, secondary method would be placement of fillers or fat in the cheek to lift the cheek, improving the jowls and marionette lines.  This will not help a double chin.  Best of luck


Saint Louis Plastic Surgeon
4.8 out of 5 stars 48 reviews

What is the best way to get rid of marionette lines

Thank you for your question and photographs.  Marionette lines are best improved with the use of dermal fillers to help soften these facial creases.  Liposuction can then be performed to the neck to help improve the appearance of a double chin.  In cases of more severe jowling, a surgical facelift/necklift best addresses all of these issues to leave a pleasing jawline.   Hope this helps

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Marionette lines

Liposuction is a poor treatment for marionette lines.  Fillers or fat grafting usually help for this area.  Jowl and neck issues are often treated best with a face and neck lift.  Fat grafting may be added at the time of surgery to enhance the outcome.  There are many excellent surgeons in your area.  I would recommend making an appointment with one to discuss your concerns.

Liposuction is almost never indicated for treatment of jowling.

Nonsurgical treatment of jowls includes fillers. Generally a gel emerges from dissent of the midface fat to the anchoring point between the corner of the mouth and the cheek. The best solution is surgical-a facelift. Skin tightening technology does not work.

Marionette lines and chin -- fillers / fat/ sculptra, you may need lifting, chin implants

Marionette and other lines on the face need more than just direct filling with fillers.  They improve best with facial sculpting and lifting and this requires a combination approach with fillers, skin tighetning, and lasers.  Please see a cosmetic dermatologist with experience.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 167 reviews

Periroral rejuvenation

Sometimes fillers can help with depressions around the corners of the mouth.  Best to be seen in person.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Lines aroung the mouth

This is something that has to be determined with an exam.If the lines are due to a loss or atrophy of tissue then fat or fillers or if your jowls ,are too heavy maybe some judicious lipo. 

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.8 out of 5 stars 56 reviews

Treatment for Marionette Lines

A marionette is a puppet controlled from above using wires or strings.  These puppets moved their mouths by moving their lower lips and chins as a single unit.  In live human beings, marionette lines refers to those paired lines that go from the corners of our mouths then down and out to each side of our chins (like a puppet).  There are 3 reasons that marionette lines form.

1. Solar aging of our skin from sun damage and time passing.
2. Deflation or atrophy of fatty tissues in our faces as we age (even obese people get deflated faces).
3. Ptosis or falling of the soft tissues on our faces.

Fixing them requires:
1. Skin care, skin resurfacing with lasers or chemical peels
2. Fat grafting or transfer to replace and replenish the deflated fat compartments of our faces.
3. Lifting of the soft tissues back up to where they are supposed to be with a facelift.

Liposuction will NOT fix marionette lines.  In fact the OPPOSITE (fat transfer) is the treatment.  Liposuction may make your neck look better by removal of submental fat, but will not address your marionette lines.

Looking at your picture, you probably don't need a facelift yet.  I would recommend Botox injections into your DAO (depressor anguli oris muscle) - 5 units on each side.  This will help prevent the corners of your mouth from pulling down by temporarily weakening the muscle that pulls them down.   I would also inject filler or fat into your marionette lines to "fill the wrinkle/valley."  All of this could be done in the office under local anesthesia.  Filler being temporary, fat transfer being more permanent.  




Marionette lines, Jowls and double chin - liposuction and fillers can help

Dear Slugo44
These are 2 separate problems with different causes and hence both have to be dealt with independently.
Marionette lines respond well to Dermal Fillers such as Juvederm Voluma and Modelis.
Fat transfer is also an option
Double chin responds well to liposuction or the non surgical option of Kybella.
If you are having lipo to your neck consider fat grafting to your marionette lines and chin
Cheek fillers will enhance your cheeks but will not address the marionette lines
Hope you find this useful

What is the best way to get rid of marionette lines?

For most men and women in their 50's, marionette lines become increasingly bothersome.  IMO the best treatment is the injection of hyaluronic filler (ie Juvederm) to soften the marionettes. Filler BTW can also be used for the horizontal neck wrinkles at the same time.  Double chins are best treated with liposuction if there is thickness from fat when you pinch a double layer of your upper neck skin.

Discuss your options with a Bd Certified plastic surgeon or derm and enjoy your results!

Jon Perlman MD FACS

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 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.