Folding in the Marionette Lines Area?

I am 41 years old with good skin. However, I am developing folding skin that are going down from the corners of the mouth to the sides of my chin. They aren't marionette lines but rather folding in that area when my mouth is closed. I have been told that fillers can fix the problem, but I am afraid of getting a chipmunk look or a wide chin look especially that I am a petite person with a small face. Is filler a good idea? Thank you.

Doctor Answers 4

Folding in the Marionette Lines Area?

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Thank you for your question. Due to gravity and normal aging process, we can develop what's called marionette lines and oral commissures. Fillers can treat these areas by filling in the folds or creases temporarily up to 6-9 months, and mini facelift surgery for more permanent result. I hope this helps.

Belotero for Fine Marionette Lines

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Dermal fillers such as Restylane, Radiesse, Belotero and Juvéderm typically work best for marionette lines. These injectable formulations counteract wrinkles, sagging, loss of volume and wrinkles due to aging, which all contribute to the appearance of these lines.

Belotero might be a good choice. It can be injected closer to the skin surface to address fine wrinkles. Additionally, you may want to look into laser skin rejuvenation treatments such Fraxel and Spectra, which stimulate new collagen production to address unevenness, age spots, scars and wrinkles. If the lines are deeper however, Radiesse or one of the other hyaluronic acid filler such as Juvederm and restylane would be preferable.


Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 33 reviews

Options to help with folding in marionette area

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Pictures would be helpful to give you the best advice.  It's possible that there might be surgical options to help with the issue of folding in your marionette area.  It is also possible that fillers could help as well.  Sometimes this problem can be improved by injecting a filler just beside the fold to help even out the area.  Other times, a filler can be injected into a different adjacent area which can help to pull up the fold and lead to improvement.  If the fillers are done well, it should not cause you to have a chipmunk look or wide chin look.   

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

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Pseudo-marionette lines

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Hello shakerandseb, thanks for your question.  Without seeing a photo of you or doing a thorough physical exam, it is difficult to say what exactly is going on.  However, based on your age and description, if they are not marionette lines, you may be developing early signs of midfacial descent with aging, where the midface soft tissue gradually loses its tone and start to sag.  This can lead to the folding that you describe, as well as deepening of your nasolabial folds (smile lines).  If you have fair skin, excessive sun exposure, or smoke, all these factors will increase your chances of aging more rapidly.  Although a facelift may still be a bit early for you, some filler can nicely camouflage mild folding around the mouth.  This can be done in a modest and tasteful manner, but be sure you go to a board-certified plastic surgeon as it seems like everyone, including dentists and nurses at medispas, are now offering botox and filler products with questionable results.  Hope that helps! -Dr.92660.

Parviz Goshtasby, MD, FACS
Newport Beach Plastic Surgeon

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.