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 16

Treating puppet (marionette) lines

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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
4.9 out of 5 stars 194 reviews

Treatment for Lines Coming Down Each Side of The Mouth

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Dear Mobile3658:

Hyaluronic acid fillers like Juvederm can help soften up the nasolabial fold and marionette lines on the sides of the mouth.  I recommend having a thorough facial exam to determine whether reflating of the cheek might be the better initial treatment option thus preventing from over-filling the lower third of the face.  Hope this information helps.

Marionette Lines

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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.

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Best way to Smooth Puppet (Marionette, Drool) Lines

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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

Lines coming down from each side of your mouth

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Hi - thanks for your question! These lines are often called "marionette lines." There are many ways to address these, ranging from fillers for a temporary and less invasive approach to a facelift for a more comprehensive, long-lasting solution. An in-person evaluation will help your surgeon guide you towards the treatment best suited to your needs.

Softening Marionette Lines

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The best way to treat the lines that run along the side of the mouth, more commonly known as marionette lines, would be with one of the hyaluronic acid fillers available today. If the folds are slight I would recommend Vollure or Restylane Defyne. If the folds are more severe, I commonly layer a filler that has more volume such as Juvederm Ultra Plus or Restylane Lyft, with a Juverderm Ultra or Restylane. The combination of the two really help to soften the lines and give a more youthful appearance. Treatment should be repeated about every 8 months as needed.

Best of luck!

Dr. Kaniff

Thomas E. Kaniff, MD, FACS
Sacramento Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Marrionette lines

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Hi there!

It sounds like you are describing what is called the marionette lines here. These deeper folds are best treated with hyaluronic acid based dermal fillers to soften depth. It is also important to consider why these lines become more prominent because this can help with a more natural fix. With age, fat pads in the middle of the face descend and cause the marrionette lines to become worse. Therefore midface volume and non surgical lift can greatly improve these lines for a more natural result. 

Hope this helps! 

Best wishes. 

Dr Rupert 

Fear no more!

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I love going fillers as much as I love putting on my make up, because it is an art!

Chances are you need a combo of Botox and fillers. Botox should be placed carefully because it can cause a "joker smile" if you are not a candidate for it! Therefore, I always have patients smile really big to see what the effect of the botox will be on their smile before we even discuss this as an option.


Fillers are great because they support the angles back up! Most people think that they need to put fillers just in the area of the sagging! Not true! There are "vectors" to sagging. IF you find the area of the vector and place fillers there, you create a bigger lift to pull up the parts of the face sagging. Then once you lift from there you also add fillers to the M-lines to enhance them.

You NEVER want to have too much fillers on the lower face- it causes an aged appearance because young faces are like a nice triangle and older faces are an inverted triangle. So, simply put, enhance the upper face can help make a natural restoration to the sagging angles of the mouth.

I always determine which combo of fillers to use based on the consolation: as my patients are talking I watch them animate their faces. The answer comes to me based on their unique anatomy! It really is so satisfying to see their happy faces after!

Best of luck!

Tanya Kormeili, MD
Los Angeles Dermatologist

Marionette Lines and Best Treatment

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I find that these marionette lines are part of the "jowls" that most patients hate and are some of the first signs of aging.  Thermage is a fabulous way to produce new collagen and tighten the jowls and improve the appearance.  Restylane Lyft is a fantastic filler to treat this area and the results last up to a year.  Please consult an expert in lasers and fillers for the best cosmetic results. Best, Dr. Green

Deep perioral wrinkles

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Thank you for your question. There are multiple treatment modalities that can be used to treat deep wrinkles around the mouth. Volume replacement (best achieved with injectable fillers such as Juvederm) Botox therapy, skin resurfacing (chemical peel or laser therapy) and/or surgical lifting procedures can be used effectively to help address such deep wrinkles. A consultation with an expert in facial rejuvenation/facial plastic surgery will allow for a proper assessment of what treatments are most suitable for your individual needs.

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.