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 13

Treatment for Lines Coming Down Each Side of The Mouth

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.


Kelowna Physician
5.0 out of 5 stars 9 reviews

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.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

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.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 178 reviews

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
4.9 out of 5 stars 109 reviews

Fear no more!

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
5.0 out of 5 stars 6 reviews

Marionette Lines and Best Treatment

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

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

Deep perioral wrinkles

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.

Edward Buckingham, MD
Austin Facial Plastic Surgeon
4.9 out of 5 stars 46 reviews

Facial lines

Marionette lines can be treated with very good success using dermal fillers like radiesse, Beloterro or Restylane and juvederm. I would suggest getting an evaluation by a reputable provider.

Kristin J. Tarbet MD, FACS
Bellevue Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Without An Exam- It's tough to recommend surgical or non-surgical options.

It’s not unusual for patients to develop marionette lines during facial aging.When these lines are minimal they can often be treated with injectable fillers.When these lines are more severe and accompanied by redundant saggy skin surgical intervention may be necessary.It’s important to understand that none of these solutions are permanent.In other words, we’re able to set the clock back, but never stop the clock from ticking.
In someone who is 69 years old, redundant facial skin is probably present.Under these circumstances, it’s impossible to make a recommendation without a physical examination or pictures.This recommendation will depend upon the patient’s physical findings and aesthetic goals.In some cases, facelift surgery will be indicated.
The cost of these procedures varies tremendously and depends on whether surgical or nonsurgical methods are chosen.If you have deep marionette lines it’s important to consult a board certified plastic surgeon.This surgeon should be able to formulate an appropriate treatment plan for your problem.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

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
4.7 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.