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

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.

Those lines are referred to as marionette lines and they are often treated using injectable dermal fillers. There are a number of fillers that can work well in this area, but I particularly like Restylane Defyne because it fills in the lines effectively without limiting the natural movement of the face. Fillers are quick to administer and do not require any downtime afterward. Results can last anywhere from 6 months to 1 year in most cases. If you want a longer-lasting result, you will likely need to look at a surgical facelift, possibly combined with facial fat transfer to the midface, to achieve a more youthful contour. Improvements gained from this approach can last up to 10 years or even longer in some cases. I advise you to schedule a consultation with an experienced, board-certified facial plastic surgeon for a comprehensive examination and detailed discussion of your concerns and goals. With a customized treatment plan, you should see a result that is both natural and meets your expectations.

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.

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

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 

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.

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.

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.

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

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