Help Me Treat my Marionette Lines? (photo)

I'm a 32 yr old white female with marionette lines. When I was a teenager up through my early 20's I would get acne on the corners of my mouth resulting in some scarring (mainly on the left side in the images posted). I remember seeing the marionette lines as early as 25 and by 28 they looked about as bad as they do now. Should I do botox and filler or just botox? Help! I'd really like these to go away as long as it looks natural.

Doctor Answers 8

The Treatment of Marionette Lines and the Downturn of the Corner of the Mouth

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Have reviewed your photos and I do appreciate the exccentuated marionette lines that you are concerned with. I also notice the downturn at the corners of your mouth. I would recommend only a filler introduced in the following manner:

  • A direct placement of the filler of your choice in two planes beneath your marionette lines will diminish your problem.
  • I would also place a small amount of filler on the underside of the upper lip near the corner.  This will roll the lip up nicely to produce more of a smile and also secondarily reduce the deepened marionette lines. 

Good Luck

Eau Claire Plastic Surgeon
4.7 out of 5 stars 22 reviews

Dermal Fillers and Restylane for Marionette Lines

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For marionette lines, you should opt for dermal fillers since Botox or Dysport are not injected into this part of the face. Dermal fillers, such as Restylane, Radiesse, Belotero and Juvéderm, counteract sagging, loss of volume and wrinkles due to aging. Which dermal filler you should opt for use depends on how to deep you lines, as Radiesse provides the most structure suppost. Additionally, you may want to look into laser skin rejuvenation treatments since you also have acne scarring. Fraxel and Spectra work by stimulating new collagen production to address unevenness, age spots, scars and wrinkles.


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

Effective Treatments for Unsightly Marionette Lines.

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First, you should know that Botox is used to stop the muscle contractions that create lines across the brow, between the eyes, and around the eyes. Botox is not a common application for treating marionette lines. Nevertheless, there are effective treatments readily available. These include such hyaluronic acid dermal fillers as Juvederm, Perlane and Restylane. All three are very effective in plumping out marionette lines for 6 months or more. Still, for longer-lasting results, I’d recommend Ultherapy, an ultrasound treatment that takes from 60 to 90 minutes. It is completely non-invasive and can achieve a dramatic toning and tightening of sagging, furrowed skin in the areas of the chin, neck and brow. Better yet, usually only one treatment is necessary to achieve results that will last up to two years.

Hal Michael Bass, MD
Miami Plastic Surgeon

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Treatment of marionette lines

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Thank you for the question!  Looking at your photo, you do have some downturning of the corner of your mouth as well as the beginning of marionette lines.  I believe that fillers (Juvederm, Restylane, Radiesse, etc.) are the best for non-surgical correction of this area.  They will be longer lasting than the neurotoxins, for which, I believe, do not give great results for this problem.  Fillers will typically last 4-6 months and will adequately "fill" these areas.

Another consideration would be for fat grafting to these areas where fat is harvested via liposuction and reinjected to these areas.  It will be permanent, with very little downtime and minimal complication rate.  It could also be placed in you nasolabial folds and corners of your lips to add volume.

I hope that this helps!  Best of luck!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Several ways to fix this

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As mentioned by the other physicians, Neurotoxin, such as Botox or Dysport can help with this problem as well as a fillers such a Radiess, Juvederm, Restylane or Fat.   There are also minor surgical procedures such as an internal or external lifts that can soften these folds.  Sometimes the best results are obtained with combinations of these procedures.


Lane Smith, MD
Las Vegas Plastic Surgeon
4.6 out of 5 stars 98 reviews

Treatment of Marionette lines

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Hello.  After reviewing your photos, even though you are younger, you seem to have some loss of volume around your oral commissures which can accentuate your Marionette lines.  The best way to treat this would be to replace the lost volume with some filler product.  I am not sure if you frown a lot which can lead to hyperactive depressor anguli oris muscles that serve to pull down the corner of your mouth, but if so, a small amount of neurotoxin and help relax this as well.  However, I try to stay conservative with the neurotoxins around the mouth because there is a very small margin for error before you risk an asymmetric smile or irregular oral motion.  I would recommend some filler first.  Hope that helps! -Dr.92660

Parviz Goshtasby, MD, FACS
Newport Beach Plastic Surgeon

Improvements around the mouth

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Ideally, I would treat your marionette region with Juvederm or Restylane and a touch of botox into the muscles that pull down the corners of your mouth.  The botox with allow for less downward pull and will likely result in a much slower absorption of the filler.  This means it will last longer.  

Justin Yovino, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 103 reviews

Marionette Lines: Botox vs Filler

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When treating the marionette lines, the procedure used should be based on what you desire to accomplish. For down turning of marionette lines without any volume loss in the corners of your mouth, a small amount of Botox may be all you need. However, as we continue to age we lose more fat volume in the face and a filler such as Juvederm or Restylane can be very effective at both replacing the lost volume and correcting the downturn. Though you are young, you have lost some volume in the corners of your mouth, so I would suggest beginning with filler. This is one of my favorite spots to place filler, because a dramatic result is achieved with a small amount of product. 

Meg Cherry, MD
Birmingham Dermatologic 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.