What are marionette lines, and why do they form?
Marionette lines are lines that run from the corner of the mouth down towards the jawline. With age, lower-face volume loss, downward descent of tissue, loss of support in the chin and jawline, skin laxity and the action of muscles that pull the mouth corner down all play a part in forming them. In most people several of these factors are present together.
The mouth corner is a point where three parts of the face meet: tissue descending from the cheek, the chin area and the area around the mouth. With age the midface loses volume, the cheek fat shifts down and forward and begins to collect along the jawline. This build-up creates a fold running towards the chin. At the same time, support at the tip of the chin and the front of the jawbone can decrease, so the tissue below the mouth corner is no longer held up well enough. Loss of collagen and elasticity in the skin then increases the depth of the fold.
The muscle that pulls the mouth corner down, the depressor anguli oris (DAO), moves the mouth corner downwards and outwards; in people with strong activity in this muscle, the mouth corners can turn down even at rest. As a result, a person may notice an expression that looks sad, tired or stern even though they do not feel that way. A recessed chin tip, tooth loss, weight changes, smoking and sun damage also contribute to this look. Because the cause of marionette lines differs from person to person, treatment does not focus on a single line; the lower face as a whole is assessed at the examination.
What is the difference between a marionette line and a nasolabial line?
The nasolabial line is the smile line running from the side of the nose to the corner of the mouth; the marionette line starts at the corner of the mouth and runs down towards the jawline. They lie in different areas of the face, become more marked for different reasons and often call for different support points. They can occur together and can affect each other’s appearance.
The nasolabial line is the boundary between the midface and the area around the mouth, and it is often related to cheekbone and midface support. The marionette line relates to the lower face: it develops between the chin, the jawline, the mouth corner and the soft tissue in that area. The causes of the smile line, when direct filler is considered and how a natural look is kept are covered on the nasolabial filler page; this page focuses only on the marionette area. If both lines are present on the same face, whether midface support is adequate is looked at first.
The relationship between the two lines matters too: while loss of midface support deepens the smile line, tissue that descends can also weigh down the mouth corner and the marionette area. For this reason, in some people treating only one area does not change the look of the other enough. On the other hand, adding a lot of product to each line separately can lead to a heavy, full look around the mouth. When planning, the whole face is watched at rest and while speaking; which area is the priority and in what order to proceed are decided together.
How is filler planned for marionette lines?
In the marionette area, filler is usually planned as one of three routes or a combination: giving volume to support points in the chin and jawline, placing a measured amount of soft filler in the area just below the mouth corner, and placing a small amount of superficial product directly in the line. Which is suitable is decided at the examination according to the cause of the line.
If the chin tip is set back and the jawline has lost support, the marionette look is often related less to the line itself than to this lack of support. In that case, measured support to the chin and jawline can help re-support the tissue beneath the mouth corner; the line may soften indirectly as a result. In this approach, dense, shape-holding products are generally used in the deeper layer. Details of chin and jawline filler are covered on the relevant pages; it should be remembered that the effect varies from person to person.
For treatment just below the mouth corner and along the line, a softer gel that can move with the area is chosen, because this area moves a great deal during speaking, eating and smiling. The product is placed in small amounts, usually in the subcutaneous layer, with a fine needle or a blunt-tipped cannula. Too much product here can make the mouth corner look puffy and produce an unnatural bulge. For this reason the aim is to soften the shadow rather than fill the line completely. After swelling has settled, often within two to four weeks, the result is assessed and a small top-up is given if needed.
Can botox and other methods help marionette lines?
If the action of the muscle that pulls the mouth corner down (DAO) is marked, a very low dose of botulinum toxin to this muscle may be considered in some people; however, this area is delicate and the treatment requires experience. Device treatments for skin laxity, biostimulators for widespread volume loss and surgical options for marked sagging can also be considered.
Botulinum toxin given to the DAO muscle can reduce the force pulling the mouth corner down and help the corner sit more neutrally. However, this muscle works together with the other muscles around the mouth; a wrong dose or placement can change the smile and lip movement. For this reason the treatment is done in selected cases, at a low dose and by an experienced doctor. In some people botulinum toxin and filler are planned together; what botulinum toxin does and how it differs from filler are covered on separate pages. Botulinum toxin given to the chin muscles is considered separately, to soften a dimpled look at the tip of the chin.
Device treatments such as focused ultrasound or radiofrequency aim to tighten mild to moderate laxity; they do not add volume. Biostimulators such as calcium hydroxylapatite or poly-L-lactic acid aim to give a gradual change in people with more widespread lower-face loss of support, and they are not dissolved by hyaluronidase. If there is marked sagging, excess skin or very deep folds, filler and other non-surgical methods may not give the expected change; in that case, referral for surgical facelift options may be made. Which method or which combination is suitable is decided at the examination according to your facial structure and expectations.
What are the risks of filler in the marionette area?
Common effects are swelling, bruising and tenderness. The area around the mouth and chin needs care in terms of blood vessels; vascular occlusion, infection, lumps and delayed inflammatory reactions can rarely occur. Treatment is not given or is postponed with an active cold sore, during pregnancy and breastfeeding, or with an allergy to the product’s contents.
The facial artery runs from the edge of the jaw towards the corner of the mouth and connects with surrounding vessels in this area; its course can vary from person to person. For this reason, treatment at the mouth corner and chin is carried out with an appropriate choice of layer, slow injection, low pressure and small amounts. The area around the mouth is a common site for the cold sore virus; if you often get cold sores, you should tell your doctor. Blood-thinning medicines can increase the likelihood of bruising. If a non-degradable material such as silicone or a filler of unknown content has previously been placed in the area, a detailed assessment is needed before a new treatment.
Increasing pain after treatment, blanching of the skin, a net-like purplish discolouration, colour change in the lip or chin, or any change in vision is not part of normal healing; contact the treating doctor or an emergency department without delay. Hyaluronic acid filler can be dissolved with hyaluronidase when necessary; this is a general safety measure, but it does not prevent every complication. Every treatment carries risks and results vary from person to person. Sharing the product name and date of your earlier treatments helps the plan to be made safely.
Frequently asked questions
How long does marionette filler last?
Duration varies with the product, the amount and the mobility of the area; because the area around the mouth moves a great deal, treatments with soft gels are often noticeable for 6–12 months. At chin and jawline support points, duration can be longer with denser products. An estimate specific to you is made at the examination.
Why do marionette lines make my mouth corners look downturned?
Marionette lines create a shadow below the mouth corner, so the corner can look as if it is turned down. In addition, the muscle that pulls the mouth corner down and reduced support in that area can make the expression heavier. This look does not reflect your mood, but it can give others an impression of tiredness or sadness.
Is chin filler also needed when having marionette filler?
It is not always needed; if the chin tip is set back or the jawline has lost support, chin support can indirectly soften the marionette look. If the chin structure is adequate, a measured treatment only to the mouth-corner area may be enough. The decision is made at the examination by assessing the face from the front and the side.
Can marionette filler cause a lump at the mouth corner?
If the product settles unevenly or too much is used, palpable lumps and a puffy look can form. A measured amount, the right layer and a soft gel help reduce this possibility. Lumps from hyaluronic acid filler can be dissolved with hyaluronidase when necessary; a lump that does not go away should be shown to your doctor.
Is botox alone enough for marionette lines?
If the effect of the muscle pulling the mouth corner down is dominant, botox may help the corner sit more neutrally in some people. If there is volume loss or tissue descent, however, it may not be enough on its own. Botox in this area is a delicate treatment; the need and dose are decided at the examination.
When do marionette lines need surgery?
With marked excess skin, advanced sagging or very deep folds, filler and non-surgical methods may not give the expected change. In that case the doctor may refer you for options such as a surgical facelift. The decision is made by assessing the condition of the tissue and your expectations together.
What should I look out for after marionette filler?
In the first days it is generally advised to avoid massage of the area, positions that press on it, intense exercise, saunas and alcohol. A cold compress may reduce swelling. If you notice increasing pain, blanching of the skin or a net-like purplish discolouration, contact your doctor without delay. Swelling and bruising usually ease within a few days; the final look is assessed within two to four weeks.
Sources (3)
- Hong GW et al. (J Dermatolog Treat): Anatomical-based diagnosis and filler injection techniques: marionette line (static labiomandibular fold) (2025)
- Lorenz FJ et al. (Facial Plastic Surgery): The Role of Toxins and Fillers in Optimizing Perioral Rejuvenation (2025)
- Global Aesthetics Consensus Group (Plastic and Reconstructive Surgery): Global Aesthetics Consensus: Hyaluronic Acid Fillers and Botulinum Toxin Type A—Recommendations for Combined Treatment and Optimizing Outcomes in Diverse Patient Populations (2016)
This content is for general information and does not replace a personal medical assessment.