Marionette wrinkles

Marionette wrinkles are vertical lines that extend from the corners of the lips to the chin, resembling the shape of marionette puppet lips. These wrinkles typically start as shallow lines under the corners of the lips around the age of 35, and with aging, they deepen and become more noticeable, giving the appearance of a downturned mouth. Besides being a natural sign of aging, many individuals find these wrinkles and drooping corners of the lips bothersome as they can make them appear frowning, unhappy, or sad, even when they’re not. While we can’t halt the aging process or completely prevent marionette wrinkles, there are aesthetic and anti-aging treatments available to soften or even eliminate them.

Marionette lines appear beneath the nasolabial folds, starting from the corners of the lips and extending downward to the outer corners of the chin. The primary cause of their formation is aging, but factors such as gravity, genetics, sun exposure, and harmful habits like smoking can accelerate their development.
The appearance of these wrinkles is associated with facial and skin aging due to the following factors:

• Reduced production and depletion of collagen, elastin, and hyaluronic acid in the skin. As we age, our body produces fewer of these essential substances that contribute to tight, smooth, and clear skin. Dry, dehydrated, and less elastic skin is prone to wrinkles.
• Repetitive muscle movement, specifically the DAO (depressor angulis oris) muscle, which is attached to the corners of the lips and pulls them downward. Over time, activities like talking, laughing, and chewing contribute to the formation of these wrinkles.
• Loss of volume and changes in the position of subcutaneous tissue. Aging leads to the resorption of bone tissue, resulting in a smaller jaw and chin. Fat tissue diminishes and descends, causing additional folds on the lower cheeks and chin, while the muscles lose their tone.

To learn more about the aging of subcutaneous tissue and skin, you can find further information here.

Various non-surgical treatments can help diminish the visibility of marionette lines and wrinkles. Among them, hyaluronic fillers prove to be the most effective, particularly for prominent marionette wrinkles. By utilizing fillers, we restore lost volume beneath the skin, effectively reducing the visibility of wrinkles.

As mentioned, the most effective non-surgical method for treating marionette wrinkles is filling them with hyaluronic fillers. However, several factors should be considered for optimal results. Firstly, the depth of the wrinkles and the condition of the surrounding areas, such as the chin and jaws, need to be assessed. After a thorough analysis, a treatment plan is devised.

Shallow marionette wrinkles

For shallow marionette wrinkles, we inject hyaluronic filler into the subcutaneous tissue to fill the wrinkles and add volume. This also tightens the skin under the lips, lifts the corners of the lips, and imparts a younger and more attractive appearance to the lower part of the face.

Deep marionette wrinkles

In most cases, especially for individuals over 40, addressing marionette wrinkles requires correcting adjacent facial areas with hyaluronic fillers to achieve a harmonious outcome. Aging alters the shape of the chin, resulting in the prominence of marionette lines. By contouring the chin with fillers, we compensate for volume loss, support the lips, lift their corners, and soften marionette wrinkles. Botox can also be used to lift drooping lip corners. If midface sagging accompanies the appearance of marionette wrinkles, folds may form above the lips. In such cases, we first correct the cheeks and cheekbones with fillers before treating marionette wrinkles. In instances of significant tissue loss, surgical facelift may be the only viable solution.

What can you expect after treatment?

• Marionette wrinkles become less pronounced or nearly invisible.
• The corners of the lips are lifted, giving the face a happier and younger appearance, eliminating the sad expression.
• Hyaluronic fillers maintain the natural look and facial expressions, particularly for dynamic facial areas.

On average, 1 ml to 2 ml of filler is needed to address shallow marionette wrinkles. For deeper wrinkles that require correction of surrounding areas (cheeks, chin), 3 ml to 4 ml of hyaluronic filler is necessary. The treatment is nearly painless, utilizing anesthetic cream, and lasts approximately 45 minutes. After the procedure, you can resume your daily activities. More information about hyaluronic filler treatment can be found here. Immediate results are noticeable after the treatment, and the effects of the filler typically last about one year.
The images below depict examples of our patients before and after marionette wrinkle and chin correction using hyaluronic fillers. Following treatment, the marionette wrinkles are softened and less noticeable.
The picture below shows examples of our patients before and after the correction of marionette wrinkles and chin with hyaluronic fillers. After treatment, marionettes are softened and less noticeable.

Marionette wrinkles cannot be fully corrected through Botox alone. However, Botox can be used to lift the drooping corners of the lips, which can help soften the appearance of marionette wrinkles. The sagging of the corners of the lips, along with the thinning of the skin and subcutaneous tissue that appears with aging, is influenced by the excessive activity of the DAO muscle. This triangular muscle is located beneath the corners of the lips and is responsible for pulling the lips downward. By injecting Botox into the DAO muscle, it relaxes and no longer pulls the corners of the lips downward, resulting in lifted lip corners.

Shallow marionette wrinkles in the form of superficial, thin lines can be made less noticeable with treatments to improve the quality of the skin. These are CO2 laser treatments, TCA chemical peeling or biorevitalization to strengthen skin tone.

CO2 laser

The fractional CO2 laser is used for skin regeneration, tightening and rejuvenation, as well as for the removal of other irregularities such as stretch marks or acne scars. Laser penetrates to the deepest layers of the skin, triggering the production of collagen fibers, elastin and new skin cells. The overall effect is firm skin with an even texture, while shallower wrinkles and fine lines are softened. Marionette wrinkles, especially those deeper and in the form of folds, cannot be removed with a CO2 laser because the cause of their formation is under the skin. What is possible is to soften the shallow marionette wrinkles as well as the wrinkles around the lip , to tighten the skin and thereby improve the appearance of the lower third of the face. Read all about Candela C02 laser treatment here.

In the picture below, you can see what the result of the removal of shallow and thin wrinkles with a CO2 laser around the lips, cheeks and chin looks like.

The prices for marionette wrinkle removal depend on the treatment we perform, and you can view the treatment prices on the Pricelist page. If you have additional questions or want to book an appointment, please call us at 060/345-0304 or write at estetikabgd@gmail.com.