Marionette Lines Treatment And Prevention Options

Written by Donna Hart, MD, Board Certified Dermatologist on March 25, 2021 11 Comments

marionette lines treatments

Originally published on December 4, 2017. Updated on March 25, 2021 to include information on new marionette lines treatment options.

While commonly referred to as “laugh lines”, marionette lines (also known as nasolabial folds) are no laughing matter!

Marionette lines are creases or folds that run vertically from the corners of the mouth down to the chin. These lines are reminiscent of the jaw of a marionette, hence the unfortunate name. Ironically, marionette lines are not caused by years of laughing. The lines are a common result of the natural aging process that includes a combination of depleting fat (and other facial tissue underneath the skin) with a loss of skin elasticity. The chin is particularly susceptible to wrinkles because it’s an area of great movement where the skin is thinner than other areas of the face.

Genetics can also play a key role in the development of marionette lines and how prominent they become. In fact, genetically susceptible individuals can begin to develop some degree of marionette lines during their childhood.

Learn more about what causes marionette lines, how they’re best prevented, and how you can treat them once they are visible.

marionette lines
Example of marionette lines

What Causes Marionette Lines? 

Marionette lines are primarily caused by factors outside of our control. This includes gravity, age-related loss of collagen or elastin, and genetics.


Gravity is an unavoidable cause of wrinkles. When we’re younger, abundant collagen, elastin, and skin volume balances the effects of gravity. But as we get older, our skin loses volume and structure, becoming vulnerable to this constant, invisible downward pull.


Soft tissue becomes thinner as we age, an effect that’s referred to as volume loss. In addition, facial structures such as bone lose volume. The jawline becomes thinner due to changes in hormones and loss of mineral content. Collagen, a protein which gives skin its structural support, and elastin, a protein which gives skin its elasticity, also decrease with age.


Our jaw is constantly in motion. After a lifetime of smiling, frowning, eating, and talking, the depressor muscle at the corners of the mouth become over-activated. When this muscle pulls down on the corners of the mouth, even at rest, marionette lines appear.


The age at which skin thins due to declining collagen and elastin levels is largely dependent upon genetics. While some people won’t experience wrinkles until late in their 40’s, others may see early signs of marionette lines in their 20’s o 30’s.

Lifestyle Factors

Avoidable lifestyle factors that contribute to aging skin and early wrinkles include excessive sun exposure and smoking. Both produce free radicals which lead to oxidative stress, inflammation, and skin damage at the cellular level. Remember that prevention is far easier than treatment, so do what you can to refrain from smoking and protect your skin from the sun.

Preventing Marionette Lines

While there is no way to absolutely prevent the development of marionette lines, there are a few ways you can slow them down. Follow these simple preventative methods:

Sleep Better

Stomach (face down) and side sleepers are more prone to developing facial wrinkles as their face experiences the pull of gravity all night long. The pressure from the pull of gravity is especially harsh on the nasal-labial fold area of the face. Try to sleep on your back as much as you can. If you simply must sleep on your side try to position your pillow so the lower half of your face doesn’t touch it.

Sun Protection

Excessive UV exposure on the skin can contribute to the loss of collagen and skin elasticity, both of which are essential to preventing marionette lines during natural aging. Always use a high SPF broad-spectrum sunscreen, avoid the sun during peak UV hours, and wear a wide brimmed had when outdoors during a long period of time.


The chemicals found in cigarettes are known to induce early onset aging and damage the skin. Smoking cigarettes causes the deterioration of current collagen in the skin as well as a decrease in future collagen production. Ditch the habit to help your skin (and entire body) look and feel its best.

Skin Care

Another way to prevent marionette lines is to simply take care of your skin by consistently following a daily skin care regimen that suites your skin type. This includes using a daily moisturizer and applying an anti-aging night cream to regenerate the skin. Products containing ingredients like vitamin C, hyaluronic acid, peptides, and other growth factors can work to rebuild lost collagen and restore skin elasticity.


What you eat and drink each day can play a key role in terms of your skin’s resistance to the effects of aging. Dry skin is more prone to forming wrinkle and lines, so staying properly hydrated will ensure that your skin looks and feels its best.

Treating Slight To Moderate Marionette Lines

Once you start seeing marionette lines, the sooner you treat them, the better. If your marionette lines appear only during certain facial expressions, it’s not too early to begin treatment. If you wait until your wrinkles are constantly visible, it will be more challenging to reduce their appearance.

Some great treatments for slight to moderate marionette lines include:

Topical Treatments

The easiest and least expensive way to treat marionette lines is with a proper anti-aging skin care routine. Anti-aging and wrinkle prevention creams, serums, and cleansers should contain one or more of the following active ingredients.

  • Antioxidants to reduce oxidative stress (Vitamin C or Vitamin E)
  • Vitamin B3, or niacinamide, to improve elasticity
  • Collagen peptides to fight collagen decline
  • Hyaluronic acid to promote collagen growth
  • Retinoids to exfoliate skin and promote new cell growth

If the above over-the-counter products don’t seem to be doing enough, try combining them with one or more of the following treatments.

Retinol and Retin-A

Retinol and Retin-A are both retinoids, a Vitamin A derivative. Retinols are commonly found in over the counter products, while Retin-A is available by prescription only. Both treat wrinkles by exfoliating dead skin cells and promoting skin cell turnover. Retinoids can also help stimulate collagen production.

Both can treat marionette lines, although you should be careful not to apply these topicals to your lips or mouth. As the stronger of the two, Retin-A works more quickly, but can lead to excessive dryness, redness or irritation.

To prevent a negative reaction, keep skin well moisturized and avoid sun exposure while using these products.

Moisturizing with Hyaluronic Acid

Hyaluronic acid is a gel-like substance naturally found in your skin that promotes collagen growth. It declines with age, just as collagen does. Replenishing hyaluronic acid via moisturizers, serums, and other skin care products may help prevent wrinkles.

Hyaluronic acid is also a common ingredient in dermal fillers such as Juvederm and Restylane, where it functions to promote collagen production and keep skin hydrated.

Severe Marionette Lines Treatment Options

If you already have fairly prominent marionette lines, there are several cosmetic treatment options that are both safe and effective:

Dermal Fillers

Fillers are non-surgical, injectable treatments that offer the ability to instantly smooth lines and wrinkles. In the case of marionette lines, a hyaluronic acid-based filler such as Juvederm can be used to restore lost volume for a plump and youthful appearance. Radiesse (another popular filler) instantly adds volume back into the skin while also utilizing an ingredient that stimulates the production of collagen over time.

Botox and Other Neuromodulators

Botox is the brand name of the most commonly used neuromodulator in the United States. This injectable wrinkle-reducer is derived from Botulinum toxin and works by temporarily paralyzing the muscles into which it was injected.

Injecting Botox into the depressor muscles relaxes these muscles and reduces the appearance of marionette lines. Importantly, consistent use of Botox while wrinkles are in the early stages of forming helps prevent them from further deepening.

Because Botox is temporary, repeated treatment every 4-6 months is necessary. Side effects are mild and include minor redness, bruising or swelling at the injection site.

Chemical Peels

Chemical peels come in varying strengths for home use, application by an esthetician, or application by a dermatologist. The strongest chemical peels target both the outer and middle layers of the skin. These layers are removed through chemical exfoliation, allowing new, younger skin cells to grow back in their place.

Chemical peels typically require a series of 4-6 treatments for best results. Stronger peels may also require up to 14 days for recovery.

Laser Treatments

Skin tightening lasers effectively reduce the appearance of lines and wrinkles for a smoother, more youthful appearance. These laser treatments transfer heat and laser light under the surface of the skin. By heating the tissue to lift and tighten the underlying foundation, this strengthens the skin and stimulates the growth of new collagen. Some of these types of skin tightening laser treatments include Fraxel, Thermage, and Ultherapy.


Micro-needling (also known as Collagen Induction Therapy) uses controlled damage to spur the skin’s natural creation of new tissue. By creating minor skin injury during the procedure, the skin’s natural healing process initiates the production of new collagen and elastin fibers that thicken the skin and reduce the appearance of wrinkles. Micro-needling can be combined with topical skin rejuvenation treatments like or growth factor gels.


Individuals with deep and prominent marionette lines can benefit from facelift surgery. A facelift is a surgical procedure that makes the face tighter by removing excess skin and tightening any loose underlying facial muscles. While more invasive than all the other above treatment options, a facelift procedure will provide the most dramatic and long-term improvements to the lower face area.


Donna Hart, MD

Donna Hart, MD, a medical, surgical and cosmetic dermatologist, completed her dermatology residency at the John H. Stroger, Jr. Hospital of Cook County in Chicago, where she served as chief resident. Dr. Hart is Board Certified by the American Board of Dermatology, and is a member of the American Academy of Dermatology, American Society for Dermatologic Surgery, and Women’s Dermatologic Society.

11 Responses to “Marionette Lines Treatment And Prevention Options”

  1. Avatar Patricia says:

    For treatment of my marionette lines I having been massaging natural oils into my clean, moist, warm face, such as hemp, avocado, almond, aloe, then do a facial steam treatment to open my pores enabling the oils to absorb. Is this an effective treatment, or are there better effective home remedies?

    • WD Staff WD Staff says:

      Hi Patricia,

      Thanks for reading our post and submitting your great question. Those are most of the popular home remedies I’ve heard. Our advice would be if those prove ineffective, you can come in for a free assessment regarding one of the professional treatments described above. We can tailor an effective treatment plan for your specific needs!

      Thanks again,
      WD Staff

  2. Avatar MARY says:

    I am 67 years old, very very few wrinkles ..round face, not fat but round, my issue is the marionette lines are getting deeper and my upper lip must be falling because at times i can feel the upper part of the line that has formed….best think is?? what to do..

    • WD Staff WD Staff says:

      Hi Mary,

      Thanks for reading our post and submitting your excellent question! We would definitely recommend getting an in-person consultation with a certified dermatologist or plastic surgeon as it is difficult to provide guidance without assessing the skin in person!

      That said, it sounds like you may benefit from a simple non-surgical filler treatments since you indicate that you have few wrinkles and firm skin. Individuals with more severe symptoms will generally need a surgical procedure.

      We hope that helps!

      WD Staff

  3. Avatar Villonell says:

    Saved as a favorite, I love your blog!

  4. Avatar Rose says:

    Thanks for this post, very helpful. I’m dealing with the beginnings of marionette lines and want to get started counteracting them. Do you recommend anything for addressing early marionette line formation?

  5. Avatar Brittany says:

    I am fairly young (32) I have some drooping if my jowls as well as a slight double chin developing and faint marionette lines. I rely on my physical appearance for my work and feel I have exhausted topical or non invasive options am I too young to consider a mini lift?

    • WD Staff WD Staff says:

      Hi Brittany,

      Actually, it sounds like a mini lift may be the ideal treatment option for you. Its mostly used for younger candidates that have very early signs of aging. As always, we encourage you to see a board certified plastic surgeon to confirm if a mini lift is right for you!

      WD Staff

  6. Avatar Kanva says:

    Similar to the nose to mouth lines, mouth to chin lines (marionette lines) can tend to age or ‘clutter’ ones face, giving the appearance of unwanted shadows that pull the face down. By injecting dermal fillers into these deep wrinkles along the mouth and chin, the lines will disappear and bring a youthful, full look back to your face.

  7. Avatar Kathy says:

    I’m 66 and your classic RBF – since I was just a little girl people have always said “What are you mad about?” Obviously, age makes the marionette lines worse. I even tried actual plastic surgery in 2009! I took my life’s savings to a plastic surgeon I worked with – HORRIBLE. He changed the shape of my face with a chin implant that he “thought” the wings would fill out the lines, but I STILL had the marionette lines and the shape of my face is square now!! He literally didn’t care. I’ve thought about (Quick lift) threading but heard it doesn’t last and can fail on just one side, making you look even worse. Recommendations??

    • WD Staff WD Staff says:

      Hi Kathy,

      I’m sorry to hear about about the results of that chin implant. I think the best thing to do would see a (different) board certified surgeon for an in-person assessment. Most of the time we do not recommend threading, we just find the results to be minimal and short lasting. However, the chin implant adds another layer of complication.

      Unfortunately, coming in for an in-person assessment would be the best advice we can provide.

      WD Staff

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