What are puppet lines?

Marionette lines are folds that run from the corners of the mouth to the jawline. They can give a tired, stern or sad facial expression even when you look relaxed. They occur not primarily because of mimicry, but because of structural changes in the skin and underlying tissues as you age. As the volume around the mouth and cheeks decreases and the skin weakens, the lines become more visible.

Marionette lines often occur in combination with other aging features such as sagging jawline, volume loss in the cheeks and deeper nose-lip folds.

Causes of marionette lines

• Volume and fat loss due to aging, causing the cheeks and mouth region to become less firm.
• Skin sagging due to decrease in collagen and elastin.
• Gravity causing the underside of the face to become heavier over the years.
• Genetic predisposition such as bone structure, jawline shape and connective tissue strength.
• Sun damage that weakens the skin and accelerates aging.
• Lifestyle such as smoking, alcohol, stress and sleep deprivation.
• Mouth muscles where overactivity of muscles around the mouth can enhance folding.

Types of puppet lines

• Superficial marionette lines due to incipient skin sagging and slight volume reduction.
• Lighter folds that are visible at rest but can still be mitigated well.
• Deep marionette lines clear vertical folds extending to the jawline.
• Loss of volume at the corners of the mouth causing the corner of the mouth to point downward.
• Sagging in the lower face where marionette lines are associated with loss of jaw contour.

Marionette lines by age: when do they occur and what can you do about them

The age at which marionette lines appear varies from person to person. It depends on genetic factors, lifestyle, sun exposure and skin structure. A different approach is appropriate for each stage of life.

Thirties

The skin gradually loses firmness and the first superficial lines may appear.

• Skin care with antioxidants.
• Sun protection.
• Collagen-stimulating treatments.
• Mild peels or microneedling.

Forties

Volume loss in the midface creates more visible marionette lines.

• Filler treatment to restore volume.
• Collagen stimulation such as laser or needling.
• Vitamin A and C in skin care.

Fifty years and older

The skin becomes thinner and less elastic. Marionette lines are evident.

• Fillers to fill folds.
• Skin firming with laser.
• Intensive skin care for support.

Mature skin

Marionette lines are often part of a broader sagging of the lower face.

• Combination treatments for skin and volume.
• Collagen stimulating techniques.
• Maintenance treatments for long-lasting results.

Treatments for marionette lines

At Ivy clinics, treatment is tailored to the cause of marionette lines. Often a combination of volume restoration and skin improvement is most effective.

Filler

Fillers are most commonly used for marionette lines. They can restore volume, support the corners of the mouth and soften folds. The results are immediately visible and are matched to the natural contours of the face.

Laser treatment

Laser treatments stimulate collagen and improve skin structure. Especially suitable for superficial marionette lines and general skin sagging.

Microneedling or RF needling

These treatments stimulate the production of collagen and help the skin become firmer. They can be used for fine lines and to support other treatments.

Chemical peelings

Peelings improve skin texture and can help with incipient lines, small creases and sallow skin around the mouth.

Skincare and cosmeceuticals

Care with active ingredients such as retinol, vitamin C, niacinamide and peptides can improve skin quality and help reduce visible wrinkles.

Reduce and prevent marionette lines

Although marionette lines are often a result of natural aging, you can delay their occurrence and reduce their visibility.

Sun Protection

Daily UV protection helps reduce collagen loss and prevents premature skin aging.

Skin Care

Active ingredients such as retinol, antioxidants and peptides help keep skin smoother and firmer.

Healthy lifestyle

Adequate hydration, sleep and a varied diet support healthy skin. Smoking and excessive alcohol consumption accelerate skin aging.

Volume maintenance

As more volume is lost, periodic treatments can help support facial structure.

Awareness of mouth muscles

Habits such as tension in the jaw, clenching of the jaws or tightening of the mouth muscles can worsen crease formation. Awareness of this can help.

Which treatment suits you

Free, no-obligation consultation

Want to know what Ivy clinics can do for your marionette lines? During a free, no-obligation consultation, the cosmetic doctor or skin therapist will look at your skin, volume loss and the structure of the mouth and jaw region. Together, you will determine which treatment best suits your face and needs.