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Marionette Lines

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How To Treat Marionette Lines

Marionette lines – a visible sign of ageing – can create the appearance of someone looking that bit older, more tired or even sad. They can have a profound impact on your self-esteem and sense of confidence, but fortunately there are many treatments to remove these deep lines and wipe years off one’s appearance. In this guide, we’ll look at what causes marionette lines and, most importantly, how you can get rid of them.


marionette lines

These lines run from the corners of the mouth towards the chin and get their name from their shape which mimics the characteristic facial feature of marionette puppets. Also known as ageing sad mouth, marionette lines shouldn’t be confused with nasolabial folds, which run from the nose to the mouth, although the two can develop at the same time.


Marionette lines often start to become more noticeable by our forties, but for some, they can be a concern even earlier. Many individuals in their thirties seek treatments for signs of ageing, while others might start addressing them as early as their mid to late twenties.

We all age at a different pace, a pace that is influenced by unique genetic and lifestyle factors. However, we know that the underlying cause of “sad mouth” and other facial lines is just a natural part of the ageing process.


Along with other wrinkles, folds and lines, a sad mouth appearance is a natural part of the ageing process. Central to this is collagen depletion. As we age, the body produces less collagen and elastin, and it’s this which reduces your skin’s elasticity and volume.

Other factors impact the severity of facial lines and how early they appear – these include genetics, sun exposure, diet and your ongoing skincare regime. Similarly, we tend to lose facial fat as we age which can accentuate the appearance of lines and wrinkles.


While full cosmetic surgery is an option to treat lines around the mouth, we’d only recommend that as a last resort. Full cosmetic procedures are often overkill in most instances where the same, if not better, results can be achieved with non-invasive or minimally invasive treatments.

Surgery comes with many downsides, from being expensive to requiring general anaesthetic and a lengthy period of recovery after your procedure. They may even require time off work to heal. Surgical treatments are also not a natural solution, since they require cutting and moving the skin to create the appearance of youth.

Non-surgical treatments should always be your first port of call to replenish volume and elasticity by stimulating collagen and elastin production.


We offer a range of non-surgical treatments to target marionette lines.

marionette lines

Dermal Fillers

Dermal Fillers are injections that include hyaluronic acid, a naturally occurring substance, that helps to encourage the creation of collagen in deep layers of the skin. These fillers plump and hydrate the skin and address the root cause of marionette lines – volume loss. Dermal fillers are quick to administer and target specific areas of the face for superb results.

However, it’s worth noting that the field of facial aesthetics is under-regulated and so almost anyone can set themselves up as a practitioner. For this reason, please always check the medical credentials and experience of anyone you consider. Different dermal fillers are available, and the skill of the practitioner lies in knowing which one will be most effective – or if an alternative treatment might be better.

Juvederm can address deep lines and wrinkles, helping to make the skin plumper and creating a youthful appearance. We also recommend Restylane when the lines are more active as they change dynamically as we move the mouth.

Skin tightening treatments

These treatments work by applying heat to deep layers of the skin, this also boosting collagen creation. Growing rapidly in popularity, these treatments are completely non-invasive, so a client can have a treatment and then simply go about the rest of their day without the need for recovery time.

One example is Ultracel which combines ultrasound, radiofrequency and microneedling to target all layers of the skin. This stimulates collagen production which lifts and tightens the skin for a toned, smoother effect. Another option is Ultraformer which uses high intensity focused (HIFU) ultrasound to target sagging skin to improve its appearance, texture and tone.


Botox works in a different way to fillers – rather than boosting collagen creation, it blocks the nerve signals that lead to muscle contraction to prevent wrinkles and lines from deepening. A Botox treatment can take as little as 15 minutes, yet the results last for six months.

Silhouette Soft Thread Lifting

Silhouette Soft Thread Lifting is yet another option for marionette lines which involves inserting a suture under the skin. This suture is then held in place with an absorbable cone which can be moved in all directions. The lines around your mouth are treated for signs of ageing. We will then reshape and lift the treated area for anti-ageing effects. Silhouette Soft is the only absorbable, non-permanent thread lift proven to produce collagen and not scar the underlying skin tissue.

With so many potential treatments possible, an obvious question is to wonder which one is most suited in your specific case. This is where consultations are incredibly useful.


While anyone considering treatment should be encouraged to do their own in-depth research, it’s also true to say that they’re unlikely to be an expert in the wide range of treatments available or know which one is the best option.

Instead, it is essential to consider only reputable clinics that offer a wide range of leading treatments and who undertake detailed consultations before embarking on any procedure, to ensure they’re instilling the highest of medical standards to facial aesthetics.

A consultation is an opportunity for the prospective client to discuss why they are seeking remedy, what it is about their skin and face that concerns them, and to ask any questions they may have about the treatment. The specialist can then take this into account, alongside reviewing their medical history and current health and lifestyle, and suggest the best plan of action.

It’s impossible in one blog post to say what the best treatment might be in any specific case for laugh lines – whether it’s fillers for the skin, facial peel, Botox, skin tightening to address wrinkles or another option entirely to tackle loss of volume. That’s why consultations with a medically trained doctor, rather than an unregulated practitioner, are available to talk through the various options and the pros and cons of each.


When treating wrinkles and folds, our main priority is always to create results that are impactful but natural-looking – we want to avoid the obvious look of ‘work having been done’. This is never truer than with lines at the corners of the mouth – it’s one of the first things we see whenever we talk to someone or look at them, so the results need to be natural and not stand out.

You want your face to look youthful, plump and happy, without drawing undue attention to features like lines and wrinkles. When dealing with smile lines and creases, the care and experience of the practitioner are of vital importance, ensuring just the right area is targeted. When choosing fillers or Botox, accuracy is critical both for dosage and placement. Incorrect application can lead to ineffective results or, in some cases, overly dramatic outcomes.

Before committing to a clinic, it’s wise to review before-and-after photos of previous clients and research online feedback. Look for mentions of specific treatments for fine lines and wrinkles in these testimonials to gauge the clinic’s track record, both positive and negative. This due diligence ensures informed decision-making and ensures satisfactory results.


Marionette lines are a common complaint but one that can be treated in many ways, as we’ve explored here. Treatments can be quick and affordable, especially when compared to the huge cost of a full facelift. Many procedures will have an instant impact, while others will provide results that continue to improve over time. The crucial next stage is to book a consultation with your chosen clinic to discuss which treatment option would be the best option for you.


Doctor Nyla stands as one of the foremost cosmetic dermatologists in the UK, entrusted by a roster of high-profile clients. Her wealth of expertise often sees her sought after by media outlets for expert opinions.

Situated in Liverpool, Doctor Nyla’s cosmetic clinic is not only the largest outside of London but also holds the prestigious title of being the only Diamond Clinic beyond the capital. Recognised with the Top Cosmetic Clinic Award in the UK for 2019, the clinic consistently garners glowing testimonials and boasts outstanding reviews on the independent Trustpilot site.

Whether you want to book a consultation or you’re simply seeking advice, don’t hesitate to reach out to us today. You can contact us by phone at 0162 532 4244 or send us a message by our convenient contact form.