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Marionette Lines

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How To Treat Marionette Lines

Marionette lines are a common complaint but one that can be treated in many ways. Dr Nyla clinics offer non-surgical treatment options for marrionete lines.

If you would like to arrange a consultation, or simply want further advice please contact us today. Call us on 0162 532 4244 or use our Contact Form for a free marionette line consultation.

Marionette lines – a visible sign of ageing also known by many other terms – can create the appearance of someone looking that bit older, more tired or even sad.

They are fine lines that, while common to many as they age, can still have a profound impact on confidence and self-esteem.

Fortunately, they are also relatively easy to treat, modern non-surgical procedures can remove the creases and instantly wipe years off a person’s appearance.

On this page, we will provide all the key information about marionette lines – what they are, why they appear and – the bit that is most important – how to get rid of them.

What Are Marionette Lines?

Also known as ageing sad mouth and other terms we won’t go into here, marionette lines are the lines that extend from the corner of the mouth downwards.

marionette lines

They are not to be confused with nasolabial folds, which are lines from the bottom of the nose to the corner of the mouth – of course, it is common for both to develop at roughly similar times.

The term derives from the marionette puppets – these had distinctive slits to the mouth so the impression of talking could be created through movement; the term later being applied to the lines we humans develop in the same location.

When Do Signs of Ageing Appear?

It is common for marionette lines to be apparent by the time we reach our forties, but for may they will become an issue earlier. Many clients request treatments for signs of ageing in their thirties, while for others it is as early as their mid to late twenties.

We all age differently and all have different genetic make-ups. 

What can be said with confidence is that the root cause of ‘sad mouth’, as well as other lines around the face, will come to us all; Mother Nature made us that way.

What Causes Marionette Lines?

In common 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 producers less collagen and elastin and it is this depletion that reduces skin elasticity. 

Other factors impact the severity of the lines and how early they appear – these would include genetics, sun exposure, diet and the ongoing skin care regime.

We also lose facial fat as we age and this can also extenuate the appearance of lines and ageing skin.

Surgery To Treat Marionette Lines

Undergoing full cosmetic surgery to treat lines around the mouth would typically only be as an absolute last resort.

While a full cosmetic procedure through a facelift could address the impact of lines, it would also be overkill in most cases as the same results can be achieved through noninvasive or minimally invasive methods.

Surgery has many downsides – it is expensive, the procedure would require general anaesthetic and there would be a lengthy period of recovery, potentially including time off work.

A surgical option is also not a natural remedy, it is cutting and moving skin to create the appearance of youth. 

A no surgical option that looks to fix from within would also be a sensible first option – for instance, treatments that help to replenish collagen creation and so restore skin elasticity.

Non-Surgical Treatments

A range of non-surgical treatment options is available for marionette lines.

marionette lines

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.

The dermal fillers address the root cause of why the lines are caused, addressing the volume loss.

A dermal filler is quick to administer and can target very specific areas of the face. 

However, it is worth noting that the field of facial aesthetics is under-regulated and so almost anyone can set themselves up as a practitioner – 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.

Restylane would be an option when the lines are more active – they change dynamically as we move the mouth.

Skin tightening 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 – a client can have a treatment and then simply go about the rest of their day.

Ultracel: Combines ultrasound, radiofrequency and microneedling to target all layers of the skin to stimulate collagen production which lifts and tightens the skin.

Ultraformer: 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. 

A botox treatment can take as little as 15 minutes and yet the results last for six months.

Silhouette Soft Thread Lifting is yet another option, this treatment involves inserting a suture under the skin – this suture then held in place with an absorbable cone which can be moved in all directions. 

The marionette lines are reshaped and the area is treated for signs of ageing. We will then reshape your marionette lines, 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.

Consultations for Non-Surgical Procedures

While anyone considering treatment should be encouraged to do their own research, it is also true to say that their job is not to be an expert in the wide range of treatments or know which one is the best option.

Instead, it is essential to consider only clinics that offer a wide range of leading treatments and who undertake detailed consultations – thus bringing 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.

The expert can then take this into account, alongside medical history and current health and lifestyle and suggest a plan of best action.

It is impossible in a blog post to say what the best treatment might be in any specific case for laugh lines – whether it is fillers for the skin, facial peel, botox, skin tightening to address wrinkles or another option for loss of volume. 

This level of care is available when you see a medically trained doctor, rather than an unregulated practitioner offering just a singular treatment such as one version of dermal filler.

Available treatments ensure that there will be an excellent option for treatment in all cases – whether this is to boost collagen creation through hyaluronic acid, use skin tighetning technology or other. 

An experienced practitioner can tell you why they recommend a certain course of action and why other options may be less suitable in your specific case. 

Natural-Looking Results

When treating wrinkles and folds, the priority is to create results that have an impact but are natural-looking – the obvious look of ‘work having been done’ is to be avoided.

This is never more true that with lines at the corners of the mouth – we see the mouth whenever we talk to someone or look at them and so the results need to not stand out.  

The face should look younger, happier and less tired, but without drawing overdue attention to any feature.

When dealing with smile lines, the care and experience of the practitioner are of vital importance, ensuring just the right area is targeted. If using fillers or Botox, the precise quantity must be used in the exact location – otherwise results can fail to show or, worse still, be hugely exaggerated.

It is advisable to view before and after photos of past clients at any clinic you consider and also check their online reviews – what have past clients said and do they specifically mention the treatment they had for fine lines and wrinkles – whether good or bad.

Next Steps

Marionette lines are a common complaint but one that can be treated in many ways.

Treatments can be quick and affordable – especially when compared to the huge cost of a full facelift. Many treatments will have an instant impact, while others will showcase results that continue to improve over time.

The crucial next stage is a consultation with a reputable clinic to discuss which treatment option would be the best option in your instance.


Dr Nyla is one of the leading cosmetic dermatologists in the UK – she is trusted by many high-profile clients and her expertise makes her someone that media publications regularly seek an opinion from.

Her Liverpool cosmetic clinic is the largest outside London and also the only Diamond Clinic outside the capital.

Dr Nyla’s clinic won Top Cosmetic Clinic Award in the UK for 2019.

Her testimonials are universally positive and her reviews on the independent TrustPilot site outstanding.

If you would like to arrange a consultation, or simply want further advice please contact us today. Call us on 0162 532 4244 or use the Contact Form.