Plastic surgery

Marionette lines: What they are, causes and treatments

February 16th 2026 · Updated on 27 September 2026

Updated on 27 September 2026 • Reviewed by Dr. Gustavo Sordo, plastic surgeon

Marionette lines, also known as mentolabial folds , are one of the most visible and characteristic signs of facial aging. They not only add years to the face but can also convey an expression of sadness, tiredness, or severity. As people increasingly seek solutions to maintain a fresh and youthful appearance, interest in effective treatments for these lines has grown exponentially.

In this article, we'll take an in-depth look at what marionette lines are, how they differ from other facial wrinkles, and the main causes of their appearance. We'll also analyze the most advanced treatments available and discuss what you can expect in terms of results, post-treatment care, pricing, and prevention strategies to maintain youthful skin for longer.

What are puppet lines?

Marionette lines are deep wrinkles that form from the corners of the mouth toward the chin. Their name comes from their resemblance to puppets, whose movements are controlled by strings that mark similar lines on the face.

Difference with nasolabial folds

Although marionette lines and nasolabial folds are both signs of facial aging, they have distinct characteristics that influence their treatment and prevention.

Nasolabial folds are located from the wings of the nose to the corners of the lips. Their shape is more diagonal or horizontal, following the natural movement of a smile. Their main cause is a combination of volume loss in the cheekbones and gravity, which causes the skin to sag toward the sides of the mouth. They are usually noticeable from the age of 30-35, although they may appear earlier in people with less defined bone structure or thin skin.

Marionette lines, on the other hand, run from the corners of the mouth downwards towards the chin. They are more vertical and deeper, creating a "droopy mouth" effect. Marionette lines are primarily due to muscle laxity and loss of structural support in the jaw and lower third of the face, and generally become visible after age 40, although factors such as smoking, excessive sun exposure, or genetics can accelerate their appearance.

It is important to differentiate between marionette lines and nasolabial folds in order to choose the appropriate treatment.

Causes

Natural aging and collagen loss

From the age of 25, collagen and elastin production decreases by 1 to 2% annually, reducing skin firmness. This loss accelerates between the ages of 40 and 50 , leading to sagging and deep wrinkles.

Redistribution of facial fat

With age, the subcutaneous fat that gives volume to the face is redistributed or lost, especially in the lower third. This causes the skin to sag towards the jawline, thus accentuating marionette lines.

Loss of bone density (jaw resorption)

The jaw and chin lose bone density over the years, reducing the structural support of the skin and facilitating the formation of deep folds.

Repetitive muscle movements

The lower lip depressor muscles (such as the depressor anguli oris) are activated when speaking, frowning, or making expressions of displeasure. Over time, these movements contribute to the formation of lines.

External factors: sun, tobacco and pollution

Chronic sun exposure degrades collagen and elastin, smoking reduces skin oxygenation and accelerates wrinkle formation, and pollution also plays a role, as free radicals weaken the skin barrier.

Genetics and ethnicity

People with thin skin or a family history of premature aging are more likely to develop it early.

At what age do they usually appear?

In general, marionette lines begin to become noticeable from age 40 onwards, but in people with thin skin, smokers, or those who suffer from high sun exposure, they can appear as early as age 30.

What is the best treatment for marionette lines?

Marionette lines, along with nasolabial folds, are the best example of why fillers aren't always the answer: they appear because the tissue in the midface has descended and accumulates above the supporting ligaments. Simply filling the lines adds volume to an already overloaded area, resulting in a heavy lower face, which is the opposite of what you want.

In cases of mild sagging, the most effective approach is usually higher up—restoring volume to the cheekbone—and complemented with neuromodulators in the depressor muscles of the corner of the mouth. When the sagging is significant, the solution is surgical: a deep plane facelift , which releases the supporting ligaments and repositions the tissue vertically, almost always combined with lipofilling to restore lost volume. Clearly distinguishing between "sagging" and "empty" is what separates a natural result from an artificial one.

Hyaluronic acid

This is one of the most popular treatments. It fills in wrinkles and stimulates collagen production. Results last between 6 months and 1 year.

Collagen biostimulators (Sculptra, Radiesse)

These technologies stimulate natural collagen production, improving skin structure in the long term.

CO2 or Fraxel laser

These techniques help improve skin texture and reduce wrinkles through cell regeneration.

Botulinum toxin

In some cases, botulinum toxin is used to relax the depressor muscles of the corner of the mouth, but it does not fill the wrinkle.

Surgery (facelift)

In advanced cases, a surgical facelift may be the best option for complete rejuvenation and the elimination of marionette lines.

Care and recovery

Hyaluronic acid fillers or biostimulants

During the first 24-48 hours, you should avoid touching the area to prevent the product from shifting. You should avoid strenuous exercise, as this increases the risk of swelling. You should also avoid sleeping on your back to avoid pressure on the treated area.

Local cold should be applied if there is inflammation, SPF 50+ sunscreen should be used to prevent hyperpigmentation, and saunas or very hot environments should be avoided.

Deep laser or peeling

Key precautions should be followed, such as using repair creams with panthenol or hyaluronic acid, strictly avoiding the sun for 4 weeks, and not scratching scabs if they form.

After a surgical facelift

During the first month, you should wear a compression garment if indicated by your surgeon, sleep with your head elevated to reduce edema, and limit sudden neck movements.

Before and after: Results

If fillers with hyaluronic acid are used, wrinkles are filled by 70 to 80%, the corners of the mouth appear slightly raised, and the skin is more hydrated, with results that last between 8 and 12 months.

And if you undergo a facelift, you can achieve a 90% reduction in wrinkles, with a more defined facial contour and firmer skin. These results last 5 to 10 years.

We recommend you take a look at all our before and after facelift cases.

How much does it cost to remove marionette wrinkles?

The price depends on the treatment. At our clinic, hyaluronic acid fillers, performed by Dr. Alejandro Mendieta, range from €500 to €1.500 depending on the area and amount. For other treatments (biostimulators, threads, laser), the price is calculated during the consultation.

A facelift, on the other hand, is surgery: at our clinic, it ranges from €15.000 to €22.000, depending on the technique and the complexity of the case. We explain this in our article on facelifts in Madrid.

How to choose the best treatment for you?

Personalized professional assessment

A dermatologist or plastic surgeon should analyze the degree of wrinkle depth, skin quality (thickness, sagging), and underlying bone structure of the patient.

In our Plastic Surgery Clinic in Madrid, you will find Dr. Gustavo Sordo, a plastic surgeon with more than 20 years of experience and a solid track record in facial cosmetic surgery.
If you are thinking of undergoing a facial lifting in MadridYou can book a consultation with us. Our technique combines precision and sensitivity, offering personalized solutions to rejuvenate your face without sacrificing a natural appearance.

Each procedure is designed to respect the patient's unique expression and restore harmony and firmness to the face with long-lasting, elegant results.

Goals and lifestyle

If you're looking for immediate, non-invasive results, hyaluronic acid can be used. If you prefer progressive but long-lasting effects, biostimulants are a good option. If you need a non-surgical facelift, you can opt for the use of tensioning threads and laser. And if you have advanced sagging skin, the best option is a surgical facelift.

Budget and recovery time

Fillers are the most affordable option (starting at €250) and offer 0 days of downtime. Surgery, on the other hand, requires a larger investment (€5.000+) and a four-week recovery period.

What happens if you don't treat the marionette lines?

Over time, they become deeper, giving a tired and aged appearance. Furthermore, the sagging worsens, making it difficult to correct in the future.

Tips to prevent its appearance

Daily sun protection

Use an SPF 50+ with UVA/UVB and blue light protection.

Skincare with retinoids and antioxidants

At night, retinol or tretinoin to stimulate collagen, and in the morning, Vitamin C + Hyaluronic Acid to hydrate.

Facial exercises and massages

Gentle upward movements from the chin can improve circulation.

Diet and habits

Eat bone broth, oily fish, and berries. Avoid tobacco and excessive alcohol.

Frequently Asked Questions (FAQs)

Does marionette line treatment hurt?

Topical anesthesia is used for fillers and threads. Discomfort is minimal.

Can men also treat these wrinkles?

Yes, more and more men are opting for these treatments.

Can they be completely removed without surgery?

Yes, with fillers, laser, or threads, but in advanced cases, surgery is more effective.

How long does hyaluronic acid last on marionette lines?

Between 6 months and 1 year, depending on metabolism.

Why do marionette lines occur in young people?

Due to genetics, rapid volume loss or excessive facial habits.

Conclusion

Marionette lines are a common sign of aging, but today there are multiple options for correcting them. Prevention with skincare and healthy habits is key, and a consultation with a specialist will help you choose the best treatment for each case.