Marionette lines run from the corners of the mouth downward toward the jaw, and they are named for the hinged mouth of a puppet. What brings patients in is rarely the lines themselves. It is being asked repeatedly whether something is wrong when nothing is, because the combination of downturned corners and creases beneath them makes a neutral face read as unhappy.
SmileLift™ was developed by Sam Assassa, MD, who founded Beverly Hills Aesthetics in 1995 and has served as Founder and President of the American Association of Aesthetic Medicine and Surgery since 2006. He is board certified in Internal Medicine.
What Causes Marionette Lines
Four changes act together.
Volume loss around the mouth. The tissue that supported the corner diminishes, so it sits lower.
Descending cheek tissue. Midface fat that has slid downward collects along the jawline, and the jowl that forms deepens the crease beside it.
Muscle pull. The depressor anguli oris runs from the corner of the mouth toward the jaw and its job is pulling the corner down. It continues working while the tissue around it loses support.
Skin changes. Elasticity declines and the crease etches in.
Dr. Assassa describes this as an interaction between skin quality, muscle function, support structure, and fat volume, which is why single treatments applied to it tend to underperform.
The Line and the Corner Are Two Complaints
Worth separating, because patients often want one and are offered the other.
The line is the crease running down from the corner. It is a skin and volume problem and responds to filler and resurfacing.
The corner position is where the mouth actually sits at rest. That is the thing changing what your face communicates, and it is a muscle and structural problem.
Many people care far more about the second than the first without having the words for it. If your complaint is being misread rather than a visible crease, say so, because it points to a different treatment.
Marionette Versus Laugh Lines
Laugh lines run from the nose to the mouth corner. Marionette lines run from the mouth corner down toward the jaw. They are adjacent, they frequently appear together, and they need different treatment.
How Marionette Lines Are Treated
- SmileLift™, a thirty minute in-office procedure developed here that addresses the position of the mouth corner directly.
- Botox® corner mouth lift, relaxing the muscle pulling the corner down, repeated every few months.
- Dermal filler, restoring support at the corner and softening the crease beneath it.
- Jawline contouring, where a jowl forming above the line is deepening it.
- Cheek treatment, addressing the descent that started the sequence.
Have Your Marionette Lines Assessed in Beverly Hills
Dr. Assassa will establish whether your concern is the crease, the corner position, or the descent above both, and recommend accordingly. Request a consultation or schedule your appointment online.