Marionette lines are one of the most common signs of facial aging. In this blog, board certified dermatologist Dr. Lisa Ishii breaks down what marionette lines are, what causes their formation, and common treatment options.
What are Marionette Lines?
Marionette lines, or “melomental folds,” are a common aging concern of the perioral region. They refer to the folds that appear starting on the corners of the mouth downwards towards the jaw, causing a crease resembling the mouth of a marionette string puppet. Patients oftentimes note that this fold makes them appear “sad” or “frowning” at rest.
What Causes Marionette Lines?
Marionette lines are caused by a multifactorial process, including bony changes of the mandible, loss of fat in the perioral and chin regions, changes in muscle tone of the lower face, and loss of collagen and elastin in the skin. Common findings one may see with marionette lines include jowl formation and “heavy” appearance of the lower face.
Can Skincare Treat Marionette Lines?
While some medical-grade skincare items may help with improvement of the skin-quality around the marionette lines, unfortunately topical treatments are unlikely to provide a dramatic result. A multi-modal approach of in-office treatments with topical skincare to support results works best.
In-Office Treatment Options Explained
As marionette lines have a multifactorial cause, in-office treatment may involve a multimodal treatment plan.
The most common treatment is typically a hyaluronic acid-based filler (HA filler) placed directly into the folds to provide support. In many cases, HA filler may also be placed along the jawline or other areas around the mouth to help naturally restore other areas of volume loss that are contributing to marionette line formation.
According to Dr. Ishii, it’s best combine HA fillers with neuromodulator treatments to the muscles around the mouth that pull the corners of the mouth down. This prevents the muscle from working against you and accentuating the marionette lines.
If the fatty tissue in the jowls are substantial and contributing to weighing down the area along the marionette lines, we oftentimes employ fat dissolution treatments such as Kybella or Sculpt&Lift.
Finally, energy-based devices such as Sofwave and radiofrequency microneedling help with tightening of the skin around the marionette lines to re-drape the tissue.
Marionette lines are a natural part of the aging process, but can be easily treated if you find them cosmetically bothersome. If you are looking to treat marionette lines in the Raleigh, Durham, Chapel Hill area, contact our office to start your journey.
