How to Reduce Marionette Lines and Keep a Natural Look
Marionette lines, the creases that run down from the corners of the mouth, can make a face look sad, tired, or angry even when a person feels fine. In an interview with Doctor Jonathan Weiss, a senior physician in medical aesthetics, the article explains that these lines are not just a skin issue. They are linked to aging, loss of jawbone volume, changes in the teeth, gravity pulling tissues downward, and the action of the depressor anguli oris muscle, which pulls the mouth corners down.
Weiss says the lines can appear in the 30s, not only after age 50. Their depth is shaped by genetics, smoking, poor diet, constant chewing of gum, and even sleep position. Sleeping repeatedly on one side, he says, can create years of pressure on one side of the face and deepen the wrinkles there.
For treatment, Weiss favors a combined approach rather than injecting directly into the fold. He uses fillers above and below the line to support the tissue, along with controlled botulinum toxin injections into the muscle that pulls the mouth downward. He then reassesses the patient after two to three weeks. To avoid an overdone look, he stresses careful expectation-setting and gradual treatment in several sessions with small, measured amounts.
He also notes that some patients first need broader facial lifting, such as filler in the cheeks, which can improve the mouth area as part of a more holistic plan. For longer-term improvement, he points to newer biological products, including hyaluronic acid, poly-L-lactic acid, and polynucleotides from salmon fish, which he says stimulate the skin to produce its own collagen and elastin rather than adding artificial volume.
At home, Weiss recommends 500 milligrams of vitamin C daily, Retin-A use with a stronger winter concentration and a lower summer concentration, daily SPF 50 sunscreen even indoors, and plenty of water. His main preventive advice is to consult an experienced aesthetics doctor early, before the lines become deep and fixed, because treatment started at 35 is not the same as treatment first done at 75.
