Marionette Lines

The lines that extend down from the corners of the mouth toward the chin are known as marionette lines. The marionette lines tend to deepen with age and they give the appearance that one is frowning. Some people have a strong tendency to have marionette lines, even at a young age, whereas some people never develop them. Surgical procedures like facelifts are notoriously ineffective in treating marionette lines.

The most commonly used method to treat marionette lines is to simply fill the lines with a substance known as a "filler". In the past, fillers such as fat, collagen and Cosmoplast were used. Today, fillers such as Restylane and Radiesse are more commonly used, since these fillers last much longer than most of the other fillers previously available. A five minute injection of Restylane can minimize -- or eliminate -- marionette lines. Repeat injections are performed at six to nine months. With Radiesse, repeat injections are necessary at twelve months. Microinjections of silicone, considered controversial by many physicians, is also sometimes done. Finally, permanent implants are sometimes used in this area as well. Implants made of Gor-Tex are sometimes done, but these implants can sometimes be visible or palpable.

I have found that Botox injections can be quite helpful in the treatment of marionette lines. Certain muscles, called the depressor muscles, can pull the corners of the mouth down and contribute to the downward slant to the corners of the mouth, which then leads right into the marionette lines. By injecting Botox into the depressor anguli oris muscle, the corners of the mouth go up slightly, and the n marionette lines are diminished. Typically, with this regimen, the patient will come into the office every three to four months for Botox injections and every six to twelve months for a filler, depending on the type of filler (Restylane v. Radiesse).

There are a few rarely-done surgical options that are designed to address the corners of the mouth directly. A corner lip lift involves cutting a small triangular piece of skin away from the corners of the mouth in an attempt to give an upturn to the corners. However, the scar can be objectionable and the corners can look unnatural. An ever rarer procedure involves cutting the depressor anguli oris muscle in order to deactivate it (like the Botox injections do). But most surgeons feel that the risks out weigh the benefits for this procedure.