Skin Care Education

Marionette Lines

Vertical folds or creases running from the corners of the mouth downward toward the chin. Named for their resemblance to the hinged jaw lines of marionette puppets. A common sign of lower facial ageing.

What Are Marionette Lines?

Marionette lines are the vertical folds or creases that develop from the corners of the mouth downward toward the chin. Their name is derived from the resemblance they bear to the articulated, hinged mouths of marionette string puppets, in which a visible line runs downward from each corner of the puppet’s mouth. Clinically they are sometimes referred to as melomental folds or oral commissure lines.

They are a distinct anatomical feature from the nasolabial folds, which run from the sides of the nose down to the corners of the mouth. Marionette lines begin where the nasolabial folds end, continuing downward from the mouth corners toward the chin. Both sets of lines are common age-related changes to the lower face and frequently develop in parallel, though they involve different anatomical regions and are driven by somewhat different combinations of the ageing processes that affect the lower face.

What gives marionette lines their particular cosmetic significance, beyond their depth or visibility, is the unintended resting expression they create. The downward trajectory of these folds from the mouth corners mimics the configuration of a sad, stern, or downturned expression. As a result, individuals with established marionette lines can appear sad, tired, or disapproving even when their face is completely relaxed and they feel entirely neutral. This disconnect between the actual emotional state and the perceived resting expression is one of the most commonly cited motivations for addressing this area.

Causes and Contributing Factors

Factor	Description
Lower face and midface volume loss	The progressive reduction in the fat pads of the cheeks, midface, and lower face removes the structural support that was previously holding tissue in a lifted position. As this volume decreases, the overlying tissue descends. When sufficient tissue has descended below the level of the mouth corners, it accumulates and creates the vertical fold characteristic of marionette lines. This descent-driven mechanism is the primary cause of marionette line development.
Skin laxity	Declining collagen and elastin reduce the skin’s ability to hold its position in the lower face against the effects of gravity. Lax skin along the lower cheeks and around the mouth corners contributes to the descent and folding that creates marionette lines, particularly as skin that was previously firm becomes progressively less able to maintain its structural position.
Retaining ligament laxity	The mandibular retaining ligaments anchor the skin and soft tissue of the lower face to the underlying bony framework. As these ligaments elongate and weaken with age, they release their hold on the overlying tissue, which then descends more freely under gravity, contributing to the formation and deepening of marionette lines.
Facial bone remodelling	Progressive changes in the shape of the mandible and chin with age reduce the bony support for the overlying soft tissue of the lower face, contributing to tissue descent and the development of lower facial folds including marionette lines.
Depressor anguli oris muscle activity	The depressor anguli oris muscle, which pulls the mouth corners downward, contributes to the downward trajectory of marionette line formation over time. Habitual or strong activity of this muscle can accelerate the development and depth of these lines.
Weight loss	Significant reduction in facial fat removes the volume that was previously softening and supporting the lower face. The resulting relative excess of skin over the reduced underlying volume can make previously mild marionette lines substantially more prominent.
Genetics	The rate and pattern of lower facial ageing, including the development of marionette lines, has a significant hereditary component. Facial anatomy, fat distribution patterns, and the individual rate of structural protein decline all contribute to the timing and severity of marionette line development.

Frequently Asked Questions: Marionette Lines

These are two distinct but adjacent age-related changes to the lower face. Nasolabial folds, also called laugh lines or smile lines, run from the sides of the nose downward to the corners of the mouth. Marionette lines begin at the corners of the mouth and continue downward toward the chin. They are sequential: the nasolabial fold ends at the mouth corner where the marionette line begins. Both develop through similar age-related processes involving volume loss and tissue descent, and they frequently occur together, but they affect different parts of the lower face and are anatomically distinct.

Because the downward trajectory of the folds from the corners of the mouth creates a visual configuration that the brain associates with negative emotion. The mouth corners being pulled downward by descending tissue mimics the expression of sadness, displeasure, or disappointment. The brain reads facial shapes and configurations as emotional signals, and the downward-turning at the corners of the mouth is one of the most strongly associated signals for negative emotion. When this configuration is created by static tissue descent rather than active muscle expression, the face reads as expressing negative emotion even when the person is entirely neutral or content.

Early marionette lines typically become noticeable from the mid-40s onward in most individuals, though the underlying processes of volume loss and laxity that drive them begin considerably earlier, in the 30s. The timing varies significantly based on genetics, facial anatomy, UV exposure history, weight history, and lifestyle factors. Individuals with naturally slender faces, a history of significant weight loss, significant UV exposure, or a family history of early lower facial ageing may notice the early development of marionette lines from their late 30s or early 40s.

No, though they often develop together and are related aspects of lower facial ageing. Jowls refer to the sagging and descent of tissue specifically along the jaw edge, creating heaviness at the lower jaw margin and obscuring the definition of the jawline. Marionette lines are the vertical folds running from the mouth corners downward to the chin. Both result from similar age-related processes involving volume loss, skin laxity, and tissue descent, but they affect different anatomical locations and create distinct visual changes to the lower face.