Marionette lines start at the corner of the mouth and extend downwards and outwards towards the jaw.

Initially they may just affect the area around the corner of the mouth but over time the extend downwards and form jowls along the jawline.

They are called marionette lines in reference to puppets that have pronounced vertical lines in the same place. This gives the appearance of a crease running down from the corner of the mouth.

Marionette lines form due to volume loss in the area and often people are genetically predisposed to developing them. Volume loss in the mid face can exacerbate this problem as the mid face is partially responsible for support in the lower face. As volume in this area depletes the corners of the mouth tend to fall downwards creating an appearance of sadness or disapproval. This is often referred to as a "mouth frown".

In addition, some people have a strong muscle joining the corner of the mouth to the jaw and this can exacerbate the mouth frown.

Treatment of marionette lines can provide good results. Appropriate patient selection and skilful technique are all required to produce optimum results. It is usually best to have smaller treatments more regularly to avoid an unnatural appearance. Treatment of the cheek area is generally required as well for best results.