Marionette lines are the creases that run down from the corners of the mouth toward the chin, the ones that can make the mouth corners look like they are turning down even when you feel fine. They are named after the hinged mouth of a puppet, and they are one of the most common reasons people in their 40s and beyond come in feeling like they look tired or unhappy.
Here is the part that surprises people: the best fix is often not to inject the line itself. Marionette lines are usually a downstream symptom of volume loss higher up, so chasing the crease directly can look unnatural and miss the cause. Smart treatment works on the structure that lets the lines form in the first place.
This guide explains what marionette lines are, why they form, why cheek and chin support frequently beat direct filling, where Botox fits, and what realistic results look like.
Quick summary first: Marionette lines are creases from the mouth corners toward the chin, driven by mid-face volume loss, descending tissue, and a muscle that pulls the corners down. Filling the line directly often looks unnatural; rebuilding cheek and chin support usually gives a better, more natural lift. Botox can relax the downturning muscle (the DAO). Most plans combine techniques, and results typically last 9 to 18 months.
What are marionette lines?
Marionette lines are the vertical-to-diagonal creases that extend downward from the corners of the mouth toward the jaw. They sit just outside and below the smile lines, and over time they can make the mouth corners look downturned, giving the face a sad or stern expression at rest.
They are different from nasolabial folds, which run from the nose to the mouth corners. Marionette lines pick up where those leave off, framing the chin. Both are part of the same aging pattern, the descent and deflation of the mid and lower face, which is why injectors usually assess them together.
What causes marionette lines?
Marionette lines form from a combination of volume loss, gravity, and muscle pull, not from the skin at the crease alone. Understanding that is the key to why direct injection is so often the wrong first move.
As we age, the cheek fat pads deflate and slide downward. With less support above, the tissue around the mouth and chin loses its scaffolding and folds, and a crease sets in. Collagen and elastin decline, so skin recovers less. On top of that, a muscle called the depressor anguli oris (DAO) actively pulls the mouth corners down, deepening the line and the downturned look. Genetics and sun exposure speed the whole process.
- Mid-face volume loss removes the support that holds tissue up
- Gravity pulls deflated tissue down, folding it at the mouth corner
- The DAO muscle actively tugs the corners downward
- Collagen and elastin loss let creases set in and stay
Why isn’t injecting the line directly the answer?
Injecting filler straight into a deep marionette line can look unnatural and may not last, because it treats the symptom instead of the cause. The line is the bottom of a fold created by tissue descending from above. Pumping the crease full of product can create a firm ridge, fail to lift the mouth corner, and still leave the face looking heavy.
There is also a vascular reason for caution. The area around the mouth corners has important blood vessels, so over-injecting directly into the fold carries more risk and less reward. A small, careful amount of filler in the line can soften a deep crease as a finishing touch, but it works best after the underlying support has been restored, not as the whole plan.
How does cheek and chin support help marionette lines?
Restoring volume in the cheeks and chin lifts the tissue that creates marionette lines, softening them from the source. When the mid-face is supported again, the fold higher up has something to rest on, so the crease at the mouth corner eases without being directly filled.
Think of it like a tent. If the center pole, your cheek support, sags, the fabric folds at the edges, your marionette lines. Restore the pole and the folds smooth out. Cheek filler rebuilds that central support, and chin filler defines the lower border so the tissue has a clean frame. Many people see their marionette lines improve significantly from cheek and chin work alone, with little or no product in the line itself. This structural-first approach is why an experienced injector spends time on your whole lower face, not just the crease you pointed at.
Which products are used, and where Botox fits?
Treatment usually combines a structural filler in the cheeks and chin with a small, optional amount in the line, plus Botox to relax the muscle that pulls the corners down. The mix depends on what is driving your lines.
Fillers for structural support
Firmer hyaluronic acid fillers, such as those in the Voluma and Volux family, rebuild cheek and chin support because they hold their shape and lift. Softer HA gels can be used for a delicate touch-up in the line itself when needed. Radiesse, a collagen-stimulating product, is also used to add support and improve skin quality over time.
Botox for the DAO muscle
A few small units of Botox into the depressor anguli oris (DAO) can relax the muscle that actively pulls the mouth corners down. This lifts the corners slightly and softens the downturned look that filler alone may not fully fix. Combining DAO Botox with structural filler often produces the most natural result, because it addresses both the lost volume and the active muscle pull.
What results are realistic?
Marionette lines can be softened and the mouth corners lifted, but deep, long-standing creases rarely vanish completely, and that is normal. The honest goal is a refreshed, less downturned lower face, not a perfectly smooth one.
Results depend on how deep the lines are, how much volume has been lost, and your skin quality. Early to moderate lines respond best. Very deep, etched-in creases improve but may keep a faint shadow, and adding skin treatments like microneedling can help. Filler results in this area generally last 9 to 18 months depending on the products and placement, and Botox is repeated every three to four months. Maintenance keeps the improvement; it is not a one-and-done fix.
How much does treating marionette lines cost?
Because the best approach usually involves cheek and chin support rather than the line alone, cost is driven by total syringes plus any Botox, and is priced per syringe and per Botox area. A structural plan may use more product up front than spot-filling a crease, but it tends to look better and last longer.
Your exact plan, and therefore cost, depends on what is causing your lines. We review per-syringe and Botox pricing at consultation, where we can map whether you need mostly cheek support, chin definition, muscle relaxation, or a combination.
FAQ
Can filler completely remove marionette lines?
Usually it softens them rather than erasing them, especially if they are deep. Restoring cheek and chin support lifts the area and reduces the crease, but very etched lines may keep a faint shadow. Realistic goals lead to the most satisfying results.
Why does my injector want to treat my cheeks for mouth-corner lines?
Because marionette lines are largely caused by mid-face volume loss. Rebuilding cheek support lifts the tissue that folds at the mouth corner, softening the line from its source. Treating the cause often looks more natural than filling the crease directly.
Does treating marionette lines hurt?
Most people feel pressure and minor pinches. The area is numbed with topical cream and HA fillers contain lidocaine. Discomfort is usually mild, and many injectors use a cannula in this area to reduce bruising risk.
How long do results last?
Filler in the cheeks and chin typically lasts 12 to 18 months, while product placed in mobile areas near the mouth may last closer to 9 to 12 months. Botox for the DAO muscle lasts about three to four months and is repeated to maintain the effect.
Is Botox or filler better for marionette lines?
They do different jobs and often work together. Filler restores lost volume and support; Botox relaxes the muscle that pulls the corners down. Many people get the best result from a combination tailored to whether volume loss or muscle pull is the bigger driver.
Am I a good candidate?
Good candidates have early to moderate marionette lines from volume loss and are in good general health. Even deep lines usually improve with a structural approach. A consultation determines the right mix of filler, Botox, and skin treatments for your face.
Medically reviewed by clinical staff at OC Weight Loss and Medspa. Last updated May 2026.
Soften downturned mouth corners the smart way
If marionette lines are making you look tired or stern, the answer is rarely just filling the crease. We assess the whole lower face, rebuild cheek and chin support where it is needed, and add Botox or a light touch-up only where it helps, so the result looks like a rested version of you.
Explore our dermal fillers, read the full dermal fillers guide, learn about nasolabial fold filler, or see cheek filler before and after.
Book a marionette lines consultation
Book a Free Consultation