marionette lines treatments

Originally publishes on December 4, 2017. Updated to include information on new marionette lines treatment options.

While commonly referred to as “laugh lines”, marionette lines (also known as nasolabial folds) are no laughing matter!

Marionette lines are creases or folds that run vertically from the corners of the mouth down to the chin. These lines are reminiscent of the jaw of a marionette, hence the unfortunate name. Ironically, marionette lines are not caused by years of laughing. The lines are a common result of the natural aging process that includes a combination of depleting fat (and other facial tissue underneath the skin) with a loss of skin elasticity. The chin is particularly susceptible to wrinkles because it’s an area of great movement where the skin is thinner than other areas of the face.

Genetics can also play a key role in the development of marionette lines and how prominent they become. In fact, genetically susceptible individuals can begin to develop some degree of marionette lines during their childhood.

Learn more about what causes marionette lines, how they’re best prevented, and how you can treat them once they are visible.

marionette lines example

Example of marionette lines (Source: Radiesse)

What Causes Marionette Lines? 

Marionette lines are primarily caused by factors outside of our control. This includes gravity, age-related loss of collagen or elastin, and genetics.


Gravity is an unavoidable cause of wrinkles. When we’re younger, abundant collagen, elastin, and skin volume balances the effects of gravity. But as we get older, our skin loses volume and structure, becoming vulnerable to this constant, invisible downward pull.


Soft tissue becomes thinner as we age, an effect that’s referred to as volume loss. In addition, facial structures such as bone lose volume. The jawline becomes thinner due to changes in hormones and loss of mineral content. Collagen, a protein which gives skin its structural support, and elastin, a protein which gives skin its elasticity, also decrease with age.


Our jaw is constantly in motion. After a lifetime of smiling, frowning, eating, and talking, the depressor muscle at the corners of the mouth become over-activated. When this muscle pulls down on the corners of the mouth, even at rest, marionette lines appear.


The age at which skin thins due to declining collagen and elastin levels is largely dependent upon genetics. While some people won’t experience wrinkles until late in their 40’s, others may see early signs of marionette lines in their 20’s o 30’s.

Lifestyle Factors

Avoidable lifestyle factors that contribute to aging skin and early wrinkles include excessive sun exposure and smoking. Both produce free radicals which lead to oxidative stress, inflammation, and skin damage at the cellular level. Remember that prevention is far easier than treatment, so do what you can to refrain from smoking and protect your skin from the sun.

Preventing Marionette Lines

While there is no way to absolutely prevent the development of marionette lines, there are a few ways you can slow them down. Follow these simple preventative methods:

Sleep Better

Stomach (face down) and side sleepers are more prone to developing facial wrinkles as their face experiences the pull of gravity all night long. The pressure from the pull of gravity is especially harsh on the nasal-labial fold area of the face. Try to sleep on your back as much as you can. If you simply must sleep on your side try to position your pillow so the lower half of your face doesn’t touch it.

Sun Protection

Excessive UV exposure on the skin can contribute to the loss of collagen and skin elasticity, both of which are essential to preventing marionette lines during natural aging. Always use a high SPF broad-spectrum sunscreen, avoid the sun during peak UV hours, and wear a wide brimmed had when outdoors during a long period of time.


The chemicals found in cigarettes are known to induce early onset aging and damage the skin. Smoking cigarettes causes the deterioration of current collagen in the skin as well as a decrease in future collagen production. Ditch the habit to help your skin (and entire body) look and feel its best.

Skin Care

Another way to prevent marionette lines is to simply take care of your skin by consistently following a daily skin care regimen that suites your skin type. This includes using a daily moisturizer and applying an anti-aging night cream to regenerate the skin. Products containing ingredients like vitamin C, hyaluronic acid, peptides, and other growth factors can work to rebuild lost collagen and restore skin elasticity.


What you eat and drink each day can play a key role in terms of your skin’s resistance to the effects of aging. Dry skin is more prone to forming wrinkle and lines, so staying properly hydrated will ensure that your skin looks and feels its best.

Treating Slight To Moderate Marionette Lines

Once you start seeing marionette lines, the sooner you treat them, the better. If your marionette lines appear only during certain facial expressions, it’s not too early to begin treatment. If you wait until your wrinkles are constantly visible, it will be more challenging to reduce their appearance.

Some great treatments for slight to moderate marionette lines include:

Topical Treatments

The easiest and least expensive way to treat marionette lines is with a proper anti-aging skin care routine. Anti-aging and wrinkle prevention creams, serums, and cleansers should contain one or more of the following active ingredients.

  • Antioxidants to reduce oxidative stress (Vitamin C or Vitamin E)
  • Vitamin B3, or niacinamide, to improve elasticity
  • Collagen peptides to fight collagen decline
  • Hyaluronic acid to promote collagen growth
  • Retinoids to exfoliate skin and promote new cell growth

If the above over-the-counter products don’t seem to be doing enough, try combining them with one or more of the following treatments.

Retinol and Retin-A

Retinol and Retin-A are both retinoids, a Vitamin A derivative. Retinols are commonly found in over the counter products, while Retin-A is available by prescription only. Both treat wrinkles by exfoliating dead skin cells and promoting skin cell turnover. Retinoids can also help stimulate collagen production.

Both can treat marionette lines, although you should be careful not to apply these topicals to your lips or mouth. As the stronger of the two, Retin-A works more quickly, but can lead to excessive dryness, redness or irritation.

To prevent a negative reaction, keep skin well moisturized and avoid sun exposure while using these products.

Moisturizing with Hyaluronic Acid

Hyaluronic acid is a gel-like substance naturally found in your skin that promotes collagen growth. It declines with age, just as collagen does. Replenishing hyaluronic acid via moisturizers, serums, and other skin care products may help prevent wrinkles.

Hyaluronic acid is also a common ingredient in dermal fillers such as Juvederm and Restylane, where it functions to promote collagen production and keep skin hydrated.

Severe Marionette Lines Treatment Options

If you already have fairly prominent marionette lines, there are several cosmetic treatment options that are both safe and effective:

Dermal Fillers

Fillers are non-surgical, injectable treatments that offer the ability to instantly smooth lines and wrinkles. In the case of marionette lines, a hyaluronic acid-based filler such as Juvederm can be used to restore lost volume for a plump and youthful appearance. Radiesse (another popular filler) instantly adds volume back into the skin while also utilizing an ingredient that stimulates the production of collagen over time.

Botox and Other Neuromodulators

Botox is the brand name of the most commonly used neuromodulator in the United States. This injectable wrinkle-reducer is derived from Botulinum toxin and works by temporarily paralyzing the muscles into which it was injected.

Injecting Botox into the depressor muscles relaxes these muscles and reduces the appearance of marionette lines. Importantly, consistent use of Botox while wrinkles are in the early stages of forming helps prevent them from further deepening.

Because Botox is temporary, repeated treatment every 4-6 months is necessary. Side effects are mild and include minor redness, bruising or swelling at the injection site.

Chemical Peels

Chemical peels come in varying strengths for home use, application by an esthetician, or application by a dermatologist. The strongest chemical peels target both the outer and middle layers of the skin. These layers are removed through chemical exfoliation, allowing new, younger skin cells to grow back in their place.

Chemical peels typically require a series of 4-6 treatments for best results. Stronger peels may also require up to 14 days for recovery.

Laser Treatments

Skin tightening lasers effectively reduce the appearance of lines and wrinkles for a smoother, more youthful appearance. These laser treatments transfer heat and laser light under the surface of the skin. By heating the tissue to lift and tighten the underlying foundation, this strengthens the skin and stimulates the growth of new collagen. Some of these types of skin tightening laser treatments include Fraxel, Thermage, and Ultherapy.


Micro-needling (also known as Collagen Induction Therapy) uses controlled damage to spur the skin’s natural creation of new tissue. By creating minor skin injury during the procedure, the skin’s natural healing process initiates the production of new collagen and elastin fibers that thicken the skin and reduce the appearance of wrinkles. Micro-needling can be combined with topical skin rejuvenation treatments like or growth factor gels.


Individuals with deep and prominent marionette lines can benefit from facelift surgery. A facelift is a surgical procedure that makes the face tighter by removing excess skin and tightening any loose underlying facial muscles. While more invasive than all the other above treatment options, a facelift procedure will provide the most dramatic and long-term improvements to the lower face area.

Donna Hart, MD

Donna Hart, MD, a medical, surgical and cosmetic dermatologist, completed her dermatology residency at the John H. Stroger, Jr. Hospital of Cook County in Chicago, where she served as chief resident. Dr. Hart is Board Certified by the American Board of Dermatology, and is a member of the American Academy of Dermatology, American Society for Dermatologic Surgery, and Women’s Dermatologic Society.

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