What Are Marionette Lines | How to Make Them Go Away. Newport Beach Plastic Surgeon Explains Anatomy

These days, one of the most-requested facial problem areas is a small shadow that originates from the corner of the mouth and angles downward. In the aging face, this is sometimes known as a “marionette line” or melolabial fold. Of course, this is named after the marionette puppets that “speak” via a ventriloquist and an articulating jaw. When this presents in the aging face, I typically address it with liposuction of the jowl, fat transfer within the furrow itself, and skin tightening by means of a facelift. Of course, this is not always feasible or warranted in younger patients. Those seeking a quick fix or an easy solution may not be willing to accept the down time of the surgical procedure, and many less invasive and the expense of options do exist. One of the most straightforward and common solutions is injection of fillers into this region. In small amounts, fillers to the corner of the mouth, and in front of the jowl at the jawline can cause meaningful improvement. However, this is too commonly overdone, and can result in a square shaped jawline, wherein most patients are seeking a V-shaped jawline. I do think that conservative fillers and even Botox to this region are important methods to soften early signs of facial aging. However, there is a strict limit to how much can and should be safely performed, and just as much as the forward depression deserves to be addressed, so does the fullness behind. Think of a marionette line like the underwire of a bra. The mobile soft tissue of the cheek falls forward and hit the point of fixation causing shadow to form. While attempting to continue to fill that shadow, the real solution involves resuspension and or reduction of the soft tissue behind. Options like Facetite with liposuction of the jowls, fat transfer to a pre-jowl sulcus, and facelift may confer more long-term results that do not compromise the shape and size of the jawline. Of course, even facelifts and more aggressive strategies may fall short in completely eliminating these shadows. Individual results vary and this small issue is a tricky one to fix.