What causes marionette lines?

Marionette lines are the creases that run down from the corners of your mouth toward your chin. They can make you look sad or tired even when you feel fine. Several changes combine to form them. Fat and bone around the mouth and chin lose volume, the cheeks and jowls descend, skin loses collagen, and a small muscle called the depressor anguli oris (DAO) pulls the mouth corners downward. Genetics, sun exposure, smoking and weight loss all play a part. Dental changes and loss of tooth support can also reduce lower-face volume.

How marionette lines are assessed

At Dernia Clinic Myeongdong, your doctor looks at your lower face at rest and while you talk and smile. The key question is what drives the line: lost volume, jowls sitting above it, loose skin, or muscle pull. Lines are typically graded from mild (a faint shadow) to deep (a clear groove with downturned corners). The answer decides whether you need volume, lift, tightening or a mix. Marionette lines often appear alongside nasolabial folds, so both are usually planned together.

Treatment options for marionette lines

Dermal Filler

Dermal filler made of soft hyaluronic acid supports the mouth corners and fills the groove below them. Your doctor chooses it when volume loss is the main cause and you want an immediate change. A soft, flexible product is used because the mouth moves constantly, and HA can be dissolved if needed.

Thread Lift

A thread lift lifts the jowl tissue that hangs above the line, using dissolvable PDO threads. It is chosen when descent is deepening the groove. Expect 3–7 days of swelling or bruising. Results commonly last 12–18 months as collagen forms around the dissolving threads.

Thermage FLX

Thermage FLX tightens loose skin across the lower face with monopolar radiofrequency and stimulates new collagen. Your doctor chooses it when crepey, lax skin contributes to the lines and you want no downtime. Results build over two to six months and often last a year or more.

Comparing your options

Treatment	Best when	Downtime	From price
Dermal Filler	Volume loss is the main cause	Mild swelling for 1–3 days	₩150,000 (1cc, Korean HA)
Thread Lift	Jowls are deepening the groove	3–7 days of swelling or bruising	₩690,000 (per area, thread count varies)
Thermage FLX	Lower-face skin is lax or crepey	None to minimal (mild redness)	₩990,000 (300 shots, face)

Prices are in Korean won (KRW), exclude 10% VAT, and are confirmed at your consultation. You can compare every treatment on our price list.

Combination plans

Marionette lines rarely have one cause, so combining treatments usually looks most natural. A common plan is Thermage or threads to lift and tighten, then a small amount of filler for support. A few units of wrinkle Botox in the DAO muscle can also ease the downward pull on the mouth corners. Read Botox vs dermal filler to see how the two differ. Expect a softer, more lifted mouth area rather than a completely smooth one.

At-home care and prevention

Daily sunscreen, a retinoid if tolerated and a stable weight help slow collagen loss. Good hydration makes fine creases around the mouth less visible. Avoid smoking, which speeds up lines around the lips and chin, and use an SPF lip balm outdoors. Sleeping on your back may also reduce creasing on one side of the lower face.

Planning treatment during a trip to Seoul

Thermage has no real downtime. Filler can cause mild swelling and possible bruising for 1–3 days, and threads up to a week, so book them early in your stay. Botox takes about two weeks to reach its full effect. When several treatments are combined, lifting usually comes before filler so the filler sits in the right place. Book a consultation and your doctor will order treatments around your dates.

Safety and when to see a doctor

Filler around the mouth should be placed by a licensed doctor who knows where the blood vessels run. Seek help urgently if you notice blanching or severe pain after filler. If you get cold sores, tell your doctor, as treatment near the mouth can trigger one. Mention blood thinners too, since they raise the chance of bruising. Sudden drooping of one mouth corner, especially with other facial weakness, needs urgent medical review. RF is not used with a pacemaker. Explore more skin concerns.

What are marionette lines?

They are the lines that run from the corners of the mouth down toward the chin, named after the hinged jaws of a puppet. They come from volume loss, jowl descent, skin laxity and muscle pull.

Can Botox help marionette lines?

Botox does not fill the line, but a few units in the muscle that pulls the mouth corners down can lift them slightly. It is usually combined with filler or lifting.

How long does filler for marionette lines last?

Often around 6–12 months in this mobile area, though it varies with the product, the amount and your metabolism. Touch-ups are usually smaller than the first treatment.

Will a thread lift get rid of marionette lines?

Threads lift the jowl that deepens the line, which can soften it noticeably. Lines caused by volume loss usually still need a little filler for the best result.

At what age do marionette lines appear?

Many people notice them from their 40s, but genetics, weight loss and sun damage can bring them on earlier. Early treatment tends to need smaller amounts.

Related treatments

Dermal filler — supports the mouth corners
Thread lift — lifts the jowl above the line
Thermage FLX — tightens lower-face skin
Wrinkle Botox — eases downward muscle pull

Prices, results and reviews

Dermal filler price in Seoul — cost per cc
Thread lift results — timeline and longevity
Thread lift review — our medical team’s assessment

Related concerns and areas

Nasolabial folds — smile lines beside the nose
Jowls — fullness along the jawline
Chin treatments — shaping the lower face

Dernia Clinic Myeongdong

Marionette Line Treatment in Seoul