A doctor explains the causes of marionette lines and how to prevent and improve them!

Can Marionette Lines Be Eliminated Now? Under the supervision of a doctor, we will explain in detail the possible causes, NG habits that make it worse, and preventive and improvement measures. Marionette lines, which are mainly caused by sagging fat and weakened muscles, should be taken from the moment you start to worry about them.

marionette lines

Table of contents

  • What are marionette lines?
  • Causes of marionette lines
  • Note! NG habits that lead to deterioration of marionette lines
  • Seven measures to prevent and improve marionette lines
  • Makeup techniques to cover marionette lines and nasolabial folds
  • Early measures are the key to worrisome marionette lines!

What are marionette lines?

Description of marionette lines

The two grooves extending down from both sides of the mouth are called “marionette lines”. It looks like a ventriloquist doll, hence the name. The presence of marionette lines makes you look much older than nasolabial folds.

Some even say that it is the point that distinguishes people in their 40s from those in their 50s. If it’s definitely there at a glance, it’s in the late 50’s, and if it’s just a dent or shadow, it’s in the early 50’s. Maybe if you look closely? In that case, if you’re in your 40s… This groove is the key to distinguishing the appearance age.

Causes of marionette lines

Explain the cause of marionette lines

There are a number of reasons why marionette lines develop or worsen. Let’s take a closer look here.

Atrophy of facial bones, increase or enlargement of fat cells, laxity of ligaments, weakness of facial muscles in the upward direction, laxity of platysma muscle, sagging skin

Marionette lines are caused by physical factors such as the shrinkage of the bones that form the foundation of the face with age, the increase and enlargement of fat cells around the mouth, the loosening of the ligaments that hold fat, and the loosening of the platysma muscle. It is a line formed by the sagging of the skin and fat tissue due to the weakening of the muscles that shrink upward, such as the large and small buccal muscles.

Reduced elasticity (looseness) of facial muscles

One of the causes of marionette lines is the weakening of facial muscles, which are the muscles that create facial expressions.

People who usually don’t smile often, people who have poor facial expressions, and people who have a habit of lowering the corners of their mouths because they frown often don’t use the muscles that lift the mouth upwards, and the corners of their mouth tend to fall as they age. And it will be one of the causes of marionette lines. In fact, the corona has made the mask life longer, and the number of consultations about “mask sagging” has increased.

In addition, the weakening of facial muscles can cause not only marionette lines, but also bulldog lines (bulldog faces) and gorgo lines (gorgo lines).

In order not to weaken facial muscles, try to spend your time with a smile on a regular basis.


The bite of the teeth is also a factor that affects marionette lines. If the bite is bad, the balance of the muscles around the mouth is likely to be lost, and the muscles of the left and right cheeks will be different. This causes the skin to sag.

The habit of chewing with only one side will also upset the balance of the muscles around your mouth, so make a habit of chewing on both sides equally. It’s also a good idea to see a trusted orthodontist.


People with bad posture are said to be more prone to marionette lines. If you have a stooped back or a straight neck, your face and chin will tilt forward.

The human body is connected to one piece of skin, so if the front of the body is not tense due to stooping, etc., if the face is tilted forward, the area below the nose will be relaxed, so marionette lines and nasolabial folds will also appear. It becomes easier to occur. In front of the mirror, straighten your spine and try to raise the back of your head diagonally.

Oxidative stress due to skin dryness, inflammation, etc.

Dry skin causes wrinkles and sagging. When the skin becomes dry and lacks moisture, the barrier function of the skin deteriorates, and the ability to retain moisture also weakens.

When the skin lacks moisture, it loses its elasticity, wrinkles and sagging, and are prone to marionette lines.

Note! NG habits that lead to deterioration of marionette lines

NG habits that lead to deterioration of marionette lines

Even if you already have marionette lines, it is important not to let your cheeks sag any further.

Please pay attention to whether you are doing the following NG habits that lead to deterioration of marionette lines.

  • Poor posture and tendency to look down
  • The corners of the mouth are down in the shape of a letter
  • Rapid weight gain or loss
  • chew food with only one side
  • ultraviolet rays

If you have marionette lines, your nasolabial folds should already be deep and long. In order to prevent marionette lines from appearing and disappearing, let’s start “sagging care” that is also effective for smile lines.

I intend to pull up not only the area around the ditch, but also from the temple to the cheeks and the face line. Skin care for firmness, care with beauty equipment, and beauty medicine are effective.

Seven measures to prevent and improve marionette lines

From here, we will introduce seven measures that can help prevent and improve marionette lines.

If you want to erase marionette lines, please refer to it.

Measure 1: Lymphatic massage

One of the reasons why the grooves of the marionette line look deep is the slackness of the face line. The face line is a part where waste products and moisture tend to accumulate. When you have free time, let’s take care to drain the lymph frequently and wash away the waste and accumulated lymph.

State of lymphatic massage

Place your index finger behind your ear and place your middle finger in front of you to pinch your ear. Place your palms around the face line from below, as if you were holding your cheeks with both hands.

As it is, gently move the whole from the back to the front without applying pressure. The trick is to move it in small, loose movements to the extent that it does not create wrinkles around the eyes. Repeat this 20 times.

Measure 2: Simple face exercises

Marionette lines are caused by the platysma, depressor corners of the mouth, and cheek muscles. In addition to care with beauty equipment that trains the EMS function and fascia, training called face yoga and face exercises is effective.

Muscle training for the upper half of the face tends to be self-styled and may increase unnecessary wrinkles, but for the lower half, even if it is a little self-styled, it will not cause much damage. You may want to continue with the exercises below. Even while watching TV in the office. Get into the habit of doing exercises that are easy to do anytime.

depressor muscle exercise

State of depressor muscle exercise

Laugh only with the corners of the mouth (raise the corners of the mouth), leaving the eyes as they are. Repeat this 10 times.

platysma exercise

platysma exercise 1

Face forward and lift your chin.

platysma exercise 2

Hold for 5 seconds while feeling the muscles of your throat being pulled → Turn your face to the right, turn it to the left, and slowly return it. Repeat this 5 times. At this time, if you stretch the tongue, which is the inner muscle of the face, in the same direction as the chin, the tension of the face line under the chin will appear.

Measure 3: Face yoga

When you don’t move your face much, when you’re in a state of lack of facial exercise, it ‘s also recommended to move your face with face yoga . In face yoga, you can train your facial muscles by loosening the stiff facial muscles.

Since the training is based on moving your face, you can easily take measures against marionette lines while doing housework or while soaking in the bath.

Countermeasure 4: Pushing points

Pushing points is also one of the easy measures against marionette lines. Apply acupressure for about 5 seconds with a strength that feels good, not too strong. You should repeat this about 4-5 times.

  • Kyoshosho: A pressure
    point located about 1.5cm outside the center of the depression under the lower lip.
  • Chiso: Acupuncture
    points just outside the corners of the mouth

Measure 5: Skin Care

Skin care is also important for marionette lines. Keep your skin moisturized with highly moisturizing skin care cosmetics to prevent your skin from drying out and prevent marionette lines.

Replenishing moisture and oil to the skin will improve the barrier function and prevent wrinkles, sagging, and other skin problems.

We also recommend facial equipment . There are many types of facial equipment, such as ultrasonic facial equipment, EMS facial equipment, and radio facial equipment, so it is a good idea to find the one that suits you best.

Measure 6: UV protection

UV protection is effective not only for marionette lines, but also for preventing spots and wrinkles.

When exposed to UV rays, the collagen and elastin in the skin decrease and degenerate, causing the skin to lose its firmness.

Thorough UV protection is recommended with sunscreen, a hat, and a parasol. UV rays are pouring down all year round, so be sure to take measures against UV rays in all seasons.

Measure 7: Aesthetic medicine treatment

If you want to get rid of marionette lines immediately, or if you want to significantly improve them, you can choose cosmetic treatment.

There are many ways to treat marionette lines, but there are two main types.

  • Marionette line treatment without cutting
  • cut marionette lines treatment

Choose the treatment that best suits your needs and symptoms.

Marionette line treatment without cutting

Methods that can be treated without incising the skin with a scalpel include irradiation systems such as hyphen and Thermacool and injection systems such as hyaluronic acid injection.

As for the injection system, “reducing the fat and muscles on the marionette lines and nasolabial folds by injection + skin tightening” is the standard treatment. Treatments that increase volume, such as hyaluronic acid, perform contouring to compensate for decreased facial bones.

Botox injections may also be selected depending on the symptoms. Thread lifts (thread lifts) include soluble and insoluble threads, and the shape of the threads varies. However, indissolvable threads are currently not recommended as they can cause problems during infection and prevent other treatment devices from being used.

  • Irradiation system
    For marionette lines, irradiation system treatments such as “Therma Cool (*1)” and “Hyf (*2)” are effective. One of the latest and most powerful skin shrinking devices is “Face Tight (*3)”.
  • Injection system
    It is an old treatment to inject fat into the nasolabial folds and marionette lines. Even if the lines are not noticeable, the face will look swollen, so I don’t currently do fat injection. The procedure for the current infusion system is as follows.

    1.Reduce the fat and muscles that cause swelling to make the face smaller (fat-dissolving injections and botox system) 2.Compensate
    for atrophied bones (hyaluronic acid, etc.)
    3.Thicken the skin (PRP and baby collagen, etc.)

  • Thread lift (thread lift)
    Treatment that physically pulls up with a thread is also effective, but there are also stories that it relapses quickly or the expected change is not obtained. In particular, if you have a lot of fat or thick skin, it is difficult to expect the effect of the thread, so it is important to judge whether it is suitable for you. All treatments are the same, but the doctor’s experience, sense and skill are required. If you want to avoid disappointing results and want a perfect finish, talk to a trusted doctor.
  • Botox injections
    If the depressor muscle in the corners of the mouth is thought to be the cause, treatment may be performed to loosen the excessive work of the muscles with Botox injections. However, Botox injections act on muscles and cannot improve fat sagging. In addition, the micro-botox method, in which multiple injections are made shallowly into the skin, improves skin tension and makes the bulldog less noticeable.

(*1) Therma Cool A radiation-type medical device that irradiates radio waves (high frequency) and works mainly on collagen in the dermis layer to improve sagging. There are individual differences, but once irradiated, the effect lasts for at least six months to a year.

(*2) HIFU An irradiation medical device that uses the thermal energy of high-intensity focused ultrasound (HIFU) to work on the fascia (SMAS) and the dermis layer to improve sagging. It is said that it is easy to feel the effect mainly on the face line. There are individual differences, but once irradiated, the effect lasts for at least six months to a year. A typical hyphen device is the Ulthera.

(*3) Face Tight
The latest tightening treatment that burns and shrinks the subcutaneous fat while pinching the skin by inserting a needle under the skin. By removing aging cells from the skin, you can rejuvenate the entire skin and make your face smaller. There is downtime, but the results are great. It is recommended that you take a break.

cut marionette lines treatment

In full-scale marionette line treatment, a face lift may be performed in which an incision is made with a scalpel, the fascia (SMAS) that causes sagging is sutured, and excess skin is excised and sutured.

The surgical method and the location of the incision will vary depending on the symptoms, but the incision should be made in an inconspicuous location along the wrinkles of the ear. The treatment method varies depending on the clinic, so it is a good idea to compare several cosmetic dermatologists and beauty clinics.

Makeup techniques to cover marionette lines and nasolabial folds

Introducing makeup techniques to cover marionette lines and nasolabial folds

Worrisome marionette lines and nasolabial folds are dents on the skin. If you make a mistake with the cover method, it can also make you stand out.

Use a shade one or two shades darker than your skin tone to shade the lower half of your face. This makes marionette lines and nasolabial folds less noticeable.

Place the blush on the inside, slightly higher than the cheekbones. Elevate your cheeks to draw attention away from sagging skin.

Early measures are the key to worrisome marionette lines!

Marionette lines are said to make you look older than nasolabial folds. Early measures are important for marionette lines, which are mainly caused by sagging cheek fat, loose platysma muscles that spread from the mouth to the neck, and stiffening of the depressor muscles at the corners of the mouth.

Move facial muscles with lymphatic massage, face exercises, face yoga, etc., and protect your skin with skin care and UV protection.

If you want to significantly improve sagging and wrinkles, there is also the option of undergoing cosmetic medical treatment at a beauty clinic or cosmetic dermatologist.

Take care of your marionette lines with the measures that suit you.

Supervisor Profile: Shii Matsumiya (Tokyo Dermatology / Plastic Surgery)

Director of Matsumiya Shie Tokyo Dermatology and Plastic Surgery Shinagawa Clinic . She is a cosmetic surgeon who specializes in small face treatment (facelift) and rejuvenation treatment. She has three specialties: plastic surgery, rehabilitation, and anti-aging medicine. From her point of view, she gives lectures on muscle anti-aging and inner beauty, and she herself is a dancer, such as aerial silk and contortion.

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