Marionette lines in Suwon: how are wrinkles around the mouth addressed depending on the cause?
If vertical lines run down beside the corners of your mouth and people say your resting face looks sad or angry, it is worth first looking at where those lines come from. Marionette lines are wrinkles that run vertically from both corners of the mouth toward the chin, named for their resemblance to the mouth of a marionette puppet.
Marionette lines often form from an overlap of the muscle that pulls down the corners of the mouth, sagging of the lower cheeks, and loss of volume around the mouth, so we first separate the causes: Botox if muscle is the cause, filler for a sunken groove, and lifting for cheek sagging. At our Suwon clinic, during consultation we look at your face at rest, smiling, and with your lips pressed firmly together in turn, then decide the order of treatments.
In this article, we outline in order why marionette lines form, the types of wrinkles around the mouth and how to tell them apart, treatments and the process by cause, recovery and care, and side effects.
Marionette lines: key points
- Marionette lines form from the combined pull of the depressor anguli oris muscle, sagging of the lower cheeks, and loss of volume around the mouth.
- Indian lines, nasolabial folds, and philtrum lines differ in where they form and why, so we distinguish them separately.
- Muscle factors are commonly addressed with Botox, sunken grooves with hyaluronic acid filler, and sagging with lifting.
- For 2 to 3 weeks after filler, take care not to press or stimulate the area around the mouth.
Why do marionette lines form?
The area around the mouth moves constantly every time you talk, eat, and smile. The muscles surrounding the mouth and those that raise and lower the mouth corners converge radially, so the skin folds in many directions, and the skin is thin with few oil glands, so it dries out easily.
With age, fat around the mouth decreases and bone support weakens, so the foundation that supported the skin becomes thinner. At the same time, skin and fat from the lower cheeks move downward and accumulate above the jawline beside the corners of the mouth, and the groove of the marionette line deepens along that border.
Lifestyle habits also play a role. If you habitually press your lips tightly together, the muscles that lower the mouth corners develop and the corners droop, and frequent lip-pursing movements such as smoking or using straws cause vertical fine lines above the upper lip to form sooner.
How do you tell marionette lines apart from other wrinkles around the mouth?
| wrinkles | Where it forms | Main cause |
|---|---|---|
| Marionette lines | A vertical line running from the corner of the mouth down to the chin | Pull of the depressor anguli oris muscle, sagging of the lower cheeks |
| Indian lines | A diagonal line running from the middle of the front cheek down toward the mouth | Changes in which the cheek fat separates and sinks |
| Nasolabial folds | A line running from beside the nostril to the corner of the mouth | Loss of midface volume and cheek sagging |
| Philtrum lines and lip lines | Fine vertical lines above the upper lip and on the lip surface | Repeated contraction of the muscle around the mouth and dry skin |
If your resting face looks angry or sad with drooping mouth corners, muscle factors tend to play a large role. Checking whether the line deepens only when you smile or whether the groove remains even at rest helps separate the causes.
How can marionette lines be improved?
Treatment principles by cause
If a strong depressor anguli oris muscle makes the corners of the mouth droop, we inject a small amount of Botox into that muscle to reduce its downward pull. Because the muscles for speaking and eating are concentrated around the mouth, we keep the amount small and inject it in the precise spot. Marionette lines and Indian lines where a groove has already formed are addressed with hyaluronic acid filler that supports beneath the groove to reduce the height difference.
If sagging of the lower cheeks is the main cause, we address the elasticity of the sagging tissue with lifting and supplement the remaining groove with filler, while fine lines on the philtrum and lips are addressed in the shallow layer with skin boosters or skin Botox. If sagging is significant, we plan to do lifting first and then fill the remaining groove.
Treatment steps at our Suwon clinic
- Personalized Consultation
- Photos (Before Treatment)
- Numbing Cream / Local Anesthesia
- Design
- Disinfection
- Treatment
- Photos (After Treatment)
Filler takes about 10 minutes, and you can return to daily life right after. How long it lasts varies within a range of 6 to 12 months depending on the treated area, product, and person, and a retreatment is decided in consultation after bruising and swelling have subsided. Mouth-corner Botox can be chosen as an optional area of wrinkle Botox, and there is also a package that combines lip volume filler, mouth-corner filler, and mouth-corner Botox.
View Filler Treatment Information
View Wrinkle Botox Procedure Information
Recovery and care after marionette line filler
- You can wash your face and wear makeup starting 2 to 3 hours later, and the DuoDERM dressing applied to the treated area is removed after 1 to 3 days.
- For 3 to 7 days after treatment, avoid heavy drinking, smoking, saunas and Korean bathhouses, hot baths, and strenuous exercise.
- Take the prescribed medication consistently for 3 days to help prevent inflammation and relieve pain.
- For 2 to 3 weeks, avoid appointments such as facial meridian massage and dental treatment so the treated area is not pressed or stimulated.
The area around the mouth treated with filler may feel swollen and tight when you smile for the first few days, so the shape is checked after the swelling has gone down. Reducing the habit of pressing your lips tightly together and applying moisturizer often to your lips and around your mouth can help slow how quickly marionette lines deepen.
Side effects and precautions for marionette line treatment
Because it is an injection procedure, bruising, swelling, pain, or a foreign-body sensation may occur depending on skin condition, and most subside within 1 to 2 weeks. After mouth-corner Botox, the corners of the mouth may rarely move unevenly when you smile or feel awkward when you speak, and this returns to normal as the drug wears off. The degree of reaction and the speed of recovery vary from person to person.
Injecting a lot of filler can make the area around the mouth look bulgy when you smile, so we inject small amounts in divided doses. Rarely, nerve damage, allergic reactions, or inflammation can occur, and if filler blocks a blood vessel, there are risks such as skin necrosis. If you have a medical history such as an antibiotic allergy or any special conditions, please be sure to tell us before the treatment. If you are prone to herpes around the lips, please let us know before the treatment.
If the pain keeps getting worse even after taking prescribed medication, the skin color around the mouth changes, or blisters, itching, or heat persist, please contact the clinic right away.
What should I check before marionette line treatment?
If these apply to you, start with an examination of the wrinkles around your mouth
- Even at rest, a vertical groove remains beside the corners of my mouth.
- People tell me I look angry because the corners of my mouth droop.
- The flesh of my lower cheeks seems to have slid down and piled up above my jawline.
- I have a habit of pressing my lips tightly together.
If two or more apply, before choosing a treatment, it is best to first check whether the cause of the marionette lines is muscle, a sunken groove, or sagging. Whether to proceed, the method, and the scope are decided together in consultation after the medical team examines you.
In short, the key with marionette lines is to first determine which of muscle, groove, or sagging is the cause, then combine treatments in that order, starting with small amounts.
FAQ
Q. When do marionette lines start to appear?
A. They often become visible as volume and elasticity around the mouth begin to decrease. They can appear at a relatively young age if you have a habit of pressing your lips tightly together or have a face shape with full cheeks that slide downward, so we look at the cause before age.
Q. Is Botox alone enough for marionette lines?
A. If the lines are caused by the muscle that pulls down the corners of the mouth, Botox can help. For lines where a groove has already formed or that come from sagging cheeks, part of the line remains with Botox alone, so we consider filler or lifting as well, and the combination is decided after an examination.
Q. Are mid-cheek (Indian) lines treated with filler or lifting?
A. If the groove formed because the front cheek has hollowed, we even out the height with filler; if the groove deepened because the whole cheek has descended, we plan lifting as well. If both are mixed, we proceed in the order of lifting first and then filling the remaining groove with filler.
Q. How are philtrum lines and lip lines managed?
A. Fine vertical lines above the upper lip are addressed in the shallow layer with skin boosters or skin Botox, and deeper lines are sometimes treated with a small amount of thin filler. It is good to keep up lifestyle care as well, such as quitting smoking, using straws less, and moisturizing your lips.
Q. How long does marionette line filler last?
A. Hyaluronic acid filler is absorbed gradually, and duration varies within a range of 6 to 12 months depending on the treated area, product, and person. Because the area around the mouth moves a lot when you speak and eat, the rate of absorption may differ from other areas, so we decide while watching progress.
Q. How can I find out the cost of marionette line treatment?
A. The cost depends on the type of treatment, amount used, and number of areas. We guide you after confirming in consultation which of filler, Botox, and lifting to combine and over what range, and you can also check it on the treatment information page.
This content is provided as general treatment information and is not a substitute for diagnosis or treatment. Always consult a medical professional to decide whether and how to proceed with a treatment.