The aging process starts out differently for everyone. While some may gain weight in the stomach and hips, others will develop a buffalo hump or lose weight altogether. But one common denominator of aging, no matter where weight is gained or lost, are wrinkling and fine lines. In this article, we consider one of the more common senesencient facial lines – the marionette lines, explaining its causes, prevention, and treatment methods. 

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What are marionette lines?

Marionette lines are those fine vertical lines or wrinkle creases that are etched on a person’s face – starting from the corner of the mouth and running downward toward the chin.  Named after the mouth lines of a marionette puppet, marionette lines appear due to a loss of elasticity and firmness in the facial skin over time. With a reduced elasticity, the skin loses the ability to return to its original state after facial expressions like smiling or sternness, with these expressions slowly becoming a ‘permanent’ facial feature. 

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What causes marionette lines? 

Marionette lines appear naturally with time but can be exacerbated by multiple factors and lifestyle habits. Essentially, any action or condition that degrades or reduces the production of collagen and elastin will lead to the development of wrinkles and fine lines. This is because both of these protein compounds play an outsized role in plumping up the skin by boosting elasticity, firmness, and strength. They also reduce the skin’s susceptibility to gravity and other negative external influences.  

Related article: How To Lose Face Fat?

Some of the factors that reduce collagen/elastin production and accelerate marionette lines are:

  • Tobacco smoking

The thin skin around the mouth is significantly more prone to wrinkling, and smoking increases this susceptibility even further! The ‘smoke’ chemically induces tension in the muscles around the mouth that further degrades the comparatively little collagen and elastin in this area.

And besides containing harmful carcinogens that increase the risk of mouth cancer, smoking also constricts the buccal blood vessels – starving them of oxygen and exposing the facial skin to infections and serious damage.  Moreover, the repeated action of pursing the lips when ‘dragging’ further increases the likelihood of marionette lines, especially when the simultaneous degradation of collagen/elastin is factored in. 

Related article: Buccal Fat Removal

  • Weight loss

More often than not, weight loss in other parts of the body is accompanied by a loss of volume in the face too. A thinner face means that the facial muscles have ‘little’ to hold onto, making the face more susceptible to the force of gravity and the subsequent formation of marionette lines. 

  • Poor nutrition and hydration

Ignoring skin-friendly foods in your diet and not drinking enough water increases your skin’s susceptibility to folds, wrinkles, and fine lines. Refined sugars, refined carbs, saturated fats, and processed foods can cause the skin to lose its elasticity and show signs of  premature aging. Besides, a low water intake will cause skin dryness and a greater propensity to wrinkle. 

  • Sun exposure 

Sun exposure has some notable health benefits, but too much of it is generally not a good idea. Heat from the sun can cause moisture loss and dehydration and its ultraviolet rays are known to degrade collagen and elastin. 

  • Repeated facial articulations 

While making the same facial expression over and over does not directly contribute to the loss of collagen or elastin, it can combine with the natural reduction of skin proteins and elasticity to hasten the development of marionette lines. 

How do you prevent marionette lines?

Although marionette lines – as with general signs of aging – cannot be put off forever, there are simple lifestyle adjustments you can make to fend them off for much longer. These adjustments will ensure that at the very least, you won’t need to check your smile for fear of accentuating the lines!

  • Drink at least 6 glasses of water every day to maintain your skin elasticity 
  • Quit smoking entirely. If the habit is difficult to stop, you can slowly reduce it or use non-tobacco alternatives
  • Protect your skin from the sun’s UV rays using sunglasses, sun protection creams, and hats.
  • Eat more skin-friendly foods 
  • Sleep well, as collagen production ramps up during sleep.
  • Maintain your weight (regular weight fluctuations will reduce your skin’s elasticity overtime)
  • Consult a skincare expert to devise a daily skincare routine that covers face cleansers, toners, moisturizers, serums, and anti-aging creams (ideally those products that contain hyaluronic acid, retinol, vitamin B3, and antioxidants). 

Related article: Skin Care Treatment

How to treat marionette lines: surgical and non-surgical methods 

  • Surgical methods of treatment

Surgical treatment methods for marionette lines, wrinkles and facial folds are inherently more durable than non-surgical methods with the only downside being the relatively long recovery period. The methods are highly customizable facelifts and fat grafting, the removal of fat from one part of the body, its purification, and subsequent injection into the wrinkled areas to volumize and smoothen it.  

  • Non-surgical methods of treatment 

Botox injections (in full, Botulinum toxin type A)

Can be used to treat facial wrinkles and fine lines, including marionette lines. It falls under the category of anti-aging injectables and functions by relaxing the facial muscles underneath the injection site to smoothen the skin and reduce the apparent depth of the marionette lines. Botox is, however, not a natural substance and can thus trigger unintended effects at the injection site. 

Chemical peels

Are exfoliating agents that remove the outer layer of the skin, the epidermis (very strong peels can remove some part of the middle dermal layer). The process of exfoliation removes older skin and facilitates the generation of newer – and stronger – skin, with each new layer lessening the appearance of fine lines.  

Dermal filling

Is yet another non-surgical method of treating marionette lines.  It involves adding a filler compound to the face, usually the naturally occurring hyaluronic acid, which mimics the effects of collagen and elastin. The ‘fill’ produces almost immediate changes, with effects typically lasting between 6-18 months. However, unlike, say, facial lifts that produce long-lasting effects of up to 10 years, the short span and regular ‘maintenance’ it entails can be a put-off, as can the overly unnatural appearance created during most dermal filling procedures.  

Laser resurfacing, like chemical peels

Removes the top layers of the skin to cause the generation of stronger layers, with more mature and specialized skin cells. But unlike chemical peels, the procedure is carried out using concentrated laser energy, which has a risk of scarring and hyperpigmentation. Moreover, the effects also do not last for long.

Microneedling

Also referred to as collagen induction therapy, is the creation of small holes at the area of concern using a dermal roller or microneedling pen with very fine oscillating needle tips. The procedure provokes the production of collagen and elastin in the ‘needled’ area which will add an extra layer of elasticity to the skin, and reduce marionette lines.  

Thread lifts

 Are the longest-lasting non-surgical method covered in this list, with results lasting up to 2 years. It involves the strategic placement and expert manipulation of medical-grade PDO threads to lift and add firmness to the facial skin. The threads are bio-dissolvable and pose minimal risk to the body system. And although the results are not as immediate as dermal fillers, they build up progressively over time.

Read more about dermal fillers and thread lifts

Radiofrequency therapy

Involves using heat energy to penetrate the deeper skin layers and ‘deceive’ the body into producing more collagen in these areas. The downtime and recovery period, like most of the other non-surgical options, is also minimal. One of the more cutting-edge options in the market is the Morpheus 8, which merges radiofrequency and microneedling into a single device. 

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Conclusion

Many people consider wrinkles beautiful and everyone acknowledges that they are simply a natural part of the aging process. And although marionette lines can knock your confidence, they can also give you an aristocratic edge.