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How Marionette Lines Can Be Improved With Botox

Marionette lines are grooves or folds that run from the corners of the mouth downwards towards the jawline.

Often the corners of the mouth are turned downwards as well, leading to a sad, dissatisfied or scornful look.

This is one of the more challenging areas to treat and the fold is rarely treated directly because it simply doesn’t work.

The causes are multifactorial and are a combination of loss of volume, the negative effects of gravity and over activity of the muscles.

Bone Loss

There is a significant loss of facial bone with age and without the structural support of the bone, there are noticeable changes in the other layers of overlying soft tissue and skin.

Fat Loss

A youthful look depends on having the right amount of facial fat in the right places.  Redistribution, accumulation and atrophy of fat lead to facial volume loss.

Some areas lose fat and other areas gain fat.  Modification of these fat pads lead to contour deficiencies and heaviness in the lower parts of the face.


Facial muscles which continually contract crease the skin. Continued contraction of the muscles can contribute to etching the lines deeper into the skin.  We tend to see an increased strength of the muscles which are responsible for drooping the face. We also see decreased strength and activity of the muscles which lift the face.

A multifactorial approach will provide the most natural looking results. We usually use a combination of Botox (muscle relaxants) and Facial Fillers to treat Marionette lines.

Muscle relaxants

We have a muscle at the corner of the mouth which is responsible for causing the downturn of the mouth and a sad or dissatisfied expression.  When Botox is delivered into this muscle it will help reduce the activity which will help to engage the lip elevators (the muscles responsible for curling the lip upwards) to work harder, creating a subtle lift

In the long term this can work really well because it will stop you from making this sad face, and when the face is relaxed, the corners of the mouth will be lifted.

Dermal fillers

Rather than injecting the area directly which can lead to an unnatural and overfilled look, we can work on restoring the structure and support which has been lost over time.  

When the jawlines shape is improved and contoured, it will help to soften the appearance of the folds by improving the shape of the area.  We can also provide support for the lower lip by injecting the corner of the mouth.  

This will not eliminate the folds but it will help to improve the general shape and contour of the area.  So when looking at the face holistically and in 3D, it will appear that the lower face now balances and harmonises with the rest of the face.

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