Marionette lines are the vertical creases that run from the corners of the mouth down toward the chin. They are a natural result of facial ageing, and they respond well to the right non-surgical cosmetic treatment — provided the approach addresses what is actually causing them, not just the lines themselves. This post explains what drives marionette line formation, how treatment works, what results are realistic, and what to look for when choosing a provider in Australia.
Quick answer: Marionette lines form as the face loses volume and structural support with age, causing the skin around the lower face to descend and fold. Non-surgical cosmetic treatments can soften and lift these lines by restoring volume in the right areas. Results are visible from the first treatment and typically last 12 to 18 months depending on the approach used and individual factors.
What are marionette lines and why do they form?
Marionette lines are the folds that extend downward from the corners of the mouth toward the jawline. The name comes from marionette puppets, which have hinged lower jaws — the lines create a similar visual effect, often giving the face a downturned or drawn expression even when relaxed.
They are not caused by any single factor. According to research published in Skin Research and Technology (2024), marionette line formation involves a complex interplay of anatomical, physiological, and age-related changes. In practical terms, this means several things are happening at once: fat compartments in the midface shift downward under gravity, bone density in the jaw reduces, the skin loses elasticity as collagen production slows, and specific muscles — including the depressor anguli oris — exert a downward pull at the corners of the mouth.
The result is a fold that deepens progressively with age. In the early stages it may appear only during facial movement. Over time it becomes a static feature — present at rest, and more prominent in certain lighting.
It is worth understanding that marionette lines and smile lines treatment address two separate structures. Smile lines (nasolabial folds) run from the nose to the corners of the mouth. Marionette lines begin at the mouth corners and continue downward. They often develop together, and they share some underlying causes — but they are anatomically distinct and treating one does not automatically address the other. Read more about nasolabial folds vs marionette lines.
How are marionette lines different from nasolabial folds?
Marionette lines sit below the mouth; nasolabial folds sit above it. Both are signs of midface descent, but they are driven by different anatomical structures and require different treatment approaches.
| Feature | Marionette lines | Nasolabial folds (smile lines) |
|---|---|---|
| Location | Mouth corners to chin/jawline | Nose to mouth corners |
| Primary cause | Lower face volume loss, muscle pull, skin laxity | Midface fat pad descent, cheek volume loss |
| Effect on appearance | Downturned, drawn, or sad expression at rest | Aged, tired appearance; deepens with smiling |
| Treatment area | Lower face, pre-jowl region, corners of mouth | Midface, cheeks, nasolabial groove |
| Often treated together? | Yes — lower and mid-face ageing frequently overlap | Yes — same ageing cascade |
For a detailed explanation of nasolabial fold treatment, including how smile lines are assessed and approached differently, that is covered separately.
In our clinical experience, patients often present believing they only have one concern when assessment reveals both are present and contributing to the overall appearance. A thorough consultation will identify which structures need addressing and in what order.
What causes marionette lines to get worse over time?
Marionette lines deepen for the same reasons that all signs of facial ageing progress — but in the lower face, a specific combination of factors accelerates that process.
Volume loss in the midface is a significant driver. As the cheek fat compartments descend with age, support is removed from the structures below. This is why midface volume loss so often appears alongside marionette lines — the two concerns are anatomically connected, even when patients only notice one. Research published in Contemporary Clinical Dentistry (Tanaka et al., 2023) confirmed that deepened perioral folds — including marionette lines — are among the primary visual cues observers use to assess age and attractiveness, with the mouth area drawing disproportionate attention in faces showing these changes.
Other contributing factors include:
- Reduced bone density in the jaw and chin, which reduces structural scaffolding for overlying tissue
- Loss of skin elasticity as collagen and elastin production slows — typically beginning in the mid-20s and accelerating after 40
- Repeated downward muscle activity from the depressor anguli oris muscle, which actively pulls the corners of the mouth downward
- Genetics — some people develop prominent marionette lines earlier due to facial anatomy and inherited patterns of fat distribution
- Sun exposure, smoking, and significant weight fluctuation, which accelerate collagen breakdown and skin laxity
Understanding what is driving the lines in a specific person matters because it informs which treatment approach will work best. Treating marionette lines well is not simply a matter of filling the groove.
Cosmetic treatment options for marionette lines
Non-surgical cosmetic treatments are the most practical and widely chosen approach for marionette lines in Australia. They deliver visible results without surgical recovery, and they are reversible — an important consideration for a treatment area where precise placement is essential.
The two main categories of non-surgical treatment are volume restoration using cosmetic treatments, and collagen stimulation. In practice, many people benefit from a combination of both, used across a planned treatment schedule rather than a single session.
Volume restoration treatments
Volume restoration is the most immediate approach. Treatment is placed strategically around the lower face — not only in the marionette groove itself, but in the surrounding structures that are contributing to the descent. This might include the pre-jowl area, the corners of the mouth, and sometimes the midface, depending on what the assessment reveals.
A prospective multicentre clinical trial published in the Journal of Cosmetic Dermatology (Fundaro et al., 2023) reported a treatment success rate of 94.4% for marionette lines at three weeks post-treatment, with 88% of patients maintaining successful outcomes at 18 months. These figures reflect a structured, assessed approach — not a single-point fill of the line itself.
Results from volume restoration treatments for marionette lines are visible immediately. Longevity depends on the product used, the volume placed, individual metabolism, and lifestyle factors, but most people see results that last 12 to 18 months.
Collagen stimulating treatments
For people with more advanced marionette lines, or those who prefer a gradual improvement over time, collagen stimulating treatments are an alternative or complementary approach. Rather than adding volume directly, these treatments trigger the body’s own collagen production, building structural support gradually over several months.
The trade-off is that results are not immediate — improvement develops over three to six months — but the quality of skin and structural support achieved can be more durable. We see this approach working well for patients in their late 40s and beyond, where skin quality and structural loss are both present rather than volume loss alone.
What about cosmetic muscle-relaxing treatments for marionette lines?
This is one of the most common questions we receive. Muscle-relaxing cosmetic treatments work by reducing the activity of muscles that cause lines and creases. For marionette lines, the depressor anguli oris muscle actively pulls the corners of the mouth downward, and treating this muscle can form a useful part of a comprehensive plan. However, muscle-relaxing treatment alone is unlikely to produce significant improvement for established marionette lines — these are primarily volume and structural concerns, not purely movement-driven lines. The two approaches are often combined.
| Treatment approach | How it works | Onset of results | Typical longevity | Best suited to |
|---|---|---|---|---|
| Volume restoration | Restores lost volume, lifts and supports surrounding tissue | Immediate | 12–18 months | Moderate to deep marionette lines; most age groups |
| Collagen stimulation | Triggers natural collagen production over time | 3–6 months | Up to 24 months | Advanced lines; skin quality concerns; late 40s+ |
| Muscle-relaxing treatment | Reduces downward pull of depressor anguli oris | 5–14 days | 3–4 months | Downturned mouth corners; as an adjunct to volume treatment |
| Combined approach | Two or more of the above, sequenced appropriately | Immediate + progressive | 12–24 months | Most moderate-to-advanced presentations |
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What results are realistic — and what does the process look like?
Realistic expectations are one of the most important things to establish before any treatment. Marionette lines can be softened significantly — most patients describe looking noticeably fresher and less drawn without appearing to have had anything done. Full elimination of deep, established lines is not the appropriate goal, and any provider suggesting otherwise warrants caution.
The treatment process at our clinics is planned around the concern, not the product. Before any treatment is recommended, an assessment determines the contributing factors — which structures have lost volume, how much skin laxity is present, and whether muscle activity is a significant driver. From there, a treatment plan is built that addresses the root causes, not just the visible line.
On the day of treatment, the procedure itself is straightforward. Topical numbing is applied beforehand. The treatment takes approximately 30 to 45 minutes. Most people have some mild swelling and occasional bruising in the days following, which typically resolves within a week. The treated area should be left alone for several hours after treatment, and strenuous exercise and alcohol avoided for 24 to 48 hours.
We have seen patients who were treated with volume placed directly into the marionette groove — without addressing the surrounding structural deficits — end up with results that looked unnatural or short-lived. Our approach accounts for the full lower face picture, which consistently produces results that look right at every angle and hold for longer.
How much does marionette line treatment cost in Australia?
The cost of marionette line treatment in Australia varies depending on the treatment approach, the volume required, and the clinic you choose. At Cosmetic Connection, marionette line treatment is available on a flat-fee basis, with treatment costs ranging from $1,500 to $2,500 depending on the treatment approach and volume required.
That range reflects the reality that no two presentations are the same. A person with early, mild marionette lines will require less treatment than someone with deeper, more established lines across both the lower face and pre-jowl region. The consultation process establishes what is appropriate for your specific situation before any commitment is made.
A few things worth understanding when comparing costs:
- Per-unit or per-syringe pricing models can make it difficult to predict the total cost upfront — flat-fee pricing removes that uncertainty
- The cheapest option is rarely the best value in this treatment area — the lower face is complex anatomy where precision matters
- A consultation that includes a genuine suitability assessment is a signal of a considered, patient-first approach
For a full overview of our pricing structure, visit our flat-fee services page.
What to look for in a marionette line treatment provider in Australia
Provider selection is one of the most consequential decisions in this process. The lower face is a complex treatment area with significant anatomical variation between individuals and important vascular structures that require anatomical knowledge and careful technique.
In our experience, the questions worth asking before committing to treatment are:
- Is a suitability assessment part of the process? A provider who moves directly to recommending volume without first assessing your anatomy and the underlying causes of your lines is not approaching this thoughtfully.
- Is the treatment plan concern-based or product-based? The goal should be to address what is causing your marionette lines — not to sell a particular volume of a particular product.
- Who is performing the treatment? In Australia, cosmetic treatments should be performed by or under the direct supervision of a qualified medical practitioner. Doctor-led clinics carry a higher standard of clinical oversight and the ability to manage complications if they arise.
- Is there a guarantee or aftercare process? A clinic confident in its outcomes will stand behind its results.
A systematic review published in Aesthetic Plastic Surgery (Kyriazidis et al., 2024), analysing 48 high-evidence studies on cosmetic treatment adverse events, identified that complication rates are significantly associated with provider experience and anatomical knowledge. Choosing a qualified, experienced provider is the single most important risk-reduction decision you can make.
At our clinics across Sydney and Melbourne, every marionette line assessment is conducted by a doctor, and every treatment plan is built around your specific presentation — not a standard protocol.
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Frequently asked questions
Are marionette lines the same as smile lines?
No. Smile lines (also called nasolabial folds) run from the nose to the corners of the mouth. Marionette lines begin at the mouth corners and extend downward toward the chin. They share some underlying causes and often appear together, but they are distinct structures that require separate treatment assessment.
Do cosmetic treatments hurt?
Most people tolerate marionette line treatment well. Topical numbing cream is applied before treatment, and many products contain a local anaesthetic. Some mild discomfort, pressure, or a stinging sensation during treatment is normal. Pain is not a common feature of a well-managed procedure.
How long does marionette line treatment last?
Results from volume restoration treatments typically last 12 to 18 months. Collagen stimulating approaches can provide support for up to 24 months. Longevity varies with individual metabolism, lifestyle factors, and the volume and approach used. Most people return for a maintenance treatment annually or as their results start to soften.
Can marionette lines be prevented?
The underlying processes — bone resorption, fat compartment descent, and collagen loss — cannot be fully prevented. However, consistent sun protection, avoiding smoking, maintaining a stable weight, and addressing early volume changes before they progress are all approaches that can slow the development and deepening of marionette lines over time.
Is treatment reversible if I am not happy with the result?
Volume restoration treatments used at Cosmetic Connection can be dissolved if needed, which means the treatment is not permanent. This is one reason volume restoration is the preferred first approach in a treatment area as anatomically nuanced as the lower face — the ability to adjust or reverse the result matters.
Who is suitable for marionette line treatment?
Most adults who are bothered by the appearance of marionette lines and are in good general health are suitable for treatment. Suitability assessment at consultation considers the severity of the lines, the contributing anatomical factors, skin quality, and medical history. Some presentations are better addressed with a staged plan rather than a single session, and some are not well suited to non-surgical treatment — which a proper consultation will identify.
References
- Tanaka OM, Cavassin LD, Gasparello GG, et al. (2023). The esthetics of the nasolabial fold and age in the elderly via eye-tracking. Contemporary Clinical Dentistry, 14(1):18–24. https://pmc.ncbi.nlm.nih.gov/articles/PMC10209770/
- Stefura T, Kacprzyk A, Droś J, et al. (2021). Tissue fillers for the nasolabial fold area: a systematic review and meta-analysis of randomised clinical trials. Aesthetic Plastic Surgery. PMID: 34255156.
- Ehlinger-David A, et al. (2023). A prospective multicenter clinical trial evaluating the efficacy and safety of a hyaluronic acid-based filler with Tri-Hyal technology in the treatment of lips and the perioral area. Journal of Cosmetic Dermatology, 22(2):464–472. https://pmc.ncbi.nlm.nih.gov/articles/PMC10087550/
- Kyriazidis I, Spyropoulou GA, Zambacos G, et al. (2024). Adverse events associated with hyaluronic acid filler injection for non-surgical facial aesthetics: a systematic review of high level of evidence studies. Aesthetic Plastic Surgery, 48:719–741. https://doi.org/10.1007/s00266-023-03465-1
- Skin Research and Technology (2024). Why do marionette lines appear? Exploring the anatomical perspectives and role of thread-based interventions. https://pmc.ncbi.nlm.nih.gov/articles/PMC10993050/
