Published 28 October 2026 · Reviewed by Dr Sin Yong
Marionette lines treatment works when it follows the cause. The lines running down from the corners of the mouth usually come from a jowl that has descended, thinning support beside the chin, and a muscle that pulls the mouth corners down. Lifting, support and botulinum toxin each answer one of these. Filler in the line itself comes last, and sparingly.
Short answerMarionette lines are treated by cause. Where the jowl has dropped, lifting is considered; where support beside the chin has thinned, filler is placed along the bone; where the mouth corners are pulled down, the muscle can be relaxed. Filler in the line itself is used cautiously, because too much adds weight to the lower face. Dr Sin Yong examines the face at rest and in a smile before advising.
Marionette lines form where the jowl meets the chin. Facial fat is not one sheet but a set of separate compartments, and with age the compartments of the cheek and jowl deflate and slide downward and inward (Rohrich 2007). Tissue that once sat over the cheekbone gathers along the jaw, and the crease below the mouth corner is the line where that moving tissue folds against firmer tissue around the chin.
Four things usually add to the line, and most faces show more than one:
Jowl descent. The jowl drops and fills the space beside the chin, so the line deepens from the side. This is the lower part of the same descent that deepens the smile lines above it.
Thinning support beside the chin. The bone and soft tissue just in front of the jowl lose some projection, and a shallow dip forms. The line looks deeper because the area next to it has sunk.
Muscle pull. The depressor anguli oris, the muscle that draws the mouth corners down, can become dominant, giving a downturned or stern look even at rest.
Skin quality. Sun damage, thinning skin and weight change make the crease etch into the surface, so it stays visible when the face is still.
Earlier filler can also be part of the picture. Product placed in or around the folds can add weight that pulls the mouth corners lower, which is why a heavy-looking lower face is examined with ultrasound before anything new is added. The way the jowl itself changes is set out on jowls and lower face sagging, and the anatomy of both lines is explained in the guide to smile lines and marionette lines.
Marionette lines or smile lines? Lookalikes that change the plan
Marionette lines are often confused with smile lines, jowls and other creases around the mouth. They sit close together but have different drivers, so telling them apart decides which treatment is relevant.
Line or look-alike
Where it sits
What usually drives it
What it needs
Marionette line
From the mouth corner down towards the jaw
Jowl descent, thin support beside the chin, muscle pull
Lifting, support and muscle relaxation, matched to the driver
A quick way to see the difference at home: smile lines deepen most when you smile, while marionette lines are clearest at rest and when you look down. If gently lifting the jowl back towards the ear softens the line, descent is a large part of it. If the line stays and the area beside the chin looks sunken, support is part of it too. Neither test replaces an examination, but both explain why one product rarely answers every crease around the mouth.
“A marionette line is where the jowl meets the chin. I treat the jowl and the support first; the line itself gets the least filler of anywhere in the plan.”
Dr Sin YongOn treating marionette lines
Marionette lines treatment options: lift, support, relax or fill
Marionette lines treatment in Singapore covers several tools, and each reaches one driver. The table sets out the options Dr Sin Yong uses or discusses, what each does, and what it cannot do.
Relaxes the muscle that pulls the mouth corners down
Downturned mouth corners
Treat descent or replace volume
Skin boosters
Improve hydration and quality of thin, crepey skin
A line etched into thin skin
Lift or support
Filler in the line itself
Softens a remaining crease
A small residual line after the drivers are treated
Counter tissue still descending; more adds weight
Surgical facelift, by referral
Repositions deeper tissue and removes excess skin
Marked laxity with skin excess
Restore volume on its own
For support along the bone, Dr Sin Yong usually uses calcium hydroxylapatite (CaHA) or polycaprolactone (PCL), the firmer products used in bone-support areas; hyaluronic acid is chosen where being able to dissolve the product matters most. Where the jowl dominates, the zones of the jawline are set out on VF Lift for the jawline and jowls.
Most plans combine two or three of these in sequence: the jowl and the support first, the muscle where it pulls, and the line last. Combining energy devices, botulinum toxin and filler in one plan is common practice in the published consensus on facial treatment, provided each is chosen for a reason (Fabi 2016).
Why filler in the marionette line alone can make it look worse
Filling the marionette line is the request heard most often, and the one that most often disappoints when it is the whole plan. The line is usually the symptom of tissue moving down from above. Filler placed only in the crease lifts the floor of the line towards tissue that keeps arriving, and each top-up adds weight beside the mouth.
That weight shows in predictable ways:
The mouth corners look pulled lower, because the product sits where the jowl is already gathering.
The lower face looks wide or heavy, and the border between cheek, jowl and chin blurs.
Product can spread towards the jaw or form lumps that can be felt.
None of this means filler has no role. A small amount, placed after the jowl and the support beside the chin have been addressed, can soften a crease that remains. The order is what matters.
If filler is already in the area and the lower face looks heavier than before, the first step is not more product. Ultrasound shows what is there and where it sits. Hyaluronic acid can be dissolved with hyaluronidase; other materials need a different approach. These problems are covered in detail on smile line and marionette filler gone wrong, and an overfilled face as a whole on pillow face treatment.
How Dr Sin Yong assesses marionette lines
Dr Sin Yong examines the lower face himself on Orchard Road before any plan is written. The assessment separates the drivers, because the same line can come from different combinations.
At rest and in animation. The face is viewed from the front, in profile and at three-quarter angle, still and smiling, to see whether the line is mostly descent, muscle pull or both.
The jowl. A gentle pinch shows whether the jowl is lax tissue or a compact fat pad, which decides between lifting and a fat-directed protocol.
Support beside the chin. The jawline in front of the jowl and the chin are judged against the rest of the face.
The muscle. Pulling the mouth corners down shows how much the depressor anguli oris contributes.
Earlier treatment. Any filler, threads or energy treatment is recorded, and ultrasound is used where earlier product is present.
The plan follows in writing: what would be done and in which order, what would not be done, and the option of no treatment. Some lines need very little; a line that is part of a normal smile is not a problem to fix. The consultation process page describes the visit step by step.
Who suits non-surgical marionette line treatment, and what decides the plan
Non-surgical treatment suits mild to moderate marionette lines in a face whose skin can still redrape, in someone who prefers gradual change without incisions. Treatment waits during pregnancy or breastfeeding and while there is infection, a cold sore or inflamed skin in the area. A bleeding tendency, blood thinners, a keloid tendency or recent filler or threads change the timing or the method. Heavy skin excess on the lower face and neck is beyond non-surgical reach and is referred to a plastic surgery specialist.
What decides the plan
How many drivers are present: jowl, support, muscle and skin.
Whether earlier filler needs to be dissolved or addressed first.
Tissue thickness along the jaw, which decides the energy and depth used.
Skin quality, sun exposure and recent weight change.
Whether the smile lines and jowls are planned at the same time.
Fees are not published; a written quote follows the examination, as how fees are quoted explains.
Afterwards, in broad terms
Injections can leave swelling, tenderness or a bruise at the injection points. Energy treatments usually leave redness, warmth and tenderness that settle. Skin that turns pale, dusky or blotchy after filler, increasing pain, or any change in vision needs urgent attention; the signs are listed on warning signs after filler.
Your next step
1. MessageWhatsApp +65 8023 7170 with what is bothering you. A reply comes from the clinic, not a bot.
2. AssessmentDr Sin Yong examines you himself on Orchard Road, with ultrasound where earlier filler is involved.
3. A plan in writingWhat he would do, what he would not, the fee factors, and the option of no treatment.
Every treatment is performed by Dr Sin Yong personally. Singapore Medical Council registered · invited to share his clinical expertise internationally for CLASSYS, DEKA, Fotona, Hironic and Ilooda.
Book an assessment with Dr Sin Yong on Orchard Road. Bring the names and dates of any earlier filler in the lower face. How consultations work.
It depends on what is driving the line. A dropped jowl is a lifting question, a dip beside the chin is a support question, and mouth corners pulled down are a muscle question. Most faces have more than one, so lifting, support along the bone and small doses of botulinum toxin are often combined. Filler in the line itself is a small final step. An examination at rest and in a smile decides the mix.
Often, in part. Where a lax jowl drives the line, energy-based lifting such as HIFU, Ultherapy, Thermage FLX or VF Lift – Vertical Facelift works on the tissue that folds into it, and botulinum toxin can relax the muscle that pulls the mouth corners down. Where support beside the chin has thinned, no energy device replaces it, and filler along the bone is discussed instead.
It can help one part of them. The depressor anguli oris pulls the corners of the mouth down, and relaxing it with small doses can soften a downturned, stern look. It does nothing for jowl descent or lost support, so it is usually one element of a plan rather than the whole of it. It is a prescription medicine, given after assessment by a doctor.
Indirectly, when the line is deepened by a lax jowl. Focused ultrasound heats the SMAS and radiofrequency heats the dermis, so lax tissue contracts and remodels and less of it folds into the line. Neither adds support beside the chin or relaxes the muscle at the mouth corner. Whether energy is part of the plan depends on how much of the line is laxity.
Early marionette lines usually reflect bone structure, a dominant muscle at the mouth corner, a slimmer face or weight loss rather than marked ageing. Some people have a short chin or less support beside it, which makes the crease show earlier. Sun exposure and thin skin add to it. The plan for a younger face often leans on support and muscle relaxation rather than lifting.
Not completely, and trying to erase them usually means too much product. Some crease below the mouth corner is part of a normal adult face, especially when looking down. The realistic aim is a lighter shadow and mouth corners that no longer look pulled down, achieved by treating the jowl, the support and the muscle rather than filling the line until it disappears.
References
The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plastic and Reconstructive Surgery, 2007. source
Consensus Recommendations for Combined Aesthetic Interventions Using Botulinum Toxin, Fillers, and Energy-Based Devices. Dermatologic Surgery, 2016. source
About this page: written and medically reviewed by Dr Sin Yong, MBBS (NUS), MRCS (Edinburgh) · Last reviewed 28 October 2026 · Illustrative images only, not patients · Editorial policy
