Puppet lines are facial wrinkles that appear with natural aging. Lines run vertically between the mouth and chin, which can also create sagging in the lower half of your face.
The puppet lines are named after string puppets, which are known for having split jaws so puppeteers can help them speak. The skin around your mouth is especially prone to wrinkles because it is thinner compared to the rest of your face.
These types of wrinkles tend to develop in your 40s, but you may start to see signs in your 20s and 30s. Learn more about their causes and possible treatment options if you want to minimize their appearance.
Like other types of facial wrinkles, marionette lines are caused by natural collagen losses that occur with age. Collagen itself is a protein that naturally plumps up your skin. Gravity also plays a role in sagging skin around the chin, making marionette lines more noticeable.
As early as your 20s, your skin begins to lose elasticity as well as hydration, which increases the risk of fine lines and wrinkles. Long-term sun exposure, stress and poor diet can also contribute to facial wrinkles by prematurely breaking down collagen and elastin.
Despite the general causes of wrinkles, you may only experience certain types while other people may develop others. It’s not clear exactly what causes marionette lines in some people, but genetics are thought to play a role.
While wrinkles such as marionette lines are part of the natural aging process, it is possible to temporarily reduce their appearance. There are no medical treatments other than surgery that will permanently remove wrinkles, but some options such as injections and dermal fillers may last longer than others.
Wrinkle treatments are not considered a medical necessity, so insurance will not cover them.
Surgery for marionette lines
The only wrinkle treatment that is considered permanent is surgery. For significant wrinkles, a dermatologist may recommend a rhytidectomy (facelift). With this type of surgery, incisions are made to remove or transfer fat, while the underlying tissues are lifted up to help tighten your face.
Since a facelift is a major surgical procedure, it is usually recommended only when other wrinkle methods have failed. To treat only marionette lines, a surgeon may recommend a partial rhytidectomy (mini-lift).
Due to the importance of the procedure, you will need to take 1 to 2 weeks off work to recover. Weight fluctuations and excessive sun exposure could negate the results of your surgery, so it’s important to talk to your surgeon about adopting healthy lifestyle habits beforehand. See below for suggestions.
Laser restoration
Although considered an invasive treatment for wrinkles, laser treatments do not require the incisions that facelifts require. Laser resurfacing works by removing the top layers of your skin using a laser.
Although an effective treatment for some, laser resurfacing carries the risk of scarring and hyperpigmentation. The results are long-lasting but not permanent — you’ll likely need repeat treatments every few months.
Botox for marionette lines
Botulinum toxin type A (Botox) injections are popular solutions for facial wrinkles around the mouth and eyes. These work by relaxing the facial muscles below the injection site. In turn, your skin will become smoother with a reduced appearance of wrinkles.
Botox can cause minor bruising and irritation at the injection site. In order for Botox injections to treat marionette lines, you will need to repeat the treatment every 3 to 4 months. This treatment method works best if you are just starting to develop these types of wrinkles.
Dermal fillers
Like Botox, dermal fillers are temporary injectables that can help treat marionette lines in their early stages. Unlike Botox, fillers do not relax the muscles. Instead, they help plump your skin with either poly-L-lactate or hyaluronic acid. It is designed to mimic the effects of collagen and elastin to help smooth fine lines and wrinkles.
Hyaluronic acid dermal filler results in an immediate change, while poly-L-lactic takes several months to see results, as it is a stimulatory filler that stimulates collagen production over time.
Dermal fillers may also help address sagging caused by marionette lines, but may inadvertently worsen these results if too much is used. There is also concern that injecting these fillers into the cheek area can create an unnatural appearance.
Chemical peels
Chemical peels are applied by an esthetician or dermatologist and, depending on the type of peel, are designed to remove the outer layer of skin (epidermis) as well as parts of the middle layer (dermis). The procedure reduces the appearance of facial wrinkles and age spots, and the new skin cells that are created are stronger.
Before having a chemical peel, tell your provider if you use retinoids or facial acids, as these could make your skin too sensitive for this treatment option. To maintain your results, you will likely need a chemical peel every month.
Microneedling
Microneedling, or collagen induction therapy, is a treatment that creates very small holes in the skin to help create stronger skin cells. A dermatologist uses a derma roller or microneedling pen, a tool that contains small needles to create these small holes in the target area of skin.
When applied to deep marionette lines, microneedling can help generate more collagen to effectively fill in those deeper facial wrinkles. Depending on the results you want to achieve, you will need to repeat microneedling several times.
Retinoids
Retinoids are types of synthetic vitamin A derivatives used for wrinkles, acne and photoaging. The most common over-the-counter form is retinol, but stronger retinoids are available by prescription.
Retinoids are not recommended for pregnant women, and these types of products may increase your sensitivity to the sun.
For marionette lines, retinoids may help by getting deep under the skin to stimulate collagen. These products are not intended for use in the mouth due to sensitivity concerns, although they may be applied near the mouth.
Hyaluronic Acid
Hyaluronic acid is a substance that is naturally available in skin tissues. Like collagen, hyaluronic acid can decrease with age. This substance is found in some dermal fillers, serums, and skin care products. When applied to wrinkles, it is thought to smooth the skin.
Local treatment
If you don’t already use an anti-aging serum, you should consider adding one to your daily skin care routine. Ideally, you’ll want to start using serums from the earliest stages of facial wrinkles.
The best serum for marionette lines
Marionette lines can benefit from a serum that contains a combination of the following ingredients:
- antioxidants such as vitamins C and E to help fight free radicals that can further age the skin
- vitamin A derivatives such as retinoids
- Hyaluronic Acid
- niacinamide (vitamin B3), which is thought to help increase collagen production and improve elasticity
- peptides, which are proteins that have a firming effect on your skin
Another option that does not involve any dermatological treatment is makeup. If you want to cover your wrinkles, consider the following steps:
- Apply your foundation first.
- Then apply cream concealer after applying your foundation.
- Gently dab the concealer into your skin with your finger or a concealer brush until the product is absorbed. Do not rub the concealer.
- Apply the powder with a large makeup brush.
Focusing on eye makeup can also help distract attention from the lower half of your face if you want to. But remember: Everyone has wrinkles. They are a natural part of aging and many find them beautiful!
While there is no way to completely prevent skin aging, there are preventative measures that can slow down the development of marionette lines. Consider the following health and lifestyle tips.
Daily skin care
Wrinkle treatments won’t go far if you don’t take care of your skin on a regular basis. Wash your face twice a day and remove makeup before bed. Use your desired antiaging serum as well as facial moisturizer to keep your skin hydrated.
Weight management
Weight fluctuations can increase the risk of sagging skin. This includes below the jaw line, which can also make marionette lines more noticeable. If you need to lose weight for medical reasons, be sure to do so gradually and work with a doctor to help you maintain it.
Reduce sun exposure
Over time, unprotected sun exposure can damage both the epidermis and the dermis, which can increase the risk of fine lines, wrinkles, and sagging skin. You can protect your skin by wearing SPF 30 sunscreen every day and hats to shade your face.
Also, avoid being in direct sunlight between late morning and early afternoon – that’s when UV rays are strongest.
Adopt a skin-friendly diet
Drinking plenty of water can keep your skin hydrated, but eating the right foods can also help keep your skin healthy in the long run. Anti-inflammatory foods, such as colorful fruits and vegetables, fish and whole grains, can be especially beneficial.
Other lifestyle considerations
Other lifestyle habits can contribute to marionette lines and other facial wrinkles, including:
Puppet lines appear naturally with age, as do other facial wrinkles. Your genes, lifestyle, and general health may play a role, but there’s no way to prevent them entirely. If you’re concerned about your marionette lines, talk to a dermatologist about treatment options and tips for long-term skin care.
