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Marionette Lines and a Downturned Mouth: What Causes Them and How to Treat Them

Marionette lines and a downturned mouth can change the overall appearance of your lower face, but figuring out what to do about them isn't always simple.

Marionette lines are the folds that extend from the corners of the mouth toward the chin and jawline. They often appear alongside a downturned mouth, when the corners of the mouth droop instead of sitting level.

Several factors can shape the appearance of this area, from the muscles around the mouth to changes in facial volume and support.

Understanding what causes marionette lines and a downturned mouth can help you determine which options may be appropriate based on what they are designed to address.

What Causes Marionette Lines and a Downturned Mouth?

As mentioned, several factors can contribute to the appearance of marionette lines and a downturned mouth.

The muscles around the mouth can influence the position of its corners. The depressor anguli oris, or DAO, pulls the corners of the mouth down, while other facial muscles pull upward. When this downward pull is stronger, the corners of the mouth can appear lower, adding to a downturned appearance.

Volume and structural support can change over time. As volume is lost in parts of the face, fat pads can shift forward, creating more heaviness and folding around the corners of the mouth. Localized fat can add fullness or heaviness to the lower face as well. Any of these changes can cause marionette lines to appear.

The underlying bone and teeth are also part of the support system for the lower face. Changes in the jawbone or tooth loss can alter this foundation, leaving less support for the soft tissues above it and changing the contours around the mouth, chin, and jawline.

Because several factors can contribute to marionette lines and a downturned mouth, the right approach will depend on which of these factors are involved for you.

Anatomical diagram showing the depressor anguli oris muscle, which pulls the corners of the mouth downward and contributes to marionette lines.

What Can Help Improve Marionette Lines and a Downturned Mouth?

Options range from simple at-home approaches to professional treatments, depending on the factors being addressed. A more complex approach does not automatically mean a better result, since each option is designed to address a different aspect of marionette lines and a downturned mouth.

Gua Sha and Facial Massage

Gua sha is one of the simplest at-home approaches to consider. Because muscle activity can contribute to a downturned appearance, gua sha can be used for facial massage throughout the lower face and jawline.

Gua sha cannot replace lost volume or structural support and evidence that facial massage meaningfully improves marionette lines or a downturned mouth is limited. However, for someone looking for a simple, non-invasive option to try at home, gua sha can be an easy addition to a facial care routine.

Woman using a PlasmaGLO LED Gua Sha on her cheek.

Addressing the Muscles Around the Mouth

Electrical Muscle Stimulation (EMS) devices offer another way of working with the muscles around the mouth. These devices deliver small electrical currents to stimulate facial muscles and may be considered by someone looking for an at-home, non-injectable option that focuses on the muscular component of the lower face.

Professional neuromodulator treatments, such as Botox, take a different approach. If the DAO is creating a stronger downward pull at the corners of the mouth, a neuromodulator may be used to relax this muscle. Reducing some of this downward pull means the muscles that pull upward are met with less opposition, which may help improve the appearance of a downturned mouth.

Using botulinum toxin to treat the DAO for a downturned mouth is considered an off-label use in the United States and should only be performed by an appropriately qualified medical provider.

Restoring Structural Support and Volume

When changes in volume and structural support are influencing the appearance of marionette lines, professional treatments may focus on restoring support to the lower face.

The pre-jowl region, chin, and jawline are commonly considered by a provider when addressing marionette lines. Professional options may include strategically placed dermal filler or biostimulatory treatments, depending on the individual and the areas involved.

A qualified provider can assess how changes in support throughout the lower face may be affecting the appearance of marionette lines and determine whether restoring support may be appropriate.

Addressing Localized Fat

Localized fat can add heaviness around the lower face in some people. Professional fat-reduction treatments may therefore have a role in carefully selected cases.

However, reducing fat does not replace lost volume, restore structural support, or address muscle activity. When localized fat is one of several factors involved, fat reduction may be considered as part of a broader approach rather than as a solution for the marionette lines themselves.

Professional treatments, including injectables, carry potential risks and may not be appropriate for everyone. Consult with a qualified, experienced medical provider to discuss the potential benefits, risks, and suitability of any treatment for your individual needs.

What May Not Work Well for Marionette Lines and Why?

Facial exercises may offer some benefit when muscle activity is the main factor behind a downturned mouth. However, their effects tend to be limited when volume loss or reduced structural support is the larger contributor. Face tape works on the position of the lower face in a similar way, but it does not address these underlying changes either.

It can also seem logical to fill a visible marionette line or tighten loose skin around the lower face. However, adding too much filler directly to an area that already appears heavy can create additional fullness, while tightening the skin may provide limited improvement when changes in structural support are playing a larger role. A qualified medical provider can assess whether filler may be appropriate and where it can be strategically placed to help improve the appearance of the area.

Frequently Asked Questions

What causes marionette lines and a downturned mouth?

Several factors can be involved, including a stronger pull from the depressor anguli oris (DAO) muscle, loss of facial volume and structural support that lets fat pads shift forward, localized fat, and changes in the jawbone or teeth.

Can Botox help a downturned mouth?

If activity of the depressor anguli oris (DAO) muscle is creating a stronger downward pull at the corners of the mouth, a qualified medical provider may use a neuromodulator such as Botox to relax the muscle. This may help reduce the appearance of a downturned mouth in appropriate candidates.

Do facial exercises help with a downturned mouth?

Facial exercises may offer some benefit when muscle activity is the main factor behind a downturned mouth. Their effects tend to be more limited when volume loss or reduced structural support is the larger contributor.

What is the best treatment for marionette lines?

There is no single best treatment, since marionette lines can result from muscle activity, volume loss, reduced structural support, or localized fat, often in combination. A qualified provider can assess which factors are contributing to your specific case and recommend an approach suited to your needs.

Finding the Right Approach Starts With the Cause

There is no single cause of marionette lines or a downturned mouth, which is why there is no one-size-fits-all approach to addressing them.

The most appropriate option for you will depend on what is influencing their appearance, as well as whether you are looking for a simple at-home approach or considering professional treatment. Understanding those factors can help you narrow down your options and set realistic expectations for the type of improvement each approach may provide.