Marionette lines

Three things combine. Bone support in the lower face and along the jaw resorbs, so the framework retreats. The fat compartments of the cheek descend, and the tissue that used to sit high on the face collects lower down, either side of the chin. And the ligaments that held everything in place slacken.

There is a muscular component too: the depressor anguli oris pulls the corners of the mouth downward, and as the tissue supporting those corners weakens, its pull becomes relatively stronger and more visible.

We are extremely good at reading mouth-corner position. A downward turn at the corners is one of the most reliable visual cues for sadness, and we read it automatically and unconsciously in other people's faces.

So a structural change that lowers the mouth corners by a few millimetres changes how strangers interpret your mood. That is why people report being asked if they are alright, and why treating this area often matters to people more than the size of the line would suggest.

Structurally, and usually not by filling the line. Restoring support along the jawline and at the chin rebuilds the framework the tissue slid off, and restoring midface support stops more tissue arriving from above.

With the structure rebuilt, small amounts of product can then support the mouth corners directly, lifting them a little and softening the line that runs from them.

Where the downward muscular pull is a major contributor, relaxing that muscle allows the corners to sit higher. It is a supporting move rather than the main event, and used alone it rarely achieves much.

This surprises people. A chin that has lost projection shortens the lower third and lets everything above it crowd downward. Restoring chin projection frequently improves marionette lines more than treating the lines themselves would — and it improves the profile at the same time.

It is a good example of why I assess the whole face before treating a line. The thing that fixes your complaint is often somewhere you were not looking.

Where the line is etched into the skin as well as being a structural fold, microneedling or skin boosters improve the etched component. Structure first, then skin.

Realistically: substantial softening and a mouth that no longer turns down at rest is achievable for most people. Complete erasure of a deep, long-standing line is not, and where skin laxity is advanced the honest answer may be that surgery would do more.