Understanding Marionette Lines: Causes, Treatment, and Prevention

Introduction

A wrinkle is a natural line, fold, crease, or ridge that becomes more evident as one age. It happens all over the body. The skin is much thinner on the lower third of the face, so the wrinkles affect the mouth areas much earlier than the rest of the face.

What Age Do Wrinkles Appear?

Individuals age differently. External factors or genetic factors decide age for anyone. Wrinkles are most prominent among individuals aged 60 and above. However, wrinkles can start forming from as young as 25 years of age. The early signs of aging may happen because of the following:

• Sun damage from overexposure to the sun and not following appropriate protective measures, such as sunscreen or clothing.

• Loss of collagen - Collagen production declines slowly from age 20. Collagen is responsible for the texture and elasticity of the skin. This is a natural process by the body, but the loss of collagen may be accelerated by certain factors such as diet (excessive sugar).

• Smoking or use of other tobacco products - Smoking causes an increase in matrix metalloproteinases (MMP) which can damage collagen and elastin fibers in the skin, causing premature aging.

What Are the Types of Wrinkles?

• Dynamic Wrinkle: They are caused by the contraction of muscle fibers attached to the overlying skin.

• Static Wrinkle: They are caused by damage to the skin or from prolonged dynamic wrinkles.

• Wrinkle Folds: They are deep grooves caused by age-related sagging of facial structures.

What Are the Types of Facial Wrinkles?

With repetitive facial movements, gravity, loss of collagen, and skin elasticity, different facial wrinkles may be seen on the face. Some are as follows:

• Frown Lines:

  • Appear between the eyebrows.

  • Caused by repeated muscle contraction.

• Horizontal Forehead Creases:

  • Appear on the forehead horizontally.

  • Caused by repeated muscle contraction.

• Crow's Feet:

  • Appear horizontally on the outer corner of the eye.

  • Caused by repeated smiling, growing, and squinting.

• Nasolabial Fold:

  • Appear vertically from the outer corner of the nose to the outer corner of the mouth, even when the face is at rest.

  • Caused by loss of collagen, elastin, and hyaluronic acid.

• Smokers Line:

  • Appear vertically along the upper lip.

  • Caused by repeated muscle contraction.

• Marionette Lines:

  • Appear vertically from the corner of the mouth to the chin.

  • Caused by loss of skin elasticity and collagen.

What Are Marionette Lines?

Also known as melomental folds or static wrinkles. They are visible even when the face is at rest. They run downward (vertically) from the corner of the mouth to the chin, which becomes more prominent naturally with age.

What Causes Marionette Lines?

Marionette lines appear naturally with aging. However, some individuals may be prone to them being visible at a much earlier age. Some of the factors that may cause marionette lines are:

1. Age - From the early 20s, the production of collagen, which keeps skin tight and smooth, depletes, and skin becomes less elastic and more fragile. Decreased oil production causes the skin to appear drier, subsequently deepening the lines. Lines may also become more prominent when skin loses fat and sags with age.

2. Genetic Factor - Some individuals may have them in childhood if it runs in the family.

3. Sun Damage - Sun damage causes the skin to lose its collagen and natural oils, making it prone to aging faster.

4. Gravity - Depressor anguli oris muscle tends to pull down the corners of the mouth, causing the appearance of these lines as one age or with habits such as smoking or pursing lips often.

5. Volume Loss - The main cause for marionette lines being prominent.

• Volume loss of soft tissue (skin becomes thinner with fat loss).

• Volume loss of bone tissue- mandible bone resorption with age, loss of teeth, and not using dentures.

6. Stress - A stressful lifestyle may cause inflammation that causes inflammatory damage, thereby making these lines more prominent.

7. Diet - Excessive sugar and fat consumption can damage collagen and elastin fibers, causing the lines to appear earlier.

8. Facial Movements - Expressions (laughing, sulking) on the face, eating, and talking may also cause the deepening of the lines with age. With facial movements, tiny grooves form underneath the skin. With age, when skin loses its elasticity, it fails to bounce back to its original shape and causes the deepening of the groove resulting in skin lines and wrinkles.

How to Treat Marionette Lines?

Marionette lines may be mild, moderate, or severe depending on the deepening of the lines into the skin. The appropriate treatment option is chosen after an aesthetic facial assessment is done. Treatment options include the following:

• Topical Application: Topical anti-aging serums (retinoids, vitamin C) and creams with ingredients that aid in smoothening lines and wrinkles may help mild marionette lines.

• Chemical Peels: Chemical peeling or derma peeling is a procedure that uses a chemical solution of a certain concentration (varies depending on the area and problem) to peel off the superficial affected skin and reveal smooth underlying skin free of lines and wrinkles.

• Botox Injections: Botox help to smooth out wrinkles by sending nerve signals to the muscle fibers to relax. Even though this is a temporary procedure, the effect may last for months, and regular follow-up only increases the success of the same.

• Derma Fillers: Injecting dermal fillers into the marionette lines helps plump up the face from within, making the lines smooth and less visible.

• Laser: A short pulsating beam of light vaporizes the outer skin surface, causing the reveal of underlying youthful skin.

• Thread Lift: A non-surgical cosmetic procedure that lifts saggy skin and makes the skin tighter and firmer with the help of collagen stimulated by the same.

• Microneedling: When micro-cuts are made on the skin surface using a derma roller or micro-needling pen, the procedure stimulates collagen to make the skin tighter.

• Facelift: Done as a last resort for severe marionette lines. The procedure aims to make the skin appear smooth by removing the excess skin and tightening the underlying muscles. It is an invasive, time-consuming (long recovery time), and costly procedure.

How to Prevent Marionette Line?

Aging is inevitable, and so are the signs of aging. One cannot prevent the appearance of the lines but can help delay the appearance of the same. Some of the ways to prevent the development of marionette lines are:

• Adequate sleep.

• Drink plenty of water to keep the skin hydrated.

• Follow a skincare regime appropriate for the skin type.

• Healthy diet and lifestyle (avoid smoking, alcohol, and excessive caffeine).

• Stress management.

• Avoid overexposure to the sun.

Conclusion

Marionette lines are just a work of art that comes with aging. Plenty of non-invasive procedures can smoothen out the skin and make the lines less evident. But, as the saying goes, 'prevention is better than cure'; Adequate care (skin and self) can always delay the appearance of marionette lines.