The Ultimate (Needle-Free) Guide to Marionette Lines - The Dermatology Review

The Ultimate (Needle-Free) Guide to Marionette Lines

SKIN CARE REVIEWS

02.26.21DISCLAIMER

From prevention to treatment, wrinkles are a big topic of conversation as we get older, but did you know there are four different kinds? Crinkle lines are shallow, parallel lines that typically appear on the forehead and disappear when the skin is stretched. Permanent elastotic creases generally are the result of overexposure to the sun. Gravitational folds, on the other hand, are created as the skin loses elasticity with age. The skin begins to sag because it’s becoming detached from underlying muscle and fat. 

Lastly, there are dynamic expression lines caused by a combination of loss of elasticity and habitual facial expressions. These wrinkles typically pop up between the brow, around the eyes, and the mouth. One of the most frustrating dynamic expression wrinkles is marionette lines. The good news is several different treatments can soften the appearance of these pesky wrinkles. Let’s take a closer look. 

Marionette Lines

What are Marionette Lines?

As the name suggests, marionette lines appear like the strings on a marionette (puppet) doll. These vertical lines run from the corners of the mouth down towards the chin. To be clear, we’re not talking about nasolabial folds, which are lines that extend from the outer corners of the nose down towards the corners of the mouth. Everyone is susceptible to getting these types of wrinkles — even the glitterati. Some celebrities with marionette lines include Cameron Diaz, Helen Miran, Jamie Lee Curtis, Drew Barrymore, and Diane Keaton. While there are several treatments for marionette lines (more on that in a bit), there’s certainly nothing wrong with aging gracefully either.

How Do Marionette Lines Form?

Marionette lines form for a few different reasons, with the primary one being intrinsic (aka chronological) aging. This genetically determined process is influenced by fluctuating hormones, the deteriorating effects of free radicals such as sun exposure and pollution, the body’s inability to repair damaged skin, lower levels of hyaluronic acids within the skin, and the loss of collagen and elastin that gives our skin tone. The skin surface’s overall collagen content per unit area e is known to decline approximately 1% per year starting in your early 20s. 

With that in mind, it’s possible to start to see marionette lines in your 20s — especially if poor lifestyle factors like smoking, excessive sun exposure, living in a polluted area, and an unhealthy diet are at play. These factors make up the extrinsic aging process. Additional influences include habitual (and animated) facial expressions, ethnicity, and genetics. 

What’s interesting to note is that intrinsic aging is only responsible for 10 percent of the aging process, and is based on DNA and gene expression. So, your lifestyle habits are incredibly influential in terms of how your skin ages — and how soon the process begins. 

What is the Best Treatment for Marionette Lines?

Are you wondering how to get rid of marionette lines? You’re not alone. While there’s more than one marionette lines treatment, it’s essential to have realistic expectations — especially if the lines are deep. As with all wrinkles, marionette lines are an inevitable part of the aging process. Here are the best needle-free options to consider. 

A Solid Skincare Routine

The best treatment for marionette lines? A preventative one, of course. Even so, everyone, regardless of skin type or age (from teen years on), needs a solid skincare routine tailored to their needs and concerns. It can help prevent — or at least slowdown — the development of fine lines and wrinkles. Along with basics such as a cleanser, day and night cream, and weekly treatments such as a mask, the following should be added if you want to combat marionette lines.

  • Retinoids: When crafting a skincare routine to combat marionette lines, you need to choose products that stimulate collagen synthesis, which means they can penetrate beneath the epidermis. Retinoids — synthetic forms of vitamin A — are favored in this case. Studies suggest that retinol results in significant wrinkle improvement after 12 weeks of use.
    As retinol can increase the skin’s sensitivity to the sun, it’s best to be applied at night in a product such as Formuylst Anti-Aging Night Cream with RetinolAn advanced overnight formula that penetrates deep below the surface, innovative Encapsulated Retinol Technology delivers a higher concentrate of the essential vitamin retinol to your skin for intense rejuvenation, while naturally nourishing jojoba and safflower seed oil lock in long-lasting hydration.
  • An Ingredient-Packed Serum: Worn underneath a moisturizer, serums deliver high concentrations of various active ingredients deep into the skin because they are formulated with molecules that can penetrate deeper than creams that only work on the surface level. When treating marionette lines, look for a serum with a combination of the following ingredients: hyaluronic acid, peptides, niacinamide (B3), retinoids (but not if you’re already using a vitamin A derivative in a cream), and antioxidants such as vitamins C and E. Together, these ingredients will protect against free radicals (think UV rays, pollution, cigarette smoke), increase collagen production, and improve elasticity and hydration levels. 

The Repair Serum from Carrot & Stick is a heavy hitter in the fight against wrinkles.  The formula contains seven plant-based neuropeptides to enhance the skin’s structural integrity from the inside out, promoting smoother, more resilient skin. A blend of synthesized growth factors promotes elasticity, cell turnover and nutrient absorption to support revitalization. Rounding out the power-house ingredients list is chamomile, licorice root and green tea to help brighten the skin.

  • Sunscreen Every Day: The sun is responsible for 90% of the visible changes to the skin, so something as simple as making sunscreen a regular part of your routine can have a significant impact on the development of marionette lines. Remember, you still need to protect your skin on cloudy days too. In fact, the American Academy of Dermatology reports that, even on cloudy days, up to 80 percent of the sun’s harmful ultraviolet rays can penetrate the skin.

Face Exercises
Face yoga has been growing in popularity as a natural way to slow down the aging process, from drooping jowls to prominent marionette lines. However, the efficacy of face exercises as a method of treating wrinkles has yet to be validated in studies. While experts say face exercises can be beneficial, you have to get ready to commit to 6-7 days a week for 20-30 minutes per day. It takes approximately three to four weeks to start to notice a difference. This type of treatment doesn’t work for everyone, so speak to your dermatologist before investing in such a routine. 

Microneedling
Microneedling, or collagen induction therapy, is a treatment that involves creating microscopic holes in the skin to stimulate collagen synthesis in order to fill in fine lines and wrinkles. It’s conducted by a dermatologist who uses a microneedling pen (or a derma roller), both of which are outfitted with small needles that puncture the skin in the area(s) of concern. This isn’t a quick fix treatment. You’ll likely have to have at least three to six additional sessions. 

You should also be aware that the results are not overly dramatic. Instead, expect only mild to moderate changes. According to Dr. Kenneth Arndt, medical editor of the Harvard Special Health Report Skin Care and Repair and a founding editorial board member of the Harvard Health Letter, studies show that people themselves and objective viewers report seeing a 45% to 55% improvement to the skin 6-12 weeks after a microneedling treatment. Note that this is still a needle-free guide as microneedling is not an injectable. 

Red Light Therapy
RTL is a non-invasive treatment that uses red low-level wavelengths of an LED light to treat various skin issues, including wrinkles and scars. The red light penetrates the skin deeper than blue light therapy (which targets sun damage and acne) in an effort to promote new cell generation. Light therapy is not meant to be a standalone treatment. It should be used in conjunction with other techniques to increase their efficacy. Depending on the starting point of your marionette lines (shallow versus deep), it can take approximately 8-12 weeks to start to see results. After that, you can slow down your treatments a bit, keeping in mind that maintenance treatments are the key to long-term results. 

Chemical peels
Chemical peels are solutions that are applied to the skin by a dermatologist or esthetician in order to reduce the appearance of age spots and wrinkles via chemical exfoliation. There are various peel grades depending on whether you’re looking for a light, medium, or deep exfoliation. Some peels just target the epidermis (outer layer of skin), while those targeting wrinkles like marionette lines go deep into the dermis, the middle layer of skin. 

The peeling process typically begins 48-72 hours after your treatment and can last anywhere from 2-5 days. It’s very important not to pick at your skin as you can cause damage such as scarring. Applying a gentle moisturizer regularly is the best thing you can do to keep flakes at bay while protecting delicate skin. As with all treatments, you have to keep up with your peels if you want to maintain the results, so plan on getting a peel on a monthly basis. 

Laser Resurfacing
Laser resurfacing is a non-invasive treatment that uses lasers to remove layers of your skin. Depending on the severity of your marionette lines, either an ablative or non-ablative laser tool will be used. Ablative only removes the top layer of skin, so your lines would have to be less pronounced. Non-ablative lasers, on the other hand, also remove those top layers but also heat up the dermis (underlying skin tissue) so that the body produces new collagen. As the treated area of the epidermis (outer layer) of skin heals and regenerates, the skin appears smoother, tighter, and more toned. There are several different types of lasers but Fraxel is favored for wrinkle removal. While results can be favorable, you’ll need to repeat laser treatments every few months. Keep in mind that there’s also a risk of hyperpigmentation and scarring.

Non-Surgical Skin Tightening
Similar to laser resurfacing, non-surgical skin tightening treatments are conducted by radio frequency (Vivace, Thermage) and ultrasound treatments such as Venus Legacy and Ultherapy to stimulate collagen production and help tighten and tone marionette lines. Depending on the severity of your wrinkles, sometimes these two methods are used together with laser resurfacing. However, those with more superficial lines tend to have better results than those with deeper creases. You’ll work with your doctor to devise a treatment plan that’s spaced over the course of 18-24 months. Results are gradually noticeable over 2-3 months after each treatment. 

Plastic Surgery
Plastic surgery is in fact a major surgery and is usually not suggested unless all of the other treatment methods didn’t produce satisfactory results. Along with needing a couple of weeks of downtime to recover, it’s important to consider lifestyle influences such as excessive sun exposure, and weight gain or loss as these can negate the results of the procedure. When treating marionette lines, a plastic surgeon would likely suggest a partial rhytidectomy (mini facelift) versus a full-blown rhytidectomy.

How Can I Tell If I’m Developing Marionette Lines?

These are some early signs that can help you distinguish if you are starting to develop marionette lines: 

  • Your age — most lines start to creep up around 40 years of age or older.
  • Lifestyle factors such as excessive sun exposure, smoking, and too much alcohol can cause lines to pop up as early as one’s 20s. 
  • Increased dryness.
  • Adverse changes in your skin tone and overall condition.
  • Reduced skin elasticity resulting in looser, droopier skin. 
  • Slightly distinguishable lines running down from the corners of your mouth.

How Are Marionette Lines Diagnosed?

Obviously, a dermatologist or plastic surgeon is going to consider all of the aforementioned points when diagnosing marionette lines. However, their analysis can be a bit more in-depth than seeing how deep your lines are and how far along you are in the aging process. Some doctors used what’s known as the 5-point photonumeric scale to impartially quantify the severity of melomental skin folds. From here, a skincare professional or doctor will work with you to craft the best treatment method(s) for your marionette lines. 

How Can I Prevent Marionette Lines?

While there are several products, procedures, and treatments that can help soften the appearance of marionette lines after they’ve developed, there are a few measures you can take to slow down the appearance of these mouth lines. For example: 

  • Reduce Sun Exposure: We’ve already talked about how the sun is one of the number one causes of wrinkles, yet we can’t stress enough the importance of wearing sunscreen with an SPF of at least 30 every single day. The worst times to be out in the sun are in the late morning and early afternoon as the UV rays are the strongest during these periods.
  • A Daily/Nightly Skincare Routine: The earlier you start a proper skincare routine the better. By proper, we mean a routine that includes products formulated with results-driven ingredients that can actually make a difference in your skin. Obviously, your skincare needs are going to change as you get older, so be sure to adapt your routine on a regular basis. It’s never a bad idea to meet with a dermatologist or esthetician for guidance. 
  • A Healthy Weight Loss Plan: Rapid changes in weight can cause the skin to sag, which can make marionette lines more prominent. If you need to lose weight for health reasons, work with a doctor so that the process is gradual and attainable for the long-term.
  • Eat Clean: Adopt a healthy diet with anti-inflammatory foods such as colorful fruits and vegetables; fish; healthy fats such as olive oil, avocados, and omega-3 fatty acids; and whole grains. 
  • Sip Smart: Drink enough water each day (approximately 3.7 liters for men and 2.7 liters for women according to the U.S. National Academies of Sciences, Engineering, and Medicine) to keep your skin hydrated but limit your intake of caffeine as it zaps the body of water. Alcohol is even more destructive because it causes oxidative stress that leads to premature aging. 
  • Ditch the Smokes: Quitting smoking is easier said than done, but if you can do it, it can save your skin from premature aging. The nicotine in cigarettes causes the blood vessels to constrict in the outer layers of the skin, which in turn impairs blood flow. Decreased blood flow means your skin isn’t getting as much oxygen or vital nutrients like vitamin A. 
  • Lower Your Stress Levels: According to Dr. F. Clarissa Yang, Chief of Dermatology at Tufts Medical Center, “Mental stress or anxiety can result in physical manifestations, such as deeper wrinkles or frown lines. Stress increases cortisol levels, which speeds up the aging process.”
  • Get Enough Sleep: Get those 7-8 hours (or more) of sleep per night. Studies suggest that lack of sleep is associated with more fine lines, wrinkles, and droopy corners of the mouth. 

In Conclusion

Marionette lines are an inevitable part of the intrinsic (chronological) aging process but can be exasperated by extrinsic aging factors such as smoking, excessive sun exposure, living in a polluted area, and an unhealthy diet. From a solid skincare routine, microneedling, and chemical peels to laser resurfacing, non-surgical skin tightening, and plastic surgery, marionette lines can be controlled. It’s best to speak to a dermatologist, esthetician, or plastic surgeon to come up with the best treatment plan to suit your individual needs. Incorporate healthy lifestyle changes such as eating a clean diet, drinking plenty of water, limiting alcohol intake, limiting sun exposure, quitting smoking, getting enough sleep, and reducing stress levels to prevent marionette lines early on — though all of these factors are useful for anyone regardless of age. 

Sources:
Skin Anti-Aging Strategies,US National Library of Medicine National Institutes of Health, July 2012.
Retinoids in the Treatment of Skin Aging: an Overview of Clinical Efficacy and Safety,” US National Library of Medicine National Institutes of Health, December 2006.
Photoaging: What You Need to Know About the Other Kind of Aging,” Skin Cancer Foundation, January 2019.
Sunscreen FAQs,” American Academy of Dermatology.
Can Doing Facial Exercises Help You Look Younger?” Cleveland Clinic, April 2018.
Water: How Much Should You Drink Every Day?,” Mayo Clinic.
Gray Hair and Wrinkles,” Tufts Medical Center, March 2019.
Study Reveals the Face of Sleep Deprivation,” American Academy of Sleep Medicine, August 2013. 

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