Marionette Lines: Filler, Botox or Lifting?
Marionette lines can come from lost volume, a muscle pulling the mouth corners down or a sagging jawline. Here's how to tell which cause is biggest, what filler and Botox studies found and which signs after filler need care right away.
Marionette lines don't all call for the same fix. If the area below your mouth corners has hollowed out, filler comes first; if the muscle that pulls your mouth corners down is strong, Botox; and if skin has loosened above your jawline, lifting. Many faces have more than one of these at once, so it's worth gauging which cause is biggest before you settle on a single treatment.
In this article, we'll cover what to look for in the mirror, how far filler and Botox can go, which reactions after filler pass and which need care right away, what to consider when sagging is the main cause and how to fit treatment within your travel itinerary.
Quick summary
- Choose a marionette line treatment by which cause is biggest: hollowing, muscle pull or sagging.
- Filler study: 83.5% saw marionette lines improve by at least one grade at 12 weeks.
- In a study of 90 women aged 35 to 55, Botox plus filler did better than either one alone.
- If skin turns white, gray or blue after filler, don't wait; get medical care right away.
What Should You Check in the Mirror for Marionette Lines?
Start with your face relaxed. Check whether the corners of your mouth sit low, whether a shadow falls in the area just below them and whether skin has loosened and bulged above your jawline. Marionette lines form when several changes overlap: bone thins with age, fat compartments shift, muscles press down, ligaments pull and skin ages, with gravity adding to all of it. That's why two lines that look alike can have a different main cause.
| What you see in the mirror | Likely cause | What to look at first |
|---|---|---|
| A hollow shadow below the mouth corners | Lost volume | Filler |
| Mouth corners pulled downward | The muscle that pulls the corners down | Botox |
| Loose skin bulging above the jawline | Sagging | Lifting |
In East Asian faces, the spot beside each mouth corner where several muscles meet (the modiolus) tends to be compact. With age, that structure makes sagging around the mouth corners more noticeable.
What you see in the mirror is only a starting point. In the clinic, I watch your face both at rest and while you make expressions. Then I work out how much each cause contributes before setting the order of treatment.
Hollow Below the Mouth Corners: How Much Can Filler Help?
When hollowing is the main cause, filler supports the empty area from underneath so the shadow looks softer. In a study of 98 people, each person had hyaluronic acid filler in 2 or 3 of these areas: the smile lines (nasolabial folds), the marionette lines and the lips. Anyone who needed more got a touch-up at 4 weeks.
Twelve weeks after the last injection, 83.5% had marionette lines that improved by at least one grade on the rating scale. For comparison, 85.5% improved in the smile lines and 57.4% in lip volume. Results differ from person to person, and how much you see depends on how deep the hollow is.
Keep in mind that these numbers come from one product, Belotero Intense, so they may not carry over exactly to other fillers. The study also didn't aim to fill everything in a single session.
For marionette lines, filler is aimed at the deeper fat layers above and below the muscle rather than just under the skin. One method described for reaching those layers uses a cannula, a thin tube with a blunt, rounded tip.
Mouth Corners Pulled Down: Does Botox Help?
It can, when muscle pull is the main cause. The depressor anguli oris is a small muscle that runs from each corner of your mouth down toward the edge of your jaw. Botox in that muscle weakens its downward pull, so the mouth corners tend to sit less low. What Botox won't do is replace volume that has been lost.
That's why faces with both causes sometimes get Botox and filler together. A study split 90 women aged 35 to 55 into three groups of 30: filler only, Botox only or both. The group that had both improved more at nearly every time point. How much the combination adds for you depends on how strongly each cause shows in your face.
Filler Side Effects: What Passes and When to Get Care Right Away
Bruising, redness, swelling, pain, tenderness, itching and rash can appear right after filler. They usually settle within a few days to a few weeks*.
*Based on US FDA guidance on dermal fillers.
Filler blocking a blood vessel is reported very rarely, and its true frequency isn't known because not every case gets reported. When it happens, the signs below can appear. If your skin changes color or you feel unusual pain, get medical care right away:
- Skin near the injection site turning white, gray or blue
- Unusual pain
- Changes in your vision
Signs of a stroke include sudden difficulty speaking, numbness or weakness in your face, arms or legs, difficulty walking, vision changes, face drooping, severe headache, dizziness and confusion. If your vision changes or you notice any of these signs, go to the nearest emergency room right away. You can message us through the consultation button as well, but only alongside in-person care, never in place of it.
In these cases, it's better to postpone treatment or tell the doctor beforehand:
- You have inflammation or an infection where you'd be injected
- You have a bleeding disorder
- You've had a severe allergy or anaphylaxis
- You're allergic to lidocaine, collagen, eggs or animal products
Sagging Along the Jawline: What Should You Look at First?
When the line comes from skin that has loosened above your jawline, lifting the sagging tissue is what I look at first. Besides filler and Botox, the options described for marionette lines include thread lifting and surgery that reduces fat.
Sagging rarely shows up on its own, though. If you also have a hollow below your mouth corners or corners that pull down, lifting may be one part of the plan rather than the whole of it. Everyone's face is different, so the order is set after the exam rather than from a chart.
A useful first question at your consultation: "Which is biggest in my marionette lines: hollowing, muscle pull or sagging?" Once you have that answer, the three treatments become far easier to weigh against each other.
Fitting Marionette Line Treatment Within Your Travel Itinerary
Unless you've had sedation that day, there's no need to postpone your flight home after treatment for marionette lines.
It also helps to know what one visit can mean. Filler changes your shape the same day. Most other treatments work more gradually: rather than changing things dramatically at once, they tend to bring you a little closer to how you used to look.
Once you're home, you can send photos with your questions through the consultation button on this page. If a warning sign shows up after you're back, go to local emergency care first rather than waiting for a reply.
The Bottom Line: Find Your Biggest Cause First
Before you decide, ask which layer the filler would go into and whether Botox or lifting would be added for your face. Those answers tell you whether one treatment fits or a combination makes more sense. Like any procedure, each option comes with trade-offs, and the right plan depends on how your face moves and where it has changed.
Beautystone is a clinic in Seoul's Hapjeong area, and you can reach us with the button on this page. In your first message, include two front-facing photos (one relaxed and one with your mouth corners pulled down), any filler or Botox you've had with the dates and your travel dates.
Sources
- Which layer filler goes into for marionette lines, and why Botox is added — Journal of Dermatological Treatment, 2025
- Why marionette lines form, and the role of thread lifting — Skin Research and Technology, 2024
- 12-week results of filler for smile lines, marionette lines and lips in 98 people — Aesthetic Surgery Journal Open Forum, 2026
- 90 women comparing Botox, filler or both for lines around the mouth — Dermatologic Surgery, 2010
- How blocked blood vessels after filler show up on the skin — Aesthetic Surgery Journal, 2014
Frequently Asked Questions
Q. Why do marionette lines form?
A. Marionette lines don't come from a single cause. With age, bone thins and the fat compartments of the face shift. Gravity and muscles press downward, ligaments pull and skin ages, and together these changes deepen the line.
Q. Are marionette lines more common in East Asian faces?
A. East Asian faces tend to have a compact meeting point of muscles beside the mouth corners, which makes sagging around the mouth corners more noticeable with age. That's why the shape of the mouth corners is checked along with the line itself before choosing a treatment.
Q. Is one filler session enough for marionette lines?
A. One filler session for marionette lines may not fill everything. In a 98-person study, people who needed more had a touch-up at 4 weeks, and results were judged only after that. Whether you'd need a touch-up is decided by checking how things settle.
Q. How long do bruising and swelling last after marionette line filler?
A. Bruising and swelling after marionette line filler usually settle within a few days to a few weeks. If swelling still isn't going down after several weeks or pain keeps getting worse, have it checked by a doctor.
Q. Will mouth-corner Botox alone get rid of marionette lines?
A. Mouth-corner Botox alone may not get rid of marionette lines completely. It reduces the pull that drags your mouth corners down, but it doesn't replace lost volume. If hollowing is also part of the line, filling that volume is usually discussed as well.
Q. How common are side effects from marionette line filler?
A. In a 98-person filler study, 24.5% had a reaction related to treatment, and the rate was similar for smile lines, marionette lines and lips. Blocked blood vessels are reported very rarely, but if your skin changes color, get medical care right away.
Q. Do nerves or blood vessels run near the injection area for marionette lines?
A. Yes, the facial artery and the mental nerve, which serves the chin, run near the area treated for marionette lines. That's why choosing the injection point and depth matters. In the deeper layers, a blunt-tipped cannula is one of the methods described.
