‘Marionette lines’: What they are, why they make us look sad, and how to reduce them

These deep wrinkles can be prevented and treated. Expert dermatologists tell us how to prevent them from appearing and becoming permanent

Natural aging process
The natural aging process causes the cheekbones to lose volume and definition.wacomka (Getty Images)

When we think about facial wrinkles, the first thing that comes to mind are frown lines between the brows, crow’s feet around the eyes, and stress lines on the forehead, all located in the upper half of the face. However, early care and the rise of Botox treatments have made these wrinkles very easy to prevent and even eliminate.

But what do we do with those that occur on the lower half of our face? Smile lines (nasolabial folds), vertical lines on the upper lip, and the folds that run down from the corner of the mouth to the jaw and chin (marionette lines) become accentuated with age and are a real aesthetic challenge.

Firstly, let’s address what these lines are. Facial wrinkles are folds in the skin that appear in our youth when we begin using facial expressions in our daily interactions with each other, and which settle over the years.

But not all wrinkles are the same. “In youth we all have expression wrinkles in areas such as the crow’s feet, forehead, and brow. These so-called dynamic wrinkles disappear when we stop making the expression that causes them so, they are not something we have to worry about,” explains Bella Hurtado, technical director of Boutijour.

On the other hand, wrinkles in the lower third of the face are static. “They are given that name because they do not disappear when the face is at rest. Although they may start as expression wrinkles caused by repetitive movements and gestures, their presence is more related to the aging process. With age we lose volume in both facial fatty deposits and bone support. In addition, the production of collagen and elastin decreases, the facial support ligaments become lax and our faces begin to sag. All these factors create deep and marked wrinkles that are visible to the naked eye,” says Dr. Lia Fabiano, owner of the LF Clínic cosmetic surgery clinics in Spain.

Why are marionette lines so worrying?

We do not notice them until they appear because they give us an unflattering air of bitterness and sadness. As Dr. Fabiano says, “they are influenced by genetic predisposition and excessive exposure to the sun, which is responsible for the degradation of collagen and elastin fibers that are essential for the firmness of the skin. The natural aging process causes the cheekbones to lose volume and definition, then the law of gravity comes into action and the tissues sag, giving rise to greater volume in the lower third of the face. The chin becomes blurred and nasolabial folds emerge, running from the nostrils to the corner of the mouth. Then there are the marionette lines, which are deep wrinkles that run from the mouth to the chin. Grooves and lines are one of the biggest aesthetic concerns after the age of 50.”

Experts recommend going to a professional when we begin to notice wrinkles even at rest. After the age of 30, our body’s collagen production begins to decrease, but genetics plays an important role in the appearance of lines and folds. If you still do not have wrinkles at rest, a good preventive routine can delay them appearing and reduce them if they are already visible.

Do cosmetics work?

To avoid them appearing, it is best to invest in prevention with a routine that is rich in active ingredients that promote hydration and the synthesis of collagen and elastin. “Cosmetics rich in vitamin C and other antioxidants such as copper PCA help, as well as the well-known hyaluronic acid which, by retaining and providing hydration, maintains the skin’s balance and makes it look plump. Also of interest are products rich in peptides, which are chains of amino acids that stimulate collagen,” says Elisabeth San Gregorio, technical director of Medik8.

Estefanía Nieto, from the Omorovicza brand, explains that “we mustn’t forget retinoids, which are great allies as they are able to work on the skin’s youthfulness. They renew the deeper layers of tissue, blur fine lines, and promote a smoother and more uniform face. Daily sun protection is also essential.”

If wrinkles have already appeared and have remained very markedly fixed on the skin, we can resort to more powerful principles that are able to reverse aging. “Glutathione, the body’s primary antioxidant, visibly reduces the appearance of deep folds and strengthens the skin by protecting, repairing, and detoxifying. Neuropeptides are also ideal for reversing any prominent wrinkles,” adds Perricone MD expert, Raquel González.

Is there an anti-wrinkle diet?

The experts agree that a healthy diet can play a crucial role in preventing wrinkles. “Consumption of refined sugar in excess has no benefits for the body or the skin. Sugar takes part in a chemical process called glycation that causes oxidative damage and premature aging. In addition, it destroys collagen and elastin, the proteins responsible for firmness,” says Dr. Kira Visenberg from Clínica Premium Marbella.

Dr. Fabiano points out that “sugar is not good but what is guaranteed to give you wrinkles is smoking and drinking alcohol. Drinking distilled or fermented drinks directly clogs the dermis and takes away its luminosity. Not to mention the harms of tobacco. I have done studies on the smokers’ skin and the results are devastating. The percentage of elastin is reduced by 68% in smokers, which translates into a greater tendency for the skin to lose firmness and form of wrinkles. In addition to the characteristic grayish tone of a poorly oxygenated complexion and the barcode — the vertical perioral wrinkles that are so typical of people who smoke.”

Gestures that accelerate wrinkles

The good news is that some wrinkles can be avoided. There are many unconscious movements that we repeat numerous times throughout the day. Frowning causes wrinkles between the eyebrows that make us look angry. Smoking or drinking straight from the bottle encourages the so-called barcode to appear, and clenching the jaw too much causes lines on the chin. We also have to be careful when looking at our cell phone because spending a long time with our neck bent over causes neck lines.

Sleeping on one side is also not advisable because it allows the formation of vertical wrinkles on the forehead, between the eyebrows, and in the nasolabial fold, and it also favors the appearance of marks on the cheeks and neckline, explains Kira Visenberg from Clínica Premium Marbella. The beautician Carmen Navarro is clear: “To avoid this, the ideal is to sleep on your back, and choose soft fabrics for the pillow. Silk and satin do not wrinkle, and they don’t cling to the skin as much as cotton. There are also anti-wrinkle pillows. When you get up in the morning I recommend doing a massage in the rictus and chin area to stimulate blood circulation.”

Five minutes of daily massage

Moisturizing the skin is essential, but making small facial gestures when applying cosmetics encourages the penetration of the active ingredients and helps reduce wrinkles. “We always recommend that when applying facial cosmetics you spend a few minutes activating or stimulating the tissue with simple firming maneuvers from the corner of the lips to the hairline at eye level. It can be done manually or with the help of gua sha stones,” says Patricia Cuenca, director of Oxigen.

A light massage relaxes the muscles, stimulates the formation of fibroblasts, improves skin microcirculation, and tones the tissue. Beautician Carmen Navarro recommends “performing intense pinches every night for five minutes in the area of the upper lip, in the corners of the mouth and on the chin to erase signs of tension. Then, with gentler pinches, you can work on the nasolabial folds and marionette lines in detail. Gadgets such as massage rollers or ghua sha stones also help the product penetrate the layers of the skin. They improve blood circulation and contribute to firmer skin because they redefine facial contours and facial volume.” For the best results from using these stones, it is a good idea to use oils or creams as the stones will slide more smoothly. Additionally, you can enhance the massage if you cool the stone before using it.

Seven cabin treatments that soften marionette lines

The avalanche of aesthetic treatments for marionette lines and firm facial contours is truly endless. And as always, you have to put yourself in expert hands to find the right solution. Let’s review the most requested treatments:

Radiofrequency and ultrasound: If the problem is incipient, Thermage radiofrequency can stop it at its roots. According to Dr. Beatriz Beltrán from the BB Clinic: “Thermage improves expression lines and sagging, repositions fat, and compacts the skin. In addition, it allows you to focus on certain areas, such as the lower third of the face according to the patient’s needs. The effect is very natural.” High Intensity Focused Ultrasounds are also useful to achieve extra firmness in shallow wrinkles. “Although they are not applied directly to the marionette line area, the traction points work to achieve a harmonious and effective firming effect,” concludes Patricia Cuenca from Oxigen.

Chemical peels: They are very effective because they work at different depths of the skin. “There are superficial, medium, and deep peels and they are carried out according to each patient’s needs. These peels are medical, that is, they are performed in consultation to strip the superficial layers of the skin in a controlled manner, smooth out wrinkles, and accelerate cell renewal, which slows down over the years. At home, I also recommend periodic gentler exfoliations, but always with specific instructions for each skin type,” says surgeon Lia Fabiano.

Hyaluronic acid. One of the most effective treatments to maintain the contour is hyaluronic acid injections. The MaiLi filler manages to reposition tissues and volumes and mark the jaw line. “I don’t use it to fill in wrinkles or simply add volume to the cheekbones, but I do it in order to create a kind of ‘fabric frame’ that supports and tightens the muscle at a deeper level. 80% of the hyaluronic acid fills the bone and ligament,” explains Dr. Jorge Mercado, aesthetic doctor and creator of this technique.

Collagen inducers: Inductors such as Sculptra manage to tighten the lower third of the face while preserving a natural expression. “It provides an immediate lifting effect with gradual results. This occurs because the inducers promote the production of natural collagen, which is why the maximum result is achieved three months after performing the treatment. We can apply the product with vectors to achieve an instant tensor effect. It is the ideal treatment to prevent and correct signs of sagging, as well as to recover the beauty triangle without adding volume,” says Dr. Alicia Merino from Dermik.

Neuromodulators: If the wrinkles are soft and are caught in time, they can be treated with relaxing toxins. “They relax existing lines and prevent new ones from forming. They are applied to the upper lip to treat smoker’s lines and to the area in front of the double chin to relax the folds at the corners of the mouth downwards,” adds Visenberg.

Fractional radio frequency. Without a doubt, the star of this device that combines microneedles with radiofrequency is Morpheus 8, but what does it achieve? “The results are amazing because it smoothes wrinkles without requiring any filler. “I like to work it shallowly, about 2 millimeters, and then I complete the treatment with an exosome mask with regenerating power,” says Fabiano.

Laser: Depending on the depth of the wrinkles and the time they are installed, the CO2 laser is very effective. “It removes the most superficial layers to renew the epidermis, while regenerating the deeper layers such as the dermis, and it tightens the skin. This way we manage to eliminate wrinkles, combat, sagging and improve the quality of the skin,” Fabiano concludes.

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