Marionette Lines & Mouth Corner Sagging

The DAO Muscle

The depressor anguli oris (DAO) is a small muscle at each corner of your mouth. Its job is to pull the corners down—useful for expressing sadness or disapproval. But over decades of activity, this repetitive pulling creates permanent creases: marionette lines.

In some people, the DAO is overactive, constantly pulling the corners down even at rest. This is why DAO Botox can be so effective—it relaxes this pull, allowing the corners to return to neutral or even lift slightly.

Volume Loss Below

The area between your mouth and chin naturally loses volume with age. This creates a 'valley' that the skin folds into. Filling this volume can lift the crease from beneath.

Descent From Above

Jowling and mid-face descent push tissue downward, contributing to the fold. This is why treating marionette lines in isolation often fails—you need to address the descent from above.

The Crease Itself

Once a crease forms, skin tends to keep folding in the same place—like a well-worn fold in paper. Early intervention prevents this 'memory' from becoming permanent.

This is one of the most searched questions about marionette lines—and the answer is: it depends on the cause.

When to Use Botox (DAO Relaxation)

• Your mouth corners are actively pulled down (you can see the DAO muscle engage)
• You have a 'sad' resting expression even without deep lines
• The lines are relatively mild but the corners are noticeably downturned
• You want a subtle lift without adding volume

What Botox does: Relaxes the DAO muscle, allowing the corners to lift naturally. Creates a subtle 'corner flip.' Does NOT fill the line itself.

When to Use Filler

• You have volume loss creating the crease
• The lines are moderate to deep
• You need structural support in the lower face
• Botox alone hasn't provided enough improvement

What filler does: Directly fills the crease, restores lost volume, provides structural support. Does NOT address muscle activity.

When to Use Both

Many patients benefit from combination treatment:

• Botox relaxes the muscle pulling the corners down
• Filler softens the existing crease and restores volume
• The combination addresses both cause and symptom

We assess your specific anatomy to recommend the right approach—sometimes it's Botox alone, sometimes filler alone, often both.

If you've had marionette line filler before without great results, here's why:

The Isolated Approach Problem

Many practitioners simply inject filler directly into the marionette line and call it done. But this ignores WHY the line formed:

• If jowls are pushing tissue down, filling the line is fighting a losing battle
• If mid-face descent is contributing, the pressure from above remains
• If the DAO is actively pulling, muscle activity deepens the crease again
• If the chin lacks projection, the whole lower face drapes differently

The Holistic Approach

Effective marionette line treatment often involves:

• Mid-face assessment: Do you need cheek filler to lift from above?
• Jowl assessment: Are jowls contributing? Address them together
• DAO assessment: Would Botox to the corners help?
• Chin assessment: Would chin filler change how skin drapes?
• Then: Direct line treatment with appropriate filler

This is why we take time to assess the whole lower face before recommending treatment. The goal is lasting, natural-looking improvement—not a temporary fix that fails because the cause wasn't addressed.

Combination protocols: Most patients benefit from multiple treatments. A typical approach might combine DAO Botox + direct line filler + cheek support for comprehensive improvement.

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While you can't stop ageing, you can significantly slow the formation and deepening of marionette lines:

Preventive Measures

• Sun protection: UV damage is the biggest controllable factor in skin ageing. Daily SPF is non-negotiable.
• Don't smoke: Smoking accelerates lower face and perioral ageing dramatically.
• Maintain weight: Yo-yo dieting affects facial volume.
• Retinoids: Prescription retinoids help maintain collagen and skin thickness.

Early Intervention ('Prejuvenation')

Treating early signs before deep lines form is far more effective than waiting:

• Mild downturning: DAO Botox can prevent the crease from forming
• Early volume loss: Small amounts of filler maintain structure
• Skin quality: Sylfirm X or Polynucleotides keep skin resilient

Maintenance After Treatment

Once treated, maintaining results is easier than the initial correction:

• DAO Botox every 3-4 months prevents muscle memory
• Filler top-ups as needed (usually 9-12 months)
• Annual RF treatments for skin quality

The best time to prevent deep marionette lines is before they form. The second best time is now.

Marionette lines require a nuanced approach—not just injecting filler into the crease. Here's why patients trust us:

Holistic Assessment

We don't just see the line—we assess why it formed. Mid-face descent? DAO activity? Chin projection? Jowling? Understanding the cause determines the treatment.

Combination Expertise

Effective treatment often requires multiple modalities—Botox for muscle, filler for volume, RF for skin quality. We design personalised protocols that address all contributing factors.

Natural Results Focus

The goal is to look refreshed and less tired—not 'done.' We avoid overfilling the lines (which looks unnatural) and instead create balanced, harmonious improvement.

GMC-Registered Medical Team

The lower face is anatomically complex. All treatments are performed by GMC-registered doctors with specialist training in facial anatomy and aesthetics.

Honest About Expectations

Very deep, long-standing marionette lines may not completely disappear. We'll tell you what's realistically achievable and create a plan for gradual improvement.

Premium Products Only

We use FDA-approved fillers (Juvederm, Restylane) and botulinum toxin products (Botox, Azzalure) for optimal safety and results.