Marionette folds

Are absolutely nothing to laugh about! Because they make your face look older and make you look sadder. Did you know: Not all puppet wrinkles come only in old age? Some tend to do this early on, especially when laughing. What are the first signs? What can you do about it? Find out the answers here.

  • It pulls vertically from both corners of the mouth down to the chin.

  • Already in the 20s, muscle overactivity can cause this wrinkle.

  • Sadness, bitterness, or Merkel’s wrinkle – many names for the same problem.

Marionettenfalten entfernen.
Medically reviewed by:

Medically reviewed by:

Puppet fold: Simply explained!

A picture with many names. One is from former German Chancellor Angelika Merkel. Look at a picture of yourself and you know why. The puppet crease separates the chin and mouth area from the rest of the face, just like a marionette. In medical jargon, it is also called the mentolabial fold because it runs vertically down from the corner of the lip to the chin. That is, drooping corners of the mouth form with a usually deep furrow down to the chin. As a result, affected individuals are usually perceived as sad. This is often exacerbated by sagging cheeks, which automatically develop with age due to an increase in the lower facial fat pads.

Interesting detail: at times, the nasolabial fold merges into the marionette fold, making the face look as if it were particularly exposed to gravity by pulling facial regions downward. This means that a very pronounced additional nasolabial fold can make your face look even older. But it can also make a problem in early years.

When marionette wrinkles become a problem

Strictly speaking, puppet wrinkles are not a problem of aging, but the foundation is laid already in the late 20s and early 30s. And how? As the muscle that pulls down the corner of the mouth gains increasing strength. In addition, its counterparts that move upward become weaker. That’s the way it is with most people. To make matters worse, this often causes fat deposits to build up on the muscle that pulls down. The result: Especially when laughing heartily, a deep wrinkle and a small cheek at the side of the corner of the mouth become visible in addition to fine lip wrinkles. The good thing is that, especially at a young age, there are simple ways to counteract this.

What causes marionette wrinkles

If we were to look for two culprits, they would be overactivity of a facial muscle on the one hand and the aging process on the other. Muscle overactivity is responsible, especially in young people, for the corners of the mouth being pulled down sharply or deep marionette folds appearing at the sides of them when laughing heartily. It is called the musculus depressor anguli oris. But in order for us to look happy, there are still counterparts on the face that pull up the corners of the mouth. These are several fine muscle groups with again long Latin names. If there is now unconscious overactivity of the depressor muscle, the antagonists cannot keep the wound angles in balance and a fold is formed.

On the other hand, facial fat pads migrate from the top to the bottom as we age. That is why the face often looks heavy in older people. As the upper half of the face looks rather bony especially in the temple and eye region and rather oily in the lower third. The consequences are an increase in static facial wr inkles such as nasolabial folds, marionette lines and sagging cheeks.

What are the first signs

In your mid-20s, you’ll notice the first signs best when you laugh – due to overactivity of the chin muscle pulling down from your mouth. This will create deep vertical creases next to the corners of your mouth, pulling towards your chin. Often, small fat pads border the sides of it, but they disappear completely when the face is neutral. Since the marionette crease is a rather deep furrow, you will notice the lines descending from the corner of the mouth on both sides very quickly. Unlike frown lines or forehead wrinkles, it remains permanent early on – no matter what facial expression you have.

When should the marionette fold be treated

Ideally, as soon as they appear. This is because they produce a sad, bitter facial expression, which is why affected people usually suffer particularly from them. In your 20s and 30s, this is often barely noticeable and when exactly when you wouldn’t expect it. Namely, when laughing, where deep wrinkles and cheeks form next to the corners of the mouth. However, especially in the beginning, it is very easy to balance the volume gain in the lateral chin and lower cheek region. Why? Because the reason is the overactivity of a facial muscle. The older you get, the deeper the wrinkle digs into your skin and the greater the treatment effort becomes. You can find out how to get rid of them in the FAQ section below.

Any questions? Our FAQ section has the answers!

When you’re young, facial muscle overactivity is pretty much always responsible for wrinkles. Here, a single injection of botulinum toxin is often enough to smooth out wrinkles. The good thing is that the other facial muscles gain strength in the meantime, so you will benefit longer after the treatment, even though the Botox has already disappeared from your body. The effect usually lasts between 4-12 months. Ever heard of the strawberry chin? It works the same way there.
But if there is no overactivity, Botox will not help you. Then we can smooth the wrinkles with hyaluronic acid injections. Depending on the extent and your age, sometimes supportive treatments such as a thread lift or radiofrequency needling using Morpheus8 are necessary to provide you with a satisfactory result.

At a young age, they disappear as you relax the muscle responsible for wrinkles. This can be done by means of Botox injection. In old age, marionette wrinkles usually do not disappear at all. Since they become very deep, the only option is to smooth them out initially with hyaluronic acid injections and later with thread lifts. We will be happy to clarify with you which solution is best for you in an initial on-site medical consultation.

Two possible reasons: One is that they may be due to overactivity of the corner of the mouth muscle, usually in younger individuals, and the other is that they are a product of aging. As we age, the elasticity of the skin decreases, facial fat pads increase in the lower third of the face, and static facial wrinkles develop. In contrast, dynamic facial wrinkles such as eye or nose wrinkles always appear much earlier.

Drooping corners of the mouth are usually caused by a lack of balance between the activity of muscles that pull the corner of the mouth down and up. In this case, the muscle pulling down the corner of the mouth is overly active. But there is a simple way to relax him. The injection of botulinum toxin (= Botox). This is the most effective way to restore balance and create a friendly facial expression.

More questions? Simply make a personal consultation appointment online.


Last updated: 20.10.2023