Marionette Lines vs Nasolabial Folds: What They Are and How Each Is Treated

Although marionette lines and nasolabial folds are often discussed together, they are quite different concerns. At McKeown Medical in Glasgow, Dr Darren McKeown and our medical team focus on understanding why a particular line has developed rather than simply trying to remove it. This distinction is important because the right treatment is not always directed at the area where the line appears. 

Nasolabial folds, sometimes called nose-to-mouth lines, are the creases that run from either side of the nose towards the corners of the mouth. Some creasing here is entirely normal, but the folds can become more pronounced with age, sometimes making the face appear heavier or more tired. 

As we explain on our nose-to-mouth lines page, changes in the mid face, including loss of volume and bone resorption, can contribute to deeper folds. As the cheeks lose support, the overlying soft tissues can descend and become more prominent around the crease. This means the fold is often a reflection of changes taking place in the cheek above it. 

Marionette lines begin at the corners of the mouth and extend downwards towards the chin. They can give the face a downturned or tired appearance, even when someone feels perfectly cheerful. 

Unlike expression lines, marionette lines are not primarily caused by repeated muscle movement. They develop as volume and structural support diminish in the lower face, with changes to the bone and soft tissues around the jawline also contributing. As these tissues lose support, the skin can settle into a crease beside the chin. 

Nasolabial folds and marionette lines often appear together, and both can be associated with volume loss, so it is understandable to assume that one treatment will address both. However, the folds are more closely associated with changes in the mid face, while marionette lines involve the lower face and jawline, so similar looking lines can need quite different plans. 

Marionette lines can also be confused with downturned mouth corners, where the corners of the mouth sit lower and create a sad or stern expression. The two concerns can occur together and are separated at assessment. 

A line on its own tells us very little. We assess the face both at rest and in movement, looking at the cheeks, jawline, chin, lips and corners of the mouth together. What appears to be a crease in the skin is often related to changes in the underlying facial structure, which is why understanding the cause is so important before recommending treatment. 

For nasolabial folds, the main treatment is dermal fillers, which are hyaluronic acid-based and can be reversed with a dissolving agent if needed. Filler can be placed directly into the fold, but more often the appropriate approach is to correct the loss of cheek volume that is deepening it, with or without additional volume in the fold itself. Restoring support with cheek filler can help hold up the tissue that has settled against the crease, allowing the fold to soften. 

This is why we do not treat every fold in the same way. Treating the visible line alone can leave its cause in place, while cheek filler is not automatically the answer for every fold either. We decide the balance between cheek and fold at assessment, based on your anatomy. 

Because marionette lines develop as support is lost in the lower face, treatment focuses on restoring that support rather than simply filling the crease. Dermal filler is the main non-surgical approach. Instead of treating the line in isolation, we consider the area around the mouth as a whole, restoring volume and structure where needed. 

Depending on the pattern of ageing, this may include the chin and jawline, which we discuss on our chin and jaw filler page. For some patients, lip augmentation may also form part of the treatment plan. Where marionette lines are part of more widespread facial volume loss, our Volumetric Facelift takes a broader approach to restoring facial balance.  

Our fillers contain lidocaine, a local anaesthetic, and numbing cream is available if you would like it. Lines smooth immediately, with the best results at around two weeks. Tenderness or swelling normally lessens by the next day, most patients return to their routine the same day, and bruising can be covered with make-up from the day after. We advise sleeping with your head raised for the first few nights. Volume restoration to marionette lines typically lasts 12 to 18 months, and our guide on how long dermal fillers last explains why this varies. 

At our clinic, 167 Bath Street, Glasgow, we begin by understanding what concerns you most. We then assess your face as a whole to identify whether your concern is nasolabial folds, marionette lines, downturned mouth corners or a combination of these. Our aim is not to remove every natural crease, but to restore balance while preserving your natural expression. 

Where both nasolabial folds and marionette lines are present, we often begin by addressing the mid face. Restoring support to the cheeks can soften the folds and improve the overall balance of the lower face, allowing us to assess whether any further treatment is needed. 

If you would like to explore your options, you can book a consultation with our team. 

What is the difference between marionette lines and nasolabial folds? 

Nasolabial folds run from the sides of the nose to the corners of the mouth and are often associated with volume loss in the mid face. Marionette lines extend from the corners of the mouth down towards the chin and develop as volume and support diminish in the lower face, particularly around the jawline. 

Can one treatment address both? 

Not always. Because the underlying causes differ, treatment may need to address the cheeks and lower face separately, even during the same appointment. Restoring support to the cheeks can soften nasolabial folds and improve the overall balance of the lower face, so we usually assess the result before deciding whether further treatment is needed. 

How much does treatment cost? 

Facial fillers start from £300. The final cost depends on the areas treated and the amount of product needed, which we confirm at consultation. 

Do anti-wrinkle injections help with marionette lines? 

Anti-wrinkle injections are not usually effective for marionette lines because they do not replace lost volume or restore support to the lower face. However, when the corners of the mouth also turn downwards, carefully placed injections may help lift them slightly. During your consultation, we assess both concerns to determine which treatment is most appropriate. 

How long do results last? 

You should notice an improvement immediately after treatment, although the final result is usually best assessed after around two weeks, once any swelling has settled. Dermal filler used to restore volume around marionette lines typically lasts 12 to 18 months, although some fillers can last up to two years. The exact duration varies depending on the product used and individual factors. 

Dr Darren McKeown (GMC 6128508), MB ChB Glasgow (2005), is renowned for his expertise and artistry with dermal fillers. A Full Member of the British College of Aesthetic Medicine (BCAM), the UK’s leading professional body for aesthetic medicine doctors, and a peer-reviewed medical author, he is passionate about treatments that stand up to scientific scrutiny. Above all, he genuinely cares about helping each patient feel their most confident, natural self.