There are times when the face looks somehow sagging and the area around the mouth looks heavy.
One of the causes is marionette lines.
These lines, which run long from the corners of the mouth down toward the chin, can do more than simply make you look older; they can also create a gloomy impression or even an angry-looking expression.
“I'm smiling, but people keep asking me why I'm angry.”
Marionette lines are not so much a problem of expression as they are wrinkles caused by structural aging.
As skin elasticity decreases and the fat in the midface and lower face sags downward, the lines gradually become deeper.
The important thing is that once these lines begin to take hold, they are not easily improved by makeup or skin care alone.
That is why more and more people have recently been considering thread lifting as a more fundamental improvement method.
Today, I’ll explain in detail why marionette lines form and how thread lifting can help.

The real reason marionette lines appear
Many people think of marionette lines as simple skin wrinkles, but in reality, they are closely related to the overall downward shift of the face.
When you are young, facial fat sits stably in the upper part of the face, and the retaining ligaments that support it are also firm.
However, as time passes, collagen and elastin decrease and the retaining ligaments loosen, causing the tissues to move downward.
In particular, when the midface sags, its weight concentrates around the mouth, pulling the corners of the mouth downward and creating shadows around the jawline. This shadow is what we commonly call marionette lines.
When reduced skin elasticity is added on top of this, the result is no longer just a line but a deep wrinkle that folds in.
It is usually accompanied by the following changes:
- The facial contour becomes less defined, and the boundary between the jawline and cheeks becomes blurred.
- The deep buccal fat pads become more prominent, giving the face a heavy impression.
- The corners of the mouth naturally turn downward, sometimes creating a more negative impression than the person actually feels.
At this stage, rather than trying to solve the problem with botulinum toxin or fillers alone, it is important to take an approach that moves the sagging tissue back upward.

Why thread lifting is effective for marionette lines
The key to thread lifting is not simply pulling the skin.
Its essence is repositioning the sagging structure.
When a medical thread is inserted under the skin, the barbs or cones on the thread hold the tissue and move it upward, creating a natural lifting effect.
In the case of marionette lines, pulling only the area around the mouth has limitations.
In practice, a three-dimensional design that also considers the cheeks and jawline is needed.
At our clinic, we focus on designing the following points:
First, we determine in which direction the tissue should be moved. It is not simply about lifting upward, but about finding the vector that makes the facial contour look the most natural.
Second, we select the thread that best matches the skin thickness and degree of sagging. A thread that is too strong can look unnatural, while one that is too weak may not last well.
Third, we carefully balance the left and right sides. Even small differences can be felt strongly in a person’s overall impression.
Through this process, thread lifting goes beyond simply improving wrinkles and helps restore the overall facial structure that has started to collapse.
Another thing many people like is its natural look.
Unlike surgery that requires incisions, the recovery period is relatively short, and returning to daily life is less burdensome.
This is especially suitable for those who want to look younger without it being obvious.

The deciding factor in thread lifting results is “design”
The reason results differ even when the same thread is used is mostly determined by the design.
Marionette lines are not an isolated issue; they are a complex aging phenomenon connected to the midface, deep buccal area, and jawline, so a lifting strategy that considers the harmony of the entire face is needed.
For example, if sagging of the deep buccal area is also present, lifting that area together can make the mouth area look much lighter.
If the jawline is also refined, the face may appear smaller.
Another important point is to avoid excessive lifting.
If pulled too strongly, facial expressions can look awkward and may even make you look older.
At our clinic, after carefully analyzing the patient’s facial expression habits, skin condition, and fat distribution, we proceed with a personalized design.
The goal is not simply to remove one wrinkle, but to soften and relax the overall impression of the face.

Marionette lines deepen faster than you may think
And once they become deep, it is difficult to expect natural recovery.
But the important thing is when you start.
If lifting is performed at the stage when sagging begins, rather than after the wrinkles have become severe, you can expect much more natural and satisfying results.
If the face in the mirror feels heavier than before and you notice the corners of the mouth gradually dropping, that may be a sign that care is needed.
The important thing is not to follow trends, but to find the method that is right for you.
If you are worried about marionette lines, I recommend receiving a diagnosis first rather than deciding on your own.
Thank you.
| This post was written for informational purposes in compliance with Article 56, Paragraphs 1 through 15 of the Medical Service Act. All treatments carry a risk of side effects and complications depending on the individual. Before treatment, please be sure to have a thorough consultation with a medical professional with extensive experience before making a decision. |