Are the downturned lines from the corners of your mouth to your chin starting to make your face look tired or stern? Those are marionette lines, and the smartest plan usually blends muscle relaxation with volume restoration, adjusted to how your particular face moves and how your tissues have changed over time.
I spend a lot of clinical hours troubleshooting the lower face. Marionette lines are not one problem, they are a convergence zone. Gravity, bone remodeling, collagen loss, fat pad descent, and overactive depressor muscles all meet at the mouth corners. If you try to fix them with one tool every time, you either get a frozen smile or a lumpy lower face. The goal is a rested, neutral expression with crisp but soft contours, and that takes judgment. Here is how I decide between botox cosmetic, dermal fillers, or a combination, with real-world dosing ranges, technique notes, and edge-case tips.
What exactly causes marionette lines?
Start by mapping the layers. Skin thins and loses elasticity with age. Subcutaneous fat compartments deflate and shift. The mandibular bone resorbs slowly, which shortens the jaw’s projection and drops soft tissue forward. Over this scaffold, we layer movement patterns. Two muscles pull the mouth corners down: the depressor anguli oris, and to a lesser degree the platysma fibers that fan upward from the neck. When these muscles over-recruit, the corners etch downward creases. Meanwhile, volume loss along the prejowl sulcus and the chin labiomental area creates a shadow that reads as a line even at rest.
That interplay explains why a single modality often disappoints. If you fill without calming the pull, the filler has to fight the muscle and may look bulky. If you relax the muscles without restoring support, the corner can look slack and the crease persists. The lower face responds best to sequencing.
Where Botox fits for marionette lines
Botox cosmetic Helpful site treatment is essentially a dial that turns down muscle pull. It will not fill a trench, but it can soften the downward vector that makes the mouth corners droop. The candidates who benefit most share a few traits: strong DAO pull visible when saying “eee” or when grimacing, downturned corners that worsen with expression, and relatively good skin tone with only mild resting folds.
Common targets include the DAO, the mentalis, and selectively the platysma. A small dose placed precisely can lift the corner a few millimeters, which in the mirror reads as a friendlier expression. For most women, I budget 2 to 4 units per DAO per side. Men often need 3 to 6 units per side due to bulkier muscle mass. The mentalis typically takes 4 to 8 units in total to soften chin pebbles and a vertical chin wrinkle. If platysmal bands are contributing, micro-doses of botox platysma treatment along the mandibular border and upper bands can reduce downward drag, but this comes with caution in thin necks.
The upside is subtle elevation and a reduction in the habit of mouth-corner frowning. It also improves symmetry when one DAO overpowers the other, so botox facial symmetry work often includes the lower face. I schedule a botox review session at two weeks to check function and tweak 1 to 2 units if needed. Expect botox after one week to show partial effect, with botox 3 month results still stable and botox 6 month results tapering. Many patients set a botox maintenance plan of every 4 months to keep expression patterns calm.
Where Botox underperforms is static volume loss. If you see a visible trench or a deep labiomandibular fold at rest, anti wrinkle botox alone will not erase it. Used alone in lax, heavy tissue, it can even look soft at the corner without changing the line. That is where fillers belong.
Dermal fillers for structural support
Fillers are scaffolding. For marionette lines, I choose hyaluronic acid gels with balanced lift and flexibility. Think mid-range G’ that can move with expression without creating stiffness. I avoid overly thick, high-lift gels directly in a line that animates heavily, because they can look beaded when you smile. Instead, I build from support zones, then paint the line lightly if needed.
Three anchor areas matter. First, the lateral and medial chin support, just superior to the mandibular border, can smooth the labiomental angle and reduce the shadow that feeds the marionette groove. Second, the prejowl sulcus, which often hollows as the jowl forms, benefits from a thin layer of filler placed deeply on bone or in the subcutaneous plane to even the jawline into a soft curve. Third, the oral commissure support just lateral and inferior to the corner helps prevent collapse when smiling.
Volumes are personalized, but typical starting ranges run 0.5 to 1.5 mL per side for a conservative lower face refresh. I commonly use a cannula for the prejowl and commissure support to reduce bruising, and a fine needle for precise line softening right in the groove. Lifting the corner slightly with filler can be elegant, but the finesse lies in avoiding a puff. A nice trick is to support 5 to 8 mm away from the deepest point, then reassess the line before touching the crease itself.
Expect immediate improvement, with minor swelling for 24 to 72 hours. Bruising varies by patient and technique. Results settle in 1 to 2 weeks and last 6 to 12 months depending on product choice, metabolism, and motion. Good skincare helps the outcome. When patients combine filler with medical-grade retinoids and sunscreen, their collagen and elasticity improve, making the filler look better for longer. While Botox collagen stimulation is often discussed for microbotox approaches in skin, for structural marionette lines, collagen induction comes more from devices or biostimulators than from classic wrinkle relaxing injections.
Botox vs fillers: how I choose
I evaluate in neutral, smile, speech, and frown. If the corners plunge downward with movement but the resting fold is light, botox for expression lines in the DAO usually leads. If the fold remains deep at rest and the jawline shows early jowl shadowing, fillers are primary. In many forty-something faces, the sweet spot is sequencing both, but not always on the same day.
Think of botox for marionette lines as changing the mechanics, and fillers as changing the architecture. In a kinetic, expressive face with minimal volume loss, a non surgical botox plan gives a cleaner smile line and a less tired mouth at a dose that still allows natural movement. In a face with pronounced volume loss, a filler-first approach reduces the fold and sets a stable canvas, then botox cosmetic injections fine-tune muscle pull two weeks later. When we time them correctly, you avoid the temptation to overfill, and the Botox dose can be lighter because the filler is doing some of the heavy lifting.
The case for combination therapy
The combo wins when you can see both drivers at play. I will start by shoring up the prejowl and chin support with 1 to 2 mL total across the lower face, then place 1 to 2 units of botox cosmetic per DAO head a week or two later. The sequence matters. Fill first when volume loss is obvious, then relax the pull. If expression dominance is the primary issue with minor folds, I invert the order and add filler only if a residual groove remains after muscle softening.
Beyond the marionette zone, we often address adjacent features that amplify the problem visually. Subtle chin projection with filler and botox chin wrinkle treatment smooths the pebbled chin and improves facial balance. Platysmal band treatment with small, carefully placed doses along the mandibular border can sharpen the jawline a touch, akin to a very light botox neck lift effect, but dosage and mapping need a conservative hand, especially in slim necks.
Patient feedback supports this layered method. When I track botox 6 month results paired with conservative filler, faces tend to age more gracefully. The corners do not crash as quickly between visits, the jawline shadow stays muted, and touch-ups require smaller volumes. A personalized botox plan with scheduled botox follow up visits every 3 to 6 months keeps the muscle component in check. Fillers I refresh yearly, sometimes with microtop-ups at 9 months if a visible fold returns.
Real-world dosing, safety, and technique nuances
Precision beats bravado in the lower face. The DAO sits close to the depressor labii inferioris, which helps lower the central lip. If you drift medially with botox cosmetic procedure placement, you can cause lip incompetence or smile asymmetry. Landmarks help. I place tiny aliquots just lateral to the corner, about one finger breadth from the commissure, staying superficial. Begin low on dose. You can always add 1 to 2 units at a botox touch up visit, but you cannot reverse an overdose quickly.
For filler safety, cannula use reduces bruising and lowers intravascular risk along the prejowl and commissure area. When needles are necessary for line tracing, aspiration is not a guarantee, but slow injection and constant movement help. I keep hyaluronidase available. Avoid overly medial boluses near the labiomental foramen where the mental nerve exits. Discomfort is manageable with topical anesthetic and chilled compresses, but I also counsel patients that the chin and commissure are sensitive. Expect a few pinches, then a dull pressure when product goes in.
Complications to discuss openly include swelling, bruising, lumps, overcorrection, and in rare cases vascular occlusion. With botox, temporary smile weakness or asymmetry can occur if dosing or placement wander. These events are usually temporary and can be mitigated with careful mapping, conservative dosing, and proper aftercare, like avoiding heavy massage or aggressive facial workouts for 24 hours post botox cosmetic treatment.
Special scenarios and edge cases
Faces with thick, heavy tissues and strong platysma bands often benefit from a staged approach that includes both lower face contour support and selective botox platysma treatment. The aim is not a full botox neck lift, which can look odd in real life if overdone on a heavy neck, but a soft relaxation of upper band pull that sharpens the mandibular angle visually.
Very thin patients with paper-like skin and etched lines need a different tack. High-lift gel risks beading. I soften the area with a more flexible filler in microthreads using a cannula, paired with minimal botox to avoid mouth-corner collapse. Skin quality matters enormously here. Adding skincare that boosts collagen, like a retinoid and diligent sunscreen, will extend the benefit of filler and reduce crepe-like texture that emphasizes the lines.
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If bruxism is present, botox for clenched jaw and botox masseter reduction can balance the lower face and decrease downward pull from the lateral lower third. Patients often notice that after masseter treatment, the mouth corners sit a touch more neutral even before we touch the marionettes. This is not a primary marionette treatment, but it supports harmony. Similarly, if the chin pulls upward in a pebbled pattern, a few units of botox for pebbled chin relax the mentalis, allowing filler to sit smoothly.
Smokers or those with vertical lip lines sometimes blame the marionette area for what is really a perioral problem. Addressing botox for lip lines lightly and supporting the vermillion border with microfiller creates a frame that lifts the entire mouth unit. Again, do not chase every line with product. Support the structure first.
Results timeline and maintenance
Real expectations build trust. With Botox, you will feel a slight change at 3 to 5 days, with full effect at two weeks. Botox 3 month results look similar to the two-week mark, then begin to fade between months three Charlotte botox and four. People who talk animatedly or exercise intensely metabolize slightly faster. For many, botox every 4 months keeps expression lines tame. Others prefer botox every 6 months for a lighter maintenance rhythm, accepting a brief fade window. There is no one-size schedule, which is why a personalized botox plan works better than a fixed calendar.
Fillers give immediate smoothing, followed by a fine-tuning phase as swelling subsides. I ask patients to judge at two weeks. Longevity varies: denser gels in deeper planes along the jawline often hold 9 to 12 months, while softer gels in more mobile areas last closer to 6 to 9 months. Lifestyle matters. High-volume endurance training and fast metabolisms may shorten duration modestly.
A botox and filler combo is usually reviewed at 2 weeks, 3 months, and then at 6 to 12 months, depending on what we did. I like a brief botox review session after one week if it is a first-time DAO treatment, but most fine-tuning happens at two weeks when the drug has fully engaged. Photos in neutral and smile help guide the next steps.
Pricing logic and value
Patients often ask if a botox filler package makes sense financially. Bundles can work if they reflect what you genuinely need. For marionette management, a typical first-phase plan might include 10 to 20 units of botox across the DAO and mentalis, plus 1 to 2 syringes of hyaluronic acid filler. Prices vary by region and clinic, but the ratio stays similar: less Botox than you use for a full forehead and glabella map, more filler than you would use for a small line touch-up. Packages that force unnecessary areas rarely serve the face well. Choose a clinic that builds a customized botox treatment and filler plan rather than a one-size menu.
Complementary treatments that amplify results
Skin laxity exaggerates any fold. For mild laxity, devices that stimulate collagen, like radiofrequency microneedling or ultrasound-based tightening, can firm the lower face and chin, making both botox facial contouring and fillers look more polished. Topical strategies matter too. A retinoid at night, vitamin C in the morning, and disciplined sunscreen use keep the perioral skin thicker and more elastic. Patients also ask about botox microinjections or microbotox for pores and oil in the T-zone. While mesobotox and botox facial treatments add glow and refine texture in the upper and midface, they are not the primary answer for the marionette fold itself. They can, however, improve overall skin quality, which softens the backdrop.
Lip balance can influence how the corners read. A conservative botox upper lip lift or botox gummy smile correction can reveal more vermillion and take tension off the corners, provided it is done with low doses and a steady hand. Again, the art lies in synergy, not scattershot injections.
Who should avoid lower-face Botox
If your job or hobbies demand strong lower-face articulation, you must accept a conservative dose. Actors, singers, teachers, and multilingual professionals sometimes notice articulation changes if DAO or mentalis dosing is too high. A history of lower facial asymmetry or prior nerve injury requires extra caution. Those with very lax, heavy tissue and deep static lines will be disappointed by botox for anti aging used alone in this zone.
Pregnant or breastfeeding individuals should defer elective botox cosmetic procedures and fillers due to lack of safety data. Anyone with a history of keloids or active skin infection at the site should wait. If you have planned dental work that involves prolonged mouth opening, consider timing your filler after the appointment to reduce filler displacement risk in the perioral area.
A practical roadmap for marionette lines
- Map the driver: is it volume loss, muscle pull, or both? Check neutral, smile, and speech. Pick the lead modality: filler first for static folds and prejowl hollows, Botox first for strong DAO-driven downturn. Dose conservatively, then reassess in two weeks. Add 1 to 2 unit tweaks or micro-filler threads only if needed. Support adjacent structures: chin contour, prejowl sulcus, and skin quality make or break the result. Maintain rhythm: plan botox every 4 to 6 months, filler every 9 to 12 months, with photos to guide course corrections.
Seasonal timing and planning ahead
If you want a fresher look for a big event, schedule backwards. For a holiday botox prep, the best time for botox is 3 to 4 weeks before, which allows effect maturation and minimal tweaks. Filler should be done at least two weeks prior to account for swelling and settle time. Seasonal botox specials can be helpful, but do not let a discount rush you into a dose or area that does not serve your face. Consistency beats urgency. A botox yearly plan that anticipates high-visibility periods and quiet seasons tends to give better long-term balance.
Final thoughts from the chair
Lower-face work rewards restraint and sequencing. When a patient says the corners make them look cross or tired, I look at how the face moves before I reach for a syringe. Often we start with 8 to 12 units spread between the DAO and mentalis, or with a single syringe of filler artfully placed along the prejowl and commissure support, and we stop. Two weeks later, we see what the face still asks for. Most of the time, that slower pace gives a result that friends describe as cheerful and well-rested rather than “done.”
If you are considering botox for smile wrinkles around the mouth, botox around mouth corners, or a combined botox and dermal fillers plan for marionette lines, bring photos of how your face looked five or ten years ago. They help me see your natural chin and jawline contour, so we can restore your own architecture rather than invent a new one. The target is not a mask-like lower face. It is a gentle, confident expression that sits at neutral when you are not emoting and moves naturally when you are.
That is the real test of good marionette line management: when you stop thinking about your mouth corners at all.