Marionette lines are the creases that run from the corners of the mouth down toward the chin. As they deepen, they can make the mouth look turned down even when you are relaxed, which leads many people to hear that they look sad, tired, or upset when they feel perfectly fine. Treating these lines with dermal fillers restores lost support around the mouth and softens that downturned expression without surgery.
Dr. Melanie Ho Erb has performed thousands of eyelid surgeries and injectable treatments since completing her two-year oculoplastic surgery fellowship at Eyesthetica in Los Angeles, a program approved by the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), where she later taught incoming fellows. An oculoplastic surgeon trained at UC Irvine, she has received Top Doctor recognition from Los Angeles Magazine, Orange Coast Magazine, Castle Connolly, and Vitals since 2010. That depth of experience matters in the lower face, where the cause of a line often sits higher than the line itself.
“Marionette lines are often where people see aging around the mouth, but they are rarely where it started. When I restore support in the cheek first, I usually need far less filler near the mouth, and the result looks more natural.”
I would 100% recommend Dr. Melanie Erb to everyone, and I have. She’s worth the travel time.
What Causes Marionette Lines
Several changes work together to form marionette lines. The midface gradually loses fat and bone volume, so tissue that once sat high on the cheek descends toward the jaw. Skin loses collagen and elasticity. A small muscle near each corner of the mouth, the depressor anguli oris, pulls the corners downward with every expression, and over time this can deepen the creases. Genetics, sun exposure, smoking, and significant weight loss can all speed the process.
Because of this, two people with similar looking lines may need very different treatment. One may benefit most from filler placed directly in the fold, while another needs support restored in the cheeks so the lower face is lifted from above.
How Dermal Fillers Soften Marionette Lines
Hyaluronic acid (HA) fillers add volume beneath the skin to fill the crease and support the corners of the mouth. Dr. Erb places filler carefully in the fold and in the hollow just in front of the jowl, using small amounts so the area still moves naturally when you talk and smile. Treatment can:
- Soften the crease: reduce the depth of the lines running from the mouth to the chin.
- Lift the corners of the mouth: improve a downturned, tired expression.
- Smooth the jawline transition: blend the shadow in front of the jowl for a cleaner contour.
- Restore balance: bring the lower face back into proportion with the cheeks and lips.
For marionette lines, Dr. Erb often chooses from the Restylane family, including Restylane Defyne and Refyne, which are designed to stay flexible in areas of movement, as well as Juvéderm Ultra Plus for deeper folds. These products are FDA approved for moderate to severe facial wrinkles and folds and contain lidocaine for comfort. When the midface has lost volume, she may also recommend cheek augmentation with filler to address the source of the problem.
Expert Lower Face Treatment in Irvine
The area around the mouth is anatomically complex. Important blood vessels run nearby, the tissue moves constantly, and too much product quickly looks heavy or lumpy. As an oculoplastic surgeon, Dr. Erb has extensive training in facial anatomy and in the precise, conservative injection technique the eye area demands, and she applies that same care to the lower face.
Patients in Irvine, Orange County, and Los Angeles choose Dr. Erb for marionette line treatment because she:
- Evaluates the whole face, not just the crease
- Personally performs every filler injection
- Uses conservative amounts to keep expressions natural
- Tells patients candidly when filler alone will not give the result they want
Filler works best for mild to moderate marionette lines. When deep jowls or significant skin laxity are present, filler can soften the area, but a surgical approach may be needed for a more complete improvement. Dr. Erb will discuss what is realistic for you.
What to Expect From Treatment
Your appointment begins with a consultation to review your goals, health history, and any prior treatment. Dr. Erb applies numbing cream and ice packs before injecting, and the fillers she uses contain a local anesthetic. Results are visible right away and continue to settle over the next week or two.
Mild swelling, tenderness, or bruising may occur and usually resolves within a few days. Most patients return to regular activities immediately. Results in this area typically last about 6 to 12 months, and sometimes longer depending on the product and how your body metabolizes it.
Serious complications are uncommon, but any filler injection carries a small risk of affecting blood flow. If you notice severe or worsening pain, skin that turns pale, gray, or dusky, or any change in your vision after treatment, contact the office immediately. If you cannot reach the office or have vision changes, seek emergency medical care right away.
Frequently Asked Questions About Marionette Line Fillers
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Results usually last about 6 to 12 months, and some patients see longer results depending on the product used and their metabolism.
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Filler can noticeably soften marionette lines, but the goal is improvement rather than complete erasure. Deep lines related to skin laxity may need additional treatment for the best result.
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When the midface loses volume, tissue descends and deepens the lines below. Restoring support with cheek augmentation often lifts the lower face and reduces the amount of filler needed near the mouth.
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In some patients, a small amount of neurotoxin can relax the muscle that pulls the corners of the mouth down. This is an off-label use, and Dr. Erb will explain whether it makes sense alongside filler for you.
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Most patients return to normal activities right away. Mild swelling or bruising may last a few days.
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Yes. Many patients pair this treatment with fillers for lips, cheek filler, or laser skin rejuvenation for a refreshed lower face.
Why Choose Melanie Ho Erb, MD?
Dr. Erb is an oculoplastic surgeon who earned her medical degree at UC Irvine, completed her surgical internship and ophthalmology residency there, and finished an ASOPRS-approved fellowship in oculoplastic surgery. She has taught oculoplastic fellows at Eyesthetica and ophthalmology residents at UC Irvine and USC, and she has published book chapters and articles in peer-reviewed journals. She has also been honored as a Castle Connolly Top Doctor, Southern California Super Doctor, and Vitals Patients’ Choice Award recipient for over a decade.
Meet Dr. ErbSoften Marionette Lines in Orange County
If marionette lines are making you look tired or unhappy, dermal fillers may help restore a softer, more relaxed expression. Dr. Melanie Ho Erb offers personalized treatment that considers your entire face for natural, balanced results.
Schedule a consultation to learn how marionette line fillers can refresh your look in Irvine, Orange County, and Los Angeles.
Medically reviewed by Melanie Ho Erb, M.D. on