Marionette lines: why you look sad when you're not, and 5 things that actually help

Written by Megan Caldwell
Attending Dermatologist at Northwestern Medicine Dermatology Naperville · Last updated: August 2026

Marionette lines are the vertical creases that run from the corners of your mouth down toward your chin, named after the hinged jaw of a string puppet. They bother people more than most wrinkles because they do not just read as age, they read as mood: by deepening the shadow at the mouth corners, they pull your resting expression into a frown. They typically appear around age 40, driven mostly by structure: the jawbone remodels, the ligaments around the mouth loosen, the fat of the lower cheek deflates and descends, and sun exposure weakens the collagen that would resist all of it. You cannot completely prevent them, and the Cleveland Clinic says exactly that. What you can do is slow them down, treat the treatable share, and stop reinforcing them for 8 hours a night. Here is what causes marionette lines, the honest version of the filler and Botox conversation, and what actually helps, ranked.

In this article

• What are marionette lines, and what causes them?
• Why do marionette lines make you look sad when you're not?
• Can you get rid of marionette lines?
• How to get rid of marionette lines: 5 things that actually help
• Filler and Botox for marionette lines: the honest answers
• Does your pillowcase affect marionette lines?
• Frequently asked questions

What are marionette lines, and what causes them?

The medical name is melomental folds, and a marionette line is less a wrinkle than a boundary. The corner of your mouth is a busy anchor point: the depressor anguli oris, the muscle that pulls the corner downward, runs straight through where the line forms. Five things drive the depth, and they are not equal.

Aging, sun, smoking and lip-pursing causes per the Cleveland Clinic. Bone, ligament and fat-descent anatomy per the surgical literature. Sleep-surface mechanics per Anson, Kurtz and Fulton, "Sleep Wrinkles: Facial Aging and Facial Distortion During Sleep," Aesthetic Surgery Journal, 2016.

Why do marionette lines make you look sad when you're not?

Because they sit exactly where a frown does. Faces are read at a glance, mostly from the mouth corners and the eyes. A marionette line adds a downward shadow at the mouth corner, and as the depressor anguli oris out-pulls the weakening tissue around it, the corner itself can turn slightly down at rest. The result is a resting frown: people ask if you are tired or upset while your face is doing nothing at all.

One more pattern worth naming: if one of your marionette lines is deeper than the other, the symmetric causes do not explain it. Sun, smoking and expression hit both sides about equally. Sleep does not. A 2016 review in the Aesthetic Surgery Journal found that sleep wrinkles differ from expression wrinkles in mechanism, location and direction, forming from the compression, tension and shear of the face pressing into a sleep surface, with the lateral position accounting for about 65% of sleep time. Most people default to the same side for decades. Some asymmetry is skeletal and lifelong, so not every uneven line is a sleep habit, but the lower face sits squarely in the zone the study describes. Our guide to smile lines covers the same one-sided effect higher on the face.

Can you get rid of marionette lines?

Not permanently. The Cleveland Clinic puts it plainly: "You can't completely prevent marionette lines from forming, as they naturally occur with age." Bone remodeling and fat descent do not reverse with a cream, and every treatment buys time rather than permanence. That is not a reason to do nothing. It is a reason to rank your options by what each one returns.

How to get rid of marionette lines: 5 things that actually help, ranked

1. Daily sunscreen, and no smoking. Collagen is what resists folding, and these two protect more of it than everything else combined. Broad-spectrum SPF 30 or higher, every day, including the lower face and jawline that routines tend to miss.
2. A retinoid at night. The best-evidenced topical for rebuilding collagen. Expect months, not weeks, and start slowly: the skin beside the mouth irritates easily.
3. Injectables, matched to the actual cause. Filler where the problem is lost volume, a few units of Botox where the problem is muscle pull. The next section covers both honestly.
4. Sleep on your back. It removes nighttime compression entirely, which no product can. It is also hard to sustain, because you cannot supervise your position after you fall asleep.
5. Reduce the drag at the surface. For the roughly 65% of the night most people spend on their side, compression comes from the weight of your head and cannot be removed. Shear depends on how much the fabric grips your skin, and that part is measurable.

Filler and Botox for marionette lines: the honest answers

Filler is the standard treatment for a line with real depth, because it replaces the support the area lost. Done well, it is placed conservatively, often supporting the chin and the tissue beside the fold rather than stuffing the crease itself, and results last months to a couple of years.

The "marionette lines filler gone wrong" searches exist for a reason. The lower face is unforgiving of overfilling: too much product around the mouth reads as heaviness, lumps and migration show every time you talk. Two things keep the risk honest. Most marionette filler is hyaluronic acid, which a clinician can dissolve with hyaluronidase if you hate the result. And complications track the injector far more than the syringe, so choose a board-certified dermatologist or plastic surgeon who treats the lower face routinely. Start with less than you think you need. You can always add.

Botox is the more surprising answer. Unlike smile lines, where it is mostly the wrong tool, marionette lines have a genuine muscular component: a few units placed in the depressor anguli oris, typically 2 to 5 per side, relax the downward pull so the mouth corners rest more neutrally. It treats the frown, not the fold. A deep, etched line needs filler; downturned corners with a shallow line may need only Botox. That is why the cause-match above matters.

Does your pillowcase affect marionette lines?

It affects one of the three forces, and being precise about which one is the point. The 2016 review studied sleeping position, not fabric, and did not test or endorse any pillowcase material. What it established is that compression, tension and shear distort facial tissue for hours. Shear is friction: the sideways drag on your cheek and mouth corner each time you settle or turn.

Friction is one of the few parts of this conversation you can check as a number instead of a promise. Cotton's surface roughness measures about 0.25 µm. CloudThera™, Dreamey's engineered eucalyptus lyocell, measures 0.11 µm, which is 56% less friction and smoother than silk at 0.15 µm, so there is less sideways pull on the skin around your mouth all night. It also moves 34% more moisture vapor than cotton (570 vs 425 g/m²/h) and carries 3x less surface bacteria per Hohenstein Institute testing, so the fold your cheek rests in is not a damp one.

That surface does not come from eucalyptus by default. It comes from DermaWeave™, the proprietary finishing process that refines each 10 to 12 µm fiber, which is why commodity eucalyptus viscose sold for $40 pills by the second wash and publishes no roughness figure at all. Ask any brand for the number and see whether one exists. Measured, not marketed.

And the honest frame, stated outright: a smoother surface earns you fewer sleep creases, nothing more. No fabric erases a fold built by bone and fat changes, no fabric replaces sunscreen, a retinoid or a good injector, and no fabric outperforms sleeping on your back. It is one small controllable variable, and the only one running the whole 8 hours, 2,920 hours a year, on the side you favor.

One practical note: the same compression and shear act on your neck and chest against the rest of the bed, which our guide to the 2 kinds of neck wrinkles covers in depth. If you are changing the surface, change it everywhere your skin touches it.

Frequently asked questions

What causes marionette lines?

Structural change, mostly: the jawbone remodels with age, the ligaments around the mouth loosen, and the fat of the lower cheek deflates and descends, while sun damage and smoking weaken the collagen that would resist the fold. Muscle pull and habits like lip pursing add the expression component, and one-sided sleep compression can deepen the line on your favored side.

How do you get rid of marionette lines naturally?

You can soften them without injectables, on a timescale of months. Daily sunscreen and quitting smoking protect the collagen you still have, a nightly retinoid rebuilds some of it, and back sleeping removes one-sided nighttime compression. Face yoga and massage move fluid for a few hours, but no exercise restores bone or a fat pad.

How many units of Botox for marionette lines?

Typically 2 to 5 units per side, injected into the depressor anguli oris, the muscle that pulls the mouth corners down. It is a small, technique-sensitive dose: too much, or badly placed, can affect your smile, so this area belongs with an experienced injector. Botox relaxes the downward pull; it does not fill a deep, etched line.

Why do I have marionette lines in my 20s or 30s?

Usually genetics: some faces are built with a stronger downward muscle pull or a deeper native crease, and the Cleveland Clinic lists genetic predisposition among the causes. Early lines are also more likely to be shallow and expression-driven than structural, which means the preventive habits, sunscreen, no smoking, back sleeping, pay off more for you than for anyone else reading this.

Does a silk or eucalyptus pillowcase prevent marionette lines?

No. Neither prevents them, and a brand telling you otherwise is overselling a real but small effect. A smoother surface reduces friction, one of three forces in sleep creasing, and does nothing about the bone and fat changes that drive most of the depth. The measured figures: 0.25 µm surface roughness for cotton, 0.15 µm for silk, 0.11 µm for engineered eucalyptus lyocell. Worth having, far behind sunscreen and back sleeping.