8 Ways to Treat Marionette Lines, According to Derms

Up close of a woman in her 60s, with a towel on her head

 Studio Firma / Stocksy

When we think about facial wrinkles, our minds typically go to the top half of our faces. Forehead wrinkles, crow's-feet, and frown lines (between the brows), just to name a few, are often target areas for treatments such as wrinkle creams or botulinum toxin injections. But what about the wrinkles that occur in the lower half of our face? Whether it be nasolabial folds, vertical lip lines, or wrinkles around the jaw and chin, these lines can feel frustrating and often ignored. So, naturally, we sought out the best solutions for treating and preventing wrinkles in the lower half of the face.

Read on to hear the best solutions to treat and prevent wrinkles in the lower half of your face, straight from dermatologists Mariana Vergara, MD, and Farhaad Riyaz, MD; physician assistant Erica Bartoloni; nurse practitioner Heather Rypien, NP; and dermatological nurse Natalie Aguilar.

Meet the Expert

  • Mariana Vergara, MD, NP-C, is a cosmetic dermatologist with over 10 years of experience in aesthetic medicine and is the owner and founder of Beauty Villa Vergara.
  • Heather Rypien, NP, is a New York City–based aesthetic nurse practitioner at SkinSpirit.
  • Farhaad Riyaz, MD, is a board-certified dermatologist and medical advisor for docent.
  • Natalie Aguilar, RN, is a dermatological nurse and celebrity aesthetician.
  • Erica Bartoloni, MS, PA-C, is an aesthetic injector and skincare specialist at JECT

What Are Facial Wrinkles?

Before we get into solutions, it’s important to understand what exactly are facial wrinkles. “Face wrinkles are creases or folds in the skin that commonly appear or become more prominent with aging,” says PA-C Erica Bartoloni. Face wrinkles are completely natural and nothing to be ashamed of, celebrity aesthetician Natalie Aguilar reminds us: “People tend to forget they are natural.”

What Are the Different Types of Wrinkles?

There are two types of facial wrinkles, dynamic lines and static lines, classified by their presence.

  • Dynamic Wrinkles: “Dynamic wrinkles are caused by facial muscle contractions,” Bartoloni tells us. “For example, when we smile or furrow our brows,” adds NP Heather Rypien. 
  • Static Lines: “Static lines are the lines that are constant or permanent in the skin and appear to be 'etched' in regardless of movement,” says Rypien. These wrinkles are caused by the loss of collagen and elasticity, Bartoloni explains, and over time dynamic wrinkles can become static. 
  • Folds: While there are two categories of wrinkles, there is a third culprit in lower-face “lines” to be discussed: folds. “Folds are caused when facial muscles contract, making small 'folds' on the skin,” says Dr. Mariana Vergara. “Wrinkle folds appear mostly on the nasolabial groove, malarial groove, or neck when your skin starts to loosen.”

What Causes Facial Wrinkles?

There are a number of factors that can cause facial wrinkles. “Genetics, age, climate, lifestyle, and diet cause wrinkles in the face,” says Aguilar. “As we age, we start to lose bone and fat mass, all while our collagen production begins to slow down. Those who live stressful lifestyles have more inflammation, and inflammation causes inflammatory damage and destruction of the skin's structural components, including collagen and elastin. Diet plays a huge part in wrinkle formation. Eating sugar can cause glycation to occur. Glycation is caused when sugar molecules adhere to our collagen and elastin bundles and break them down. In time we lose the ability to keep our skin firm. Our face is also the first part of our body to wrinkle because of all the muscle expressions.”

As for which of these specifically causes lower face wrinkles, Farhaad Riyaz, MD, says, “Loss of volume in the cheeks causes the cheeks to sag, deepening the nasolabial folds and potentially causing wrinkles alongside the mouth and jawline. Expressions, talking, and eating cause wrinkles to form around the mouth.”

When to See a Professional

“I recommend seeing an experienced medical provider for a consultation when you begin seeing wrinkles at rest,” says Bartoloni. “In our mid-20s, our body’s production of collagen begins to slow down, but genetics play a big part in this as well, so the development of wrinkles may take place before or after this age. If you do not yet have lines at rest but are looking to be proactive, seeing a professional to help guide you through a plan of prevention can help you meet your goals. Your skincare regimen can be tailored to fit your needs, and in-office medical grade skin treatments can give that extra boost to optimize the skin’s overall quality, slowing the progression of future signs of aging and wrinkles."

Treatment Options

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Both Rypien and Bartoloni share that if caught early on, lines can be treated with wrinkle-relaxing toxins such as Botox or Dysport. “These work to relax the lines and prevent new ones from forming,” says Rypien. “Common areas where this can be helpful are the upper lip to address 'smoker’s lines,' the pre-jowl area to address downturned mouth corners, which can cause lines, and the chin to address skin dimpling,” adds Bartoloni. “Results can last up to 3–6 months.”

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Skin Treatments

Collagen-inducing treatments, such as microneedling, are an effective way to address fine lines and wrinkles, Bartoloni tells us. “Microneedling involves the use of a device with very fine oscillating needle tips to make controlled punctures in the skin,” she says. “These micro-injuries stimulate the body’s natural wound-healing process. This will result in a boost of collagen and elastin, which can improve the appearance of wrinkles, scarring, and the overall texture of the skin.” Other skin treatments, including laser treatments and chemical peels, can be used to “resurface the skin and soften fine lines,” says Rypien. “Medical grade chemical peels exfoliate the outermost layers of the skin and range from light to deep depending on the acid used,” adds Bartoloni. “Different acids can target different skin concerns. The type of peel should be determined by an experienced medical provider after evaluating your skin and discussing your goals. Regular treatments can improve the overall tone and clarity of the skin, preventing and diminishing existing fine lines and wrinkles.”

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Riyaz recommends a prescription-only form of vitamin A, Tretinoin. Also known as Retin-A, Renova, Retin-A Micro, or retinoic acid, Riyaz tells us that Tretinoin is 10 to 100 times more effective than over-the-counter retinol. “It works by exfoliating and stimulating cell turnover, reducing inflammation, and boosting collagen and elastin production,” Riyaz continues. “The result is reduced fine lines and wrinkles and smoother skin texture.”

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The professionals all agree that a major component to wrinkle prevention (lower and upper face) is SPF. Riyaz recommends a SPF 30 or greater to prevent “the structural and functional deterioration of the skin that UV radiation causes.” Riyaz adds, “A SPF 30+ is particularly important with all forms of retinoid use, as this powerful active ingredient makes skin more sensitive to the sun. Also, we recommend formulas with blue light filters because of increased screen time contributing to aging as well.”

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We shared earlier what happens when you have a poor diet, but on the contrary, a healthy diet can play a crucial role in wrinkle prevention. “It is important to eat a nutritious diet that the body can convert into nutrients to repair skin damage,” says Aguilar. “Also, 'eat the rainbow,' as they say,” adds Riyaz. “Include [in your diet] a variety of fruits and vegetables to help fight damaging free radicals, lean proteins to facilitate rebuilding of collagen and elastin, and healthy fats and omegas-3s found in avocados, flaxseed, nuts, and salmon.”

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A skincare regimen that includes vitamin C in the morning and retinol in the evening can improve the appearance of your skin while simultaneously helping prevent wrinkles from forming, Bartoloni tells us. “They have both been shown to stimulate the synthesis of collagen and minimize fine lines and wrinkles. When sunscreen and vitamin C are used together, they are more effective at neutralizing free radicals from UV rays, so it gives your sunscreen a boost. Vitamin C tends to be unstable and oxidizes quickly when exposed to light, so the ISDIN Vitamin C Ampoules are perfect to prevent this. Plus, the hyaluronic acid is great for extra hydration. Retinol is considered the gold standard of anti-aging ingredients. It improves the skin’s texture by increasing cell turnover and allowing new cells to generate.”

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Hyaluronic Acid Fillers

Fillers, such as Juvederm or Restylane, are often offered as a treatment option for existing static wrinkles. “Hyaluronic acid fillers, when injected correctly, can soften lines and replace lost facial volume,” says Bartoloni. “In many cases, replacing lost volume in the upper or mid-face first (for example, cheeks) will improve the appearance of nasolabial folds or jowling in the lower face. If further correction is needed in the lower face, filler may conservatively be injected directly into the area of concern. Results last for approximately one year, but it may be more or less depending on the product used and the location of treatment.”

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Consult Your Doctor

As with many cosmetic issues, the most important step in prevention and treatment is knowledge. “To most effectively treat your existing wrinkles, it is important to have a consultation with a qualified, experienced medical provider to determine the cause of the wrinkles forming,” says Bartoloni.  “Facial muscle contractions, volume loss from fat depletion, and skin laxity all play a part in the development of lower face wrinkles.” Understanding your skin as well as the cause of your wrinkles (if you’ve developed them) will allow for a more personalized and successful treatment and prevention plan.

  • At What Age Should I Start Botox?

    It is important to note that Botox is never a need, just a want. Wrinkles are a natural part of aging. That being said, if you do opt for Botox (or any other wrinkle-reducing toxin), the age depends on multiple factors. “The rule of thumb is when dynamic lines are noticeable at rest, that's a good indication to seek a professional opinion,” says Rypien. “For some people, it's in their 20s, and for others it may be 30s or 40s. There's a big genetic and lifestyle component, and by working with your expert practitioner, you’ll be able to make the best decision on when to start treating wrinkles.”

  • Will My Botox or Filler Look Fake?

    The answer to this question lies within the hands of the professional injecting you. “Seeing a qualified, experienced provider who is on the same page as you regarding your concerns, plan, and goals is important in achieving the best results possible,” Bartoloni says. “The face should always be evaluated and treated as a whole for the most natural, balanced results.”

  • What Happens If I Hate My Botox?

    Time is on your side in this case. “The beauty of Botox is it is not permanent,” says Aguilar. “Unlike filler injections that can last a long time, Botox is a procedure that can be repeated every 3 to 4 months. If you dislike it, or the way you look, never do it again, or you can try it again with a smaller amount.” If you are unhappy with filler, there are options depending on the severity. For minor issues, a medical professional is often able to massage out any asymmetrical areas. For more severe issues with filler, using Hyaluronidase to dissolve filler may be an option if you have a hyaluronic acid filler. Always consult a medical professional.

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