SEOLREIM · JOURNAL
Marionette Lines and Downturned Mouth Corners: How to Choose Among Fillers, Botox, and Lifting
Full professional English translation completed and self-reviewed against the Korean source; numerical tokens and medical cautions preserved; separate medical review of this translation is pending. Translation updated: 2026-10-28.
Marionette lines are wrinkles and shadows extending from the corners of the mouth toward the chin. They are not simply a skin crease; they result from combined mid- and lower-face volume loss, retaining ligaments, changes in the jawbone, laxity, and the downward pull of the depressor anguli oris (DAO) muscle. Heavily filling the line or weakening only the muscle with botulinum toxin is not universally correct. Depending on the cause, fillers, botulinum toxin, lifting, and chin support have different roles and different risks to expression and blood vessels.
Definition, effects and precautions at a glance
| Category | What to check |
|---|---|
| Volume and skeletal structure | Reduced support around the mouth and pre-jowl area creates shadows |
| Muscles | The downward pull of the DAO and platysma affects the mouth corners |
| Laxity and ligaments | Movement of cheek tissue and the borders of retaining ligaments accentuate the lines |
| Recovery | Swelling and bruising for several days to 2 weeks after injection; tenderness for several days after RF/HIFU |
| Main risks | Vascular occlusion, asymmetrical expression, drooling, nodules, and overcorrection |
Definition and mechanism
HA filler supplements support and shadows in selected areas, botulinum toxin reduces the force of muscles such as the DAO that pull the mouth corners downward, and RF or HIFU targets a tissue-heating response for mild laxity. The chin, anterior cheek, lips, bite, and facial expressions must be evaluated together to avoid overfilling only the lines beside the mouth.
Potential benefits and limitations
When treatment matches the cause, shadows around the mouth, the downward impression of the mouth corners, and lower-face contours may appear improved. Lines caused by expression and substantial excess skin are difficult to erase completely, and filler overcorrection can make the lower face look heavy. Botulinum toxin does not restore static volume loss, and lifting does not immediately fill a deep groove.
Who may be suitable and when to avoid treatment
Appropriate candidates are adults whose primary cause—volume loss, muscle pull, or laxity—has been identified and who understand staged correction. Previous fillers, threads, fat grafting, facial surgery, or dental treatment; facial paralysis or swallowing disorders; active autoimmune disease; infection; bleeding disorders; and pregnancy or breastfeeding must be disclosed. Occupations in which oral function is important, including speaking, using a straw, or playing a musical instrument, also require discussion.
Procedure and expected recovery period
The mouth corners, chin, volume, DAO and chin muscles, and existing filler are assessed from the front and side and during smiling and speaking. When needed, treatment begins with a small amount of one method. Filler swelling and bruising may last several days to 2 weeks, botulinum-toxin changes may develop over several days to 2 weeks, and tenderness or redness from an energy-based treatment may last several days. The result is reassessed with stable facial expressions.
Side effects, contraindications and warning signs
Fillers carry risks of nodules, infection, asymmetry, and, rarely, vascular occlusion that can lead to skin necrosis or vision loss. If botulinum toxin spreads to adjacent muscles, it can cause an asymmetrical smile, speech difficulty, drooling, or discomfort while chewing. RF and HIFU may cause burns, nerve irritation, or fat atrophy. Severe pain, pale skin, visual symptoms, or abnormal swallowing or breathing requires immediate evaluation.
Differences Among Fillers, Mouth-Corner Botox, and Lifting
| Method | Main goal | Key differences and precautions |
|---|---|---|
| HA filler | Selective support and shadow correction around the mouth and pre-jowl area | Risks of vascular occlusion, overcorrection, and nodules |
| DAO Botox | Modulates the muscle force that pulls the mouth corners downward | Risks of an asymmetrical smile, speech changes, and drooling |
| RF·HIFU | Mild laxity and loss of firmness | Burns, nerve irritation, fat atrophy, and limited effect on deep grooves |
| Thread lifting/surgery | Repositions tissue or corrects excess skin | Bruising, infection, nerve injury, scarring, and longer recovery |
Medical Q&A
Q. Should filler be the first treatment for marionette lines?
A. The sequence is determined after identifying whether the cause is pre-jowl support, volume, muscle pull, or laxity.
Q. Will mouth-corner Botox change my smile?
A. Asymmetry or functional changes may occur depending on dose and placement, so a conservative approach is important.
Q. Can lifting alone eliminate the line?
A. The component caused by laxity may improve, but deep grooves and skeletal causes may remain.
References
The anatomy and aging mechanisms of marionette lines were reviewed in a 2024 PubMed review (https://pubmed.ncbi.nlm.nih.gov/38572585/) and a 2025 anatomy-based injection study (https://pubmed.ncbi.nlm.nih.gov/39894451/). An HA filler consensus statement (https://pmc.ncbi.nlm.nih.gov/articles/PMC8435881/) and a 2026 review of vascular occlusion (https://pubmed.ncbi.nlm.nih.gov/42087426/) were consulted as safety evidence.
SEOLREIM's principle of consultation and treatment directly by the clinic director
SEOLREIM Clinic does not inject a large amount based only on one line beside the mouth. The doctor personally diagnoses facial expressions, muscles, skeletal structure, volume, and laxity, then compares only 2–3 necessary options among signature anti-aging programs such as HA filler, Botox, Sculptra, and lifting. The doctor performs the treatment directly according to SEOLREIM’s principles of authentic products, correct quantities, and attentive care.
Information for international visitors
Visitors searching for “anti-aging treatment Korea” or “cosmetic dermatology Seoul” should disclose previous fillers, Botox, and dental treatment, discuss speaking and eating functions, and provide a plan for responding to vascular symptoms or facial-expression asymmetry after returning home. SEOLREIM Clinic is on the 11th floor of the Gangnam 8258 Building, about 1 minute from Exit 3 of Gangnam Station. Appointments can be made through the website’s KakaoTalk consultation, Naver booking, or telephone channels. International visitors comparing information on a Gangnam skin clinic, Seoul skin clinic, Gangnam Station skin clinic, or Korean skin clinic should prepare their passport, allergy information, medication list, recent treatment records, and departure schedule, and should confirm available consultation languages and the scope of interpretation support before booking. Depending on the examination findings, same-day treatment may not be possible, or follow-up after returning home may be necessary.
Author, reviewer, publication date and update date
Written by: SEOLREIM Content Editor / Medical review: Completed / Review confirmation date: 2026-10-23 / Publication date: 2026-09-28 / Updated: 2026-10-27. This is general medical information and does not replace individual diagnosis or a treatment prescription.
SEOLREIM · GANGNAM, SEOUL
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