Can a thread lift help marionette lines?

Yes, if the cheek beside the corners of your mouth has dropped and now rests on top of your marionette lines, a thread lift may be considered. If the muscle pulling your mouth corners down or hollowing in front of the chin plays a larger role, lifting alone isn't enough, so your doctor will discuss other options too. Marionette lines have several overlapping causes, so the first step is working out which one is biggest.

The many causes of marionette lines

Marionette lines run from the corners of the mouth down toward the chin. They don't come from a single cause.

• Deep cheek fat (buccal fat) moves down and rests on the line.
• The muscle below the corners of the mouth pulls them downward.
• Volume in front of the chin, below the line, decreases and leaves a groove.
• The skin itself becomes thinner.

One analysis suggests that, because of where the muscles around the mouth corners meet, Asian people tend to be more prone to downturned mouth corners and these lines. (Evidence: literature review by Korean and Hong Kong researchers, 2025) A study that took MRI scans of the same people at least four years apart also concluded that deep cheek fat lengthens downward and deepens these lines.

(Evidence: Taiwanese MRI comparison study of 63 people, 2021)

When a thread lift is considered

• Pulling the cheek in front of your ear up and back with your fingertips makes the lines fade a lot.
• The cheek just outside the line looks full, as if it's resting on it.
• You also have jowls or sagging around your nasolabial folds.

In these cases, threads lift descended cheek tissue up and outward, taking weight off the lines.

When other options are discussed too

• The corners of your mouth point downward even when your face is relaxed, and the lines deepen when you talk or frown. The muscle plays a bigger role here, so your doctor will also discuss wrinkle relaxer injections to soften that muscle pull.
• Even after lifting your cheek, the area in front of your chin below the line stays sunken. Ways to fill the groove are discussed.
• The skin around your mouth has lots of fine lines. Your skin condition is assessed separately.

Rather than picking one option as better, the combination and order are set according to how much each cause contributes.

If you choose a thread lift, swelling, bruising and tightness can last a few days. Opening your mouth wide may be uncomfortable for a while, and rarely the skin can dimple. How much change you see and how long it lasts vary from person to person.

(Evidence: comprehensive US review of thread-lift literature, 2019)

What to bring to your consultation

Marionette lines change shape a lot with your expression, so a single photo makes it hard to tell the causes apart.

• A short video of your face at rest and while talking
• Older front-facing photos (to compare the height of your mouth corners)
• Records of filler or wrinkle relaxer injections around the mouth, and when you last had them
• Other areas that bother you besides the mouth (nasolabial folds, jawline)