Getting to the Root of Marionette Lines: Why This Understanding Guides Effective Lifting. Beomgye, Pyeongchon, Beomgye Station, Pyeongchon Station, Hogye-dong, Bisan-dong, Gwanyang-dong, Dongan-gu, Indeogwon, Geumjeong, Anyang

12/29/2025

This is a procedure note for Getting to the Root of Marionette Lines: Why This Understanding Guides Effective Lifting. at Beomgye(Opening Soon) KKEUT Korean Clinic.

Marionette Line Management at Kkeut Oriental Medicine Clinic: An Individualized Approach

Each person's marionette lines present with unique characteristics. At Kkeut Oriental Medicine Clinic, we prioritize analyzing their underlying causes, considering the individual's anatomical structure.

01. Individual Consultation with the Director (Prioritizing Consultation Before Treatment)

Rather than a consultation manager, medical professionals conduct the initial consultation before any treatment proceeds. They evaluate the patient's facial structure with professional medical insight, then suggest a personalized treatment plan.

02. Tailored Treatment Planning for Four Identified Cause Types

We classify the causes of marionette lines into four categories: skin laxity, fat deposits, volume depletion, and muscular factors. Based on this, treatments are selectively combined to address each individual's specific needs.

03. Dual-Check Diagnosis: Visual Assessment and Mark-Vu Analysis

The director's visual assessment is complemented by Mark-Vu imaging, a device designed for detailed skin diagnostics.

This allows for numerical confirmation of wrinkle depth, skin elasticity, and pigmentation levels, aiding in the development of a carefully considered treatment plan.

Common Inquiries (Q&A)

Q. Could you explain what marionette lines are?

Marionette lines are typically described as prominent vertical creases that appear on both sides of the mouth and extend towards the chin.

They derive their name from the resemblance to a marionette doll's mouth. These lines are also sometimes referred to as 'grumpy lines,' as downturned mouth corners might convey an unintended displeased expression.

Their appearance is often linked to the natural process of aging, during which the tissues of the mid-face and lower face may experience sagging.

Q. What are the contributing factors to the formation of marionette lines? (Causes)

Beyond the general process of aging, their development often involves a combination of complex factors.

At Kkeut Oriental Medicine Clinic, we categorize these into four primary causes.

Diminished Elasticity (Skin Laxity): With advancing age, the production of collagen and elastic fibers tends to decrease, which can result in noticeable skin sagging.

When this occurs, the skin may settle against a resilient anatomical structure known as the 'mandibular retaining ligament,' leading to a visible fold and the formation of wrinkles.

Excess Fat Deposits: This type can arise when non-elastic fatty tissue descends and becomes partially blocked by the mandibular retaining ligament, causing a noticeable bulge above the ligament.

Loss of Volume (Sunken Appearance): Aging can lead to the reabsorption of the alveolar bone surrounding the mouth, which reduces its underlying structural volume. Consequently, the overlying skin, which may also be less robust, can appear to sink into this newly formed void, accentuating the wrinkles.

Muscle Hyperactivity: This occurs when the muscles responsible for pulling down the mouth corners (depressor anguli oris) are excessively active. Additionally, ingrained facial expressions or habits can contribute to the formation of more persistent, adhered wrinkles.

Q. In what ways do treatment approaches differ based on the specific cause?

Applying standardized treatments without first identifying and addressing the underlying cause may lead to less than optimal improvement.

Therefore, treatment strategies are tailored according to the specific diagnostic findings, as outlined below.

Type A. Laxity-Predominant Type (Focusing on Elasticity Enhancement)

Targeting the Dermal Layer: Procedures such as Thermage, TenTherma, Oligio, and Onda Lifting are utilized to help firm the skin's surface.

Targeting the SMAS Layer: HIFU lifting procedures, including Ultherapy and Shurink, are employed to address and elevate supportive ligaments that have begun to sag.

Type B. Fat Accumulation Type (Addressing Unwanted Volume)

For individuals presenting with an overall higher fat volume, treatments such as Onda Lifting, InMode FX, or contour injections may be considered.

In situations where only a specific, localized area (typically above the retaining ligament) exhibits protrusion, a targeted fat reduction needle procedure or Onda Lifting can be applied to carefully reduce the fatty tissue.