Marionette Lines

The cheeks sit on deep fat pads that act like internal cushions, giving the mid-face its lift. With age they lose volume and slide downward. As the support above the crease gives way, the skin settles more heavily into the fold. This loss of volume is the main driver, which is why surface skincare alone has limits here.

Beside volume loss, collagen and elastin matter here. These dermis fibres, made by fibroblasts, let the lower face stay taut and resist folding. As fibroblasts slow with age, the framework weakens and the skin gives way where the cheek meets the jaw. With less firmness to hold it, tissue slides downward along the mouth, deepening the grooves that run toward the chin.

Over the years, the steady downward pull of gravity gradually draws the softened facial tissues lower. Once the deep support has weakened, less holds them in place, so the folds running from the mouth corners toward the chin deepen, especially where volume has already been lost.

Everyday movements like speaking and smiling add repeated folding along the same lines. On their own they are minor, but combined with volume loss and reduced elasticity, they help marionette lines become more established over time.

Losing a large amount of weight quickly removes facial fat faster than the skin can keep up. Skin relies on elastin to retract, but elastin is barely renewed in adulthood, so after rapid loss the area is often left with less support than before, and the fold can look deeper.