Cosmetic Doctor Explains
Ever wondered why sometimes your resting face ‘looks’ unhappy but you don’t feel it? You’re not alone and unfortunately this is something that happens with age but can be managed. In this article I take you through the causes of this, why it happens and how it can be prevented and treated.
As we reach our fourth or fifth decades of life we start to notice the appearance of lines that run from the corners of the mouth to the lower jaw. These lines are known as melomental folds or more commonly Marionette lines which originated from marionette string puppets that have pronounced lines to allow them to move their mouths.
Why does this happen?
These lines appear due to a number of contributing factors. The first of which is due to the natural ageing process. This is attributable to the changes that occur in the skin and bones.
As we get older, we loose elasticity and collagen in our face. Elasticity of the skin, which is responsible for our ‘recoil’, starts to reduce at the age of 30–40 years old, whilst collagen production, which provides us with our plumpness, is lost around 25 years old. Beneath this surface lies our fat pads, which also start to reduce in volume as we age. Furthermore, our bones that provide the structure to our face, also start to resorb as we age. This bone resorption is noticeable in the mandible — or jaw line.
The next contributing factor in the appearance of marionette lines are the muscles that move the corners of the mouth known as the Depressor Anguli Oris (DAO). The action of this muscle pulls the corners of the mouth down and out. If this muscle becomes too active then the repeated movement also contributes to a ‘downward’ smile. Very often patients will come by and say that they look sad but they don’t feel it.
The final impacting factor contributing to marionette lines is gravitational pull. Unfortunately, when it comes to our face, gravity likes to pull things southward. The result of which, is that these thinner areas are drawn downwards creating a depression in this area and increasing the appearance of the lines.
How to Treat?
There are several options that may be explored. The first of which is to consider dermal fillers.
Non-permanent dermal fillers are made up of hyaluronic acid — which is a man made version of what we have naturally in our skin. HA helps to keep our faces nice and plump and voluminous. Using HA filler in this area helps to correct the volume deficit in this area. However, it should be noted that this area may require a fair amount of filler placed strategically to help provide projection to the lower face. This should always be performed by a practitioner with sound facial anatomy knowledge as the filler may be pushed to the wrong area, leading to a very heavy lower face.
However, once done correctly and under an expert eye, the results can really be quite favourable.
Another option is to consider anti-wrinkle treatment to the muscles of the lower face — DAO. As said previously, these muscles pull the corner of the mouth down and out. By temporarily inactivating this muscle, the corners of the mouth settle in an upwards position. It’s important to understand that if the crease lines of the marionettes are very deep, anti-wrinkle to this area is unlikely to change this appearance. Very often dermal fillers and anti-wrinkle treatment to the corners of the mouth are done in conjunction with one another.
A final method to consider is a mini face lift or a permanent surgical procedure to lift and pull back the lower face.
These options should always be considered after seeking the opinion of an adequately qualified healthcare practitioner as each of these procedures carry a number of risks.
Of course, if none of these options excite you and you would rather know how to prevent them, then take a look at my in depth article on how to reduce the signs of ageing here.
I hope that you have found this article helpful.
Take care and stay healthy,
Dr Nora x
Please note that the contents of this article are not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or medical condition.
