Marionette lines settle in for all the same reasons as any other lines;

1. Your face loses fat. The fat underlying your skin helps to plump it up and keep your skin taut. As your face loses fat, the skin has less support, which contributes to it sagging. Practitioners call this ‘soft tissue volume loss’.
2. Your face loses bone. As you age, the bones of your skull gradually lose volume. In your face, the effect of this bone loss is a gradual loss of support for the fat and skin. You’ll hear practitioners call this ‘bony resorption of the mandible’.
3. Your ligaments loosen. As the ligaments that support the area around your chin and mouth grow looser with age, your chin gradually heads for the floor.
4. Your skin stretches as it ages. As it gets older, your skin loses its elasticity, so it stretches and sags.
5. Your skin becomes wrinkled. As wrinkles develop, incipient lines become more obvious.

While the above five problems all contribute to lines elsewhere on your face, neck, and body, marionette lines are a particular menace, because once they become etched on your face, they give it a permanently grumpy look and drag the corners of your mouth downward.

Apart from the five factors explained in the following section, the following five habits and factors may contribute to you developing marionette lines:

1. Pulling faces. If you frequently pull faces in the wrong way, that may make the marionette lines worse. For example, if you habitually pull down the corners of your mouth, that action will deepen your marionette lines. Don’t laugh – it’s true. (Actually, do laugh – laughing stretches your skin in a different direction – but don’t grump or gurn.)
2. Sun exposure. You’re probably sick of reading about the ravages that sun exposure wreaks on your skin – but applying the SPF regularly remains one of the easiest things you can do to help keep lines and wrinkles at bay.
3. Smoking. It’s no secret that smoking is dreadful for the skin. Enough said.
4. Dehydration. You don’t actually need to drink those much-ballyhooed eight glasses of water a day, but adequate hydration is vital to keeping your skin in good condition.
5. Genetics. Even if you can tick off the previous four points – you stay hydrated, you don’t smoke, you slather on the SPF automatically, and you avoid grimacing – you may have deep marionette lines programmed into your genes. If so, read on to explore your options for dealing with the lines.

Yes, anti-wrinkle injections such as Botox can help — especially if pulling faces is contributing to your marionette lines. A touch of Botox in the muscles that pull down the corners of your mouth will damp down this expression, thus helping to reduce your marionette lines.

As usual with using neurotoxins in the face, you’ll want an experienced practitioner with a deft touch who can inject the right muscles with an appropriate dose to limit the muscles’ movements without freezing them fully. The toxin will take between one and two weeks to reach its full effect, so don’t expect instant results.

Try a vitamin C serum in the morning, and a retinol product at night.

• Vitamin C serum: As you know, collagen is the protein that gives your skin its structure and firmness. As you grow older, the fibroblast cells in your body that generate collagen slow down. This means that your skin doesn’t repair itself as fast or as well as it did before, so it becomes less resilient, and lines gradually become embedded in it. Adding a vitamin C serum into your regime, straight after cleansing in the morning, helps slow down the damage and stimulate the production of new collagen.
• Retinol. Retinol is part of the retinoid family and is chemically related to vitamin A. Retinol can be transformative for the skin because it kick-starts collagen production and at the same time reduces the rate of collagen breakdown in the skin, so your existing collagen lasts longer, and new collagen is made faster.

There is an enormous number of these products available. Consult your practitioner for a specific recommendation of a cream or serum that will be suited to your skin or pick one of my recommendations, like:

Skinceuticals CE Ferulic

This serum, which combines vitamin C with vitamin E and Ferulic Acid, has become a skincare classic. If you have the cash to splash, it is a brilliant choice.

Medik8 Retinol 3TR

If you are new to retinol, this is a great product to start with. It’s a brilliant product, with a gentle formula that pretty much anyone should be able to use, and a time-release factor which slowly dispenses retinol into your skin.

Yes, dermal fillers can help with marionette lines. This, too, is a subject about which you should consult your practitioner.

Depending on how deep your marionette lines are, your practitioner may choose to use a thicker, longer-lasting type of filler to treat them. The advantage of thicker fillers is that they last longer than thinner fillers, so you won’t need to have the treatment repeated as frequently. The disadvantage is that thicker fillers must be injected deeper into your skin to avoid lumpiness, whereas thinner fillers can be injected closer to the surface of the skin without producing lumpiness.

Which filler your practitioner will use is likely to depend on your facial anatomy and the depth of the marionette lines. The practitioner may also recommend using fillers to augment your cheekbones, which may sound like a bizarre strategy for treating the lower face, but actually it works a treat, by raising everything below the cheek a fraction – and that may be enough to soften the appearance of your marionette lines.

Yes, clinical microneedling is a great treatment for stimulating the growth of new collagen in the skin. The tiny wounds created by the puncture marks made by the needles prompt a cascade of wound-healing substances within the skin, which nudge the skin into regenerating itself from beneath the surface. More collagen means skin that is more firmly supported from the inside, and which is better hydrated which means that it is plumper, too, and both of those factors will soften the look of the marionette lines.

Yes, laser is another option for treating marionette lines. Different practitioners prefer different types of lasers, but typical treatment would be to use a fractional laser to remove the damaged layers of skin in the marionette lines.

Fractional lasering fires the laser beam through a grid to create micro-channels of damage in the skin, which stimulate the growth of new skin. The laser treatment also stimulates the production of collagen, which gives your skin another boost.

Many practitioners use laser resurfacing and then follow up with dermal fillers, which boost your lasered-fresh skin from the inside.

Here are two main ways of minimising your marionette lines with makeup:

1. Invest in a thicker sort of make-up primer. This will act like a type of cosmetic filler paste, and will literally fill in the lines and wrinkles on the face, creating a much smoother base surface on which to apply your normal foundation. These primers usually have formulas that include light-reflective particles so that light landing on the skin is refracted, which creates a slightly blurred effect, which also makes lines and wrinkles less obvious.
2. Apply a lighter concealer to your marionette lines. Get some concealer that’s a shade lighter than your foundation shade. Make your face up as usual, but then apply the lighter concealer to your marionette lines. Blend in the lighter concealer gently with your finger or a brush; you’re aiming to create an optical illusion to counteract the shadow of the lines, but not to end up with a white stripe on your face.