As a body ages, the skin loses a protein called elastin. Elastin is what keeps skin supple and flexible. When the body loses elastin, wrinkles form. Vertical lines or wrinkles extending from the end of the mouth toward the chin are called marionette lines.
Marionette lines are named for marionette puppets. The puppets' heads are formed in two pieces — the mouth is a separate piece from the rest of the head. Because of this construction, there is a visible seam on either side of the puppet's mouth. Vertical chin lines from the loss of elastin are thought to mimic the appearance of this effect.
Face lines such as marionette lines can affect how people perceive someone's mood and reactions. For example, an individual with a wrinkled forehead may be upset or concentrating. Deep lines around the corners of the mouth extending toward the chin indicate displeasure or anger. This effect is called the facial impression.
The causes of marionette lines are highly variable from person to person. Genetics plays a part in when and if a person will develop these lines. Environmental stress and anxiety can worsen the effect of wrinkles or hasten their onset. Exposure to harsh wind, the sun and environmental toxins such as cigarette smoke can also increase the chance of facial line formation.
Good facial hygiene and a general skin care routine can slow the onset of vertical chin lines. Products containing tretinoin are thought to prevent the appearance of marionette lines, though little research exists to support this claim. Quitting smoking, applying sunscreen and moisturizing the skin after exposure to the elements can also slow the onset of facial lines.
The treatments for marionette lines involve plastic surgery or cosmetic injections. Botox® injections paralyze the local area around the lines to lessen their appearance and keep them from worsening. A doctor injects Botox® into the area around the mouth and chin. Another set of injections involving hyaluronic acid firms the area and restores plumpness to the lines, filling them in.
There is no permanent treatment for marionette lines. Facial exercises designed to firm the skin are usually ineffective and can worsen the appearance of vertical lines. Facelift surgery is typically ineffective at removing the lines. A doctor or other licensed healthcare professional can be consulted if concerns about vertical chin lines are worrisome, and if a patient is considering cosmetic treatment options.