Nasolabial Fold · Marionette Lines · Pacific Plaza
Smile lines run from the side of the nose to the corner of the mouth, and marionette lines continue downward from the mouth corner towards the jaw. Both deepen because of changes above and around them, not in the crease itself, which is why Dr Sin Yong plans their treatment from the cheek and jawline before any filler goes near the line.
Smile lines are the everyday name for the nasolabial fold, the line that marks where the cheek meets the upper lip. Every adult face has one; even a child shows it when laughing. It becomes a concern when the cheek above it loses support and more tissue rests against it. The nasolabial folds page explains its anatomy in detail.
Marionette lines start at the corners of the mouth and run down towards the chin, often with a mouth corner that turns down at rest. They belong to the lower face: the same loss of support, plus descent towards the jowl and the downward pull of a small muscle called the depressor anguli oris (DAO).
Most people who ask about one have some of the other. Because the two lines have partly different causes, a plan that treats them as one problem tends to help one and miss the other.
Why They Deepen
The cheek is not one block of fat. It is several separate compartments that empty and slide at different rates, generally downward and towards the midline. Beneath them, the facial skeleton also changes with age, and the bone that once held the midface forward recedes. Tissue that has lost its platform settles onto the fold below, and the shadow there deepens.
Three further influences add to this. Skin loses firmness, so a fold that once sprang back starts to stay. Repeated expression around the mouth etches the line further. And at the corners, the DAO draws the mouth downward, which is why marionette lines can make a resting face look stern or sad when you feel neither.
A faint fold is often present from youth and tends to deepen from the thirties. Genes set the starting point; sun exposure, smoking and weight change, especially rapid weight loss that empties the cheek, set the pace.
Where Filler Belongs
Filler injected only into the crease does nothing about the tissue still descending above it. Repeated over several visits, it makes the area around the mouth heavier and blurs the edge between cheek and lip. Why filling the nasolabial fold so often fails sets out how that happens.
The order is therefore reversed. Lost cheek volume and lateral support are restored first, with dermal filler placed deep in the midface; where looseness is the larger change, lifting comes first instead. Only then is anything considered for the crease itself, and it is usually a small amount of soft hyaluronic acid that could be dissolved. In a well-made plan, the crease receives the least product of any area treated.
For marionette lines the same thinking moves one level down. Support at the chin and just in front of the jowl, lifting where the lower face has descended, and relaxing an overactive DAO each address a different part of the line.
The Options
Each option below is offered at Atelier. None of them works on every cause, which is why most plans combine two and stage them.
| Option | What it does | What it cannot do | Usually suits |
|---|---|---|---|
| Cheek (midface) filler | Rebuilds the support the cheek rests on | Tighten loose skin or change muscle pull | Smile lines driven mainly by lost cheek volume |
| Small amount of soft HA in the crease | Softens a shadow that remains | Counter tissue that is still descending | A residual crease after the cheek has been supported |
| VF Lift – Vertical Facelift (monopolar RF) | Heats deeper skin and the layer beneath it so collagen remodels | Replace volume or relax a muscle | Looseness and loss of firmness |
| Thread lift (Bliss Lift) | Repositions tissue that has slid, along a planned line | Restore volume or improve the skin | Moderate descent of the cheek or jowl |
| BTX to the DAO | Relaxes the muscle pulling the mouth corner down | Treat the nasolabial fold or replace volume | Marionette lines with a downturned corner |
| Surgical facelift (by referral) | Repositions deeper tissue and removes excess skin | Restore lost volume on its own | Advanced laxity beyond non-surgical reach |
How Atelier Decides
Dr SY looks at both lines at rest and in a full smile, lifts the cheek gently with a fingertip to see how much of each fold is descent, and checks the jawline and mouth corners. That separates volume loss from looseness from muscle pull, and the plan is ranked from there. More often than not, the cheek is the first step and the most useful one.
A good result looks rested rather than done: a lighter shadow beside the mouth, corners that sit less stern, a cheek with more forward support. The fold itself stays, because a lower face with no fold looks neither young nor natural. Where the lower face has descended heavily, jowls and lower face sagging explains the lifting options, and advanced laxity is referred for a surgical opinion.
Dr Sin Yong holds a Key Opinion Leader appointment with CLASSYS.
Atelier Aesthetics · Owned by AYA
9 Scotts Road, Pacific Plaza #12-01A, Singapore 228210 · +65 8023 7170
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