LiftingWhat is the best treatment for Marionette Lines? - Expert Insights from Dr. Tak

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Hello, everyone! ๐Ÿ˜Š
I’m Dr. Seung-Wan Tak, Chief Surgeon at Dr. Tak Plastic Surgery, located in Gangnam, Seoul. Our clinic specializes in treating sagging jowls and marionette lines, providing personalized solutions to address these common concerns.

Dr. Seung-Wan Tak, Chief Surgeon at Dr. Tak Plastic Surgery in Gangnam, Seoul, performing a cosmetic procedure with precision in a sterile surgical environment.

If you’ve been researching ways to improve marionette lines, you might find yourself asking questions like:

  • “How can I get rid of my marionette lines?”
  • “Will laser or thread lifting be enough to solve the problem?”

Today, I’ll walk you through the causes of marionette lines and the most effective treatments available. My goal is to provide practical and transparent advice based on over a decade of experience performing cosmetic procedures.

Take just three minutes to read through this guide—whether you choose my clinic or another, I’m confident this will help you make informed decisions.


About Dr. Seung-Wan Tak

Before we dive in, here’s a quick summary of my credentials:

  • Board-Certified Plastic Surgeon (Certified by the Ministry of Health and Welfare)
  • Graduate of Hallym University College of Medicine
  • Advanced Training at Nagasaki National University
  • AOCMF Facial Research Workshop Participant
  • Member of the Korean Society of Plastic and Reconstructive Surgeons
  • Member of the Minimally Invasive Plastic Surgery Research Society
  • Member of the Eye Plastic Surgery Research Society

Cause #1: Marionette Lines Caused by Buccal Fat Pads

One of the main culprits behind marionette lines is buccal fat pads (deep cheek fat).

An anatomical illustration highlighting the location of buccal fat pads (deep cheek fat) in the face, a common contributor to marionette lines.

What Are Buccal Fat Pads?

Buccal fat pads are long, pouch-like fat deposits located deep within the cheeks. Unlike subcutaneous fat, buccal fat is positioned deeper and its volume is genetically predetermined. It cannot be reduced through diet or exercise.


A cross-sectional diagram of facial layers showing buccal fat pads (deep cheek fat) beneath the skin and subcutaneous fat, highlighting their location and structure.

How Buccal Fat Causes Marionette Lines

In patients with larger buccal fat pads, the effects of aging and decreased skin elasticity cause this fat to sag over time. This downward pull can result in a “bulldog-like” appearance, with drooping skin near the mouth. Eventually, marionette lines form around the corners of the mouth.

Close-up of an older woman with sagging skin around the mouth and visible marionette lines, indicated by yellow arrows, illustrating the impact of aging and buccal fat pads.

Solution: Buccal Fat Removal Surgery

For patients whose marionette lines are caused by buccal fat pads, addressing the root cause is essential. I usually recommend buccal fat removal surgery, which involves:

  1. A small, 1–2 cm incision made inside the mouth.
  2. Gently removing an appropriate amount of buccal fat through the incision.

This minimally invasive procedure takes less than an hour, leaves no external scars, and has minimal risks when performed by an experienced surgeon.

If you suspect buccal fat pads are the issue, consult with a plastic surgeon for a detailed assessment. Correctly addressing this underlying cause will yield lasting results and prevent recurrence.


Cause #2: Marionette Lines Caused by Sagging Skin

The second major cause of marionette lines is skin laxity due to aging.

Close-up of an older woman with white hair and glasses, showing sagging skin around the lower face and marionette lines, highlighted by a yellow arrow.

Why Skin Sags Over Time

As we age, the skin loses elasticity, and the supportive structures beneath it weaken. This results in sagging skin, particularly around the cheeks and jawline, leading to the development of marionette lines.

Solutions for Sagging Skin

1. Laser Lifting for Mild Sagging
If the skin laxity is mild, laser lifting can help restore skin elasticity. This includes popular treatments such as:

  • Shurink
  • Ultherapy
  • Thermage

A white Shurink laser lifting machine designed for skin tightening and collagen stimulation, commonly used in cosmetic treatments for sagging skin.An InMode radiofrequency machine used for non-invasive skin tightening and contouring, offering solutions for mild to moderate sagging skin.

These treatments use heat to stimulate collagen production, tightening the skin naturally.

2. Thread Lifting for Moderate Sagging
For moderate sagging, thread lifting may be a better option. This involves inserting thin medical threads beneath the skin to lift and reposition sagging tissue. The number of threads used is customized based on the degree of skin laxity.Dr. Tak carefully marking a patientโ€™s face in preparation for a thread lifting procedure, a minimally invasive treatment for moderate sagging skin.

3. Facelift Surgery for Severe Sagging
If the sagging is severe and the skin has significant excess, a facelift may be necessary. This surgical procedure removes excess skin and tightens the remaining tissue, providing dramatic and lasting results.


Choosing the Right Treatment

Ultimately, the best treatment for marionette lines depends on the underlying cause and severity of the issue.

  • Buccal Fat Issue: Buccal fat removal surgery is the most effective.
  • Mild Skin Sagging: Opt for laser lifting treatments.
  • Moderate Skin Sagging: Consider thread lifting.
  • Severe Skin Sagging: Facelift surgery is likely the most suitable option.

For optimal results, I strongly recommend consulting with 2–3 plastic surgeons to get a comprehensive evaluation. Each patient’s facial structure and skin condition are unique, and personalized treatment plans ensure better outcomes.


Final Thoughts

I hope this guide has clarified your concerns about marionette lines and helped you better understand the available treatments. If you’re still searching for a trusted clinic, feel free to visit Dr. Tak Plastic Surgery for a consultation.

A serene view of the cityscape from Dr. Tak Plastic Surgeryโ€™s consultation room, featuring a cozy lamp and a decorative carousel.A heartfelt moment of trust and agreement between a patient and staff member at Dr. Tak Plastic Surgery, showcasing commitment to personalized care.

We operate on a 100% appointment-only basis to provide the highest level of care. As the Chief Director, I personally oversee all consultations and procedures to ensure your satisfaction.

Thank you for taking the time to read this. I look forward to helping you achieve your aesthetic goals!


Contact Information

Visit us at:
Dr. Tak Plastic Surgery
9th Floor, 423 Gangnam-daero, Seocho-gu, Seoul, South Korea

Phone: 02-534-1234

DM us on Instagram!


#MarionetteLineTreatment #BuccalFatRemoval #SaggingSkinSolutions #ThreadLifting #FaceliftKorea #LaserLifting #AntiAgingTreatments #DrTakPlasticSurgery #FacialRejuvenation #AestheticSurgery

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9th Floor of Hanseung Building,
423 Gangnamdaero, Seocho-district, Seoul-city

Dr. Tak Plastic Surgery

Representative: Tak, Seung Wan
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02.534.1234

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