Have Smile Lines And Marionette Lines? These Are The Best & Worst Treatments To Get, According To A Derm

March 5, 2025 by Marissa Matozzo

 
Shutterstock/ TIktok.com/@shereeneidriss

“Smile lines,” commonly referred to as nasolabial folds, are the creases that stretch from the edges of your nose to the corners of your mouth.

In contrast, “marionette lines” are the vertical lines that descend from the corners of your mouth towards your chin, mimicking the appearance of a marionette puppet’s strings.

Essentially, while smile lines form around the mouth, marionette lines travel further down the face. In an insightful TikTok video, dermatologist and skincare expert Dr. Shereene Idriss provided a comprehensive explanation of the treatments to consider and avoid if you wish to diminish the visibility of these lines.

The Best & Worst Treatments For Smile Lines And Marionette Lines, According To A DermatologistWorst For Smile Lines: Sculptra

Sculptra is a type of injectable treatment designed to boost collagen production in the skin, which in turn helps to diminish the appearance of wrinkles. This cosmetic procedure is minimally invasive and aims to enhance the overall look and texture of the skin. Dr. Idriss mentioned that she does not recommend using Sculptra for treating the smile line region. “Regarding smile lines, I do not like Sculptra for this area,” she said in the aforementioned video.

She continued, “It is a personal preference because Sculptra is a stimulant that is going to enhance and increase your collagen production.” She went on, explaining that “as we get older, this area is going to naturally get longer, so by introducing something that is going to volumize this area, we are inadvertently lengthening this area and making us appear slightly older, faster, or just puffy.

Better Alternative For Smile Lines : PRP Or PRF

Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are both injectable therapies derived from a patient's own blood to aid in recovery. PRF is seen as an improved form of PRP. Idriss favors these methods for addressing the smile lines on the face, helping to diminish the appearance of wrinkles and fine lines in that area.

"I prefer PRP or PRF because that's like your own natural fertilizer," she said. Idriss added that this is "going to strengthen your tissue, and never volumize nearly as much as Sculptra could."  

Best Option For Marionette Lines: Sculptra Or Botox

Idriss emphasized that considering Sculptra or Botox for your marionette lines is a "whole different story" compared to treating your smile lines. The former lines are "due to our muscle that's pulling down our DAOS," or depressor anguli oris (DAO) muscle.

"You can hit it with Botox to minimize the muscle pulling down so the lines don't get as deep," she explained. "More importantly, these start to get more pronounced as we get older," the dermatologist noted. This is because "we lose bone mass and our jawlines start to narrow, thin out and recede."  

The Bottom Line

"The distance here starts to shorten as you get older, so you want something that's going to elongate it," she pointed out. This means that "Sculptra can actually work beautifully here as well." Idriss added, "I prefer Sculptra for the marionette lines instead of PRP." The more you know!

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