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    Marionette Lines & Jowls: The Treatment Ladder from Filler to Thread — VERZO CLINIC Bangkok

    TL;DR: Marionette lines form from the downward pull of the DAO muscle, loss of chin and jawline volume, descent of midface fat pads, and reduced skin elasticity. They create a sad or tired expression even at rest.

    Written by Dr. Waleerat Thaweebanchongsin, licensed physician with over 10 years of aesthetic-medicine experience. VERZO CLINIC near BTS Ekkamai. Free consultations via LINE @verzo.

    Last updated: April 2026

    Frequently Asked Questions

    What causes marionette lines?

    Marionette lines form from the downward pull of the DAO muscle, loss of chin and jawline volume, descent of midface fat pads, and reduced skin elasticity. They create a sad or tired expression even at rest.

    What is Botox DAO treatment?

    Botox DAO (Depressor Anguli Oris) involves injecting 4-8 units of Botox into the muscle that pulls the corners of the mouth downward. This relaxes the downward pull, allowing the mouth corners to lift naturally.

    When are threads needed for jowls vs just filler?

    Fillers work for mild jowling by restoring jawline definition. When skin laxity is significant and tissue has descended, threads provide the mechanical lift needed to reposition tissue. A combination of both often yields good results.

    What device treatments help with jowls?

    Ulthera targets the SMAS layer for deep tightening, Thermage provides radiofrequency skin tightening, and Oligio offers focused RF energy. These devices are often selected combined with threads for a multi-level approach to jowl correction.

    How do I know which level of the treatment ladder I need?

    Mild (Level 1-2): Fine lines and minimal descent, responsive to Botox DAO and filler. Moderate (Level 3): Visible jowling and deeper lines, needs threads plus filler. Severe (Level 4): Significant laxity requiring device treatment combined with threads.

    How long do results last for jowl treatments?

    Botox DAO lasts 3-4 months, fillers 9-15 months, threads 12-18 months, and device treatments 12-24 months. A combined approach with staggered maintenance provides the most consistent results.

    Back to BlogArea Solutions

    Marionette Lines & Jowls: The Treatment Ladder

    From Botox DAO to threads — find your level

    Dr. Waleerat| April 2026| 9 min read

    Frequently Asked Questions

    For more questions, contact us via LINE @verzo

    Ready to Consult?

    Consult with Dr. Waleerat for free via LINE to plan your personalized treatment.

    Consult via LINE @verzo

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    Medical Disclaimer

    Results vary depending on individual skin and body conditions.

    Please consult a physician before treatment.

    Results are not guaranteed.

    Ask on LINE

    VERZO CLINIC — 988-990-992 Sukhumvit Road, Ekkamai, Bangkok 10110, Thailand. Open daily 10:00–19:00 (Bangkok time). Staff can assist in Thai, English, Japanese and Chinese.

    Contact: LINE @verzo · WhatsApp +66 95 326 6644