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 aesthetic medicine specialist with over 10 years of specialized experience. VERZO CLINIC near BTS Ekkamai. Free consultations via LINE @verzo.
Last updated: April 2026
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.
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.
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 the best results.
Ulthera targets the SMAS layer for deep tightening, Thermage provides radiofrequency skin tightening, and Oligio offers focused RF energy. These devices work best combined with threads for a multi-level approach to jowl correction.
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.
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.
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