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Written By: Jeffrey Atlas, PA-C, Health Content Writer
Medically Reviewed By: Dr. Gopal Grandhige, MD, FACS, Board-Certified Surgeon
Last Reviewed: June 19, 2026
Yes, but probably not the way the ads make it sound. Botox softens these lines by calming one small muscle near your mouth, and on its own it won’t erase a deep groove.
Marionette lines are the two creases that run from the corners of your mouth toward your chin. Botox treats them by relaxing the depressor anguli oris, the muscle that pulls your mouth corners down. That lifts the corners slightly and softens the shadow. The crease itself comes mostly from lost volume, which Botox can’t replace.
I’ve watched this play out many times. Someone books an appointment expecting a clean slate, then leaves let down because nobody leveled with them. So I’ll keep it real. This piece covers what Botox does for these lines, where it quits, what honest before and after results look like, and how to dodge the knock-off version that lands people in the ER. I’m leaving prices out, since those shift constantly and depend on your face and your goals.
Marionette lines are vertical creases that drop from the corners of your mouth past your chin. They get their name from puppet mouths, where the jaw looks hinged by two grooves.
Most people start noticing them in their late 30s or 40s. It’s not a sign you did anything wrong. It’s a sign your face is doing what every face does over time.
Blame gravity, mostly.
As you age, your skin makes less collagen and elastin, the proteins that keep it firm and springy. The fat pads in your cheeks shrink and slide down. Bone in the lower face thins too. All of that pulls support out from under the skin around your mouth, and the corners sag. Genetics decide how early and how deep they show.
Two things create a marionette line, and mixing them up is where treatment goes wrong.
The first is muscle. The depressor anguli oris runs from your jaw to the corner of your mouth, and its one job is to drag that corner down. Every frown fires it, and over decades it presses a groove into place. This is the part Botox can quiet.
The second is volume and skin. Lost fat and slack skin let the area cave in on itself, and that’s a structural gap, not a muscle problem. You can relax the muscle all day and the gap stays. Filling it takes something that rebuilds volume. Often the smartest move is restoring support higher up the face with cheek filler, so the lower face lifts instead of folding.
A handful of everyday things deepen these lines faster than aging alone.
A Botox treatment for the lower face is quick. Most people are in and out inside 15 minutes, with no downtime to schedule around.
A typical visit runs like this:
Results don’t show up instantly. You’ll notice change in about 3 to 7 days, with the full effect near two weeks. Booking for an event? Schedule at least two weeks out.
The target is one muscle, the depressor anguli oris (DAO).
When the DAO relaxes, it stops yanking your mouth corners down, so they drift up to a more rested position and the marionette shadow softens. Done well, it turns a faintly downturned resting face calm.
Dose matters more than people expect. Most injectors use around 2 to 4 units per side, placed low and precise. Go too heavy and you can weaken the muscles you smile with, which is the opposite of the goal.
For marionette lines, fillers usually do more of the visible work than Botox. That’s not a knock on Botox. It’s the right tool for a different part of the problem.
Botox quiets the muscle. Dermal fillers replace the volume that went missing and prop the skin back up, so the crease has less room to fold. Because these lines are mostly a volume issue, filler tends to make the bigger difference.
On longevity, Botox in this spot lasts around 3 to 4 months. Fillers run longer, often past six months, and collagen-stimulating options longer still. So the real question isn’t Botox versus filler. For most people with true marionette lines, it’s both, layered by someone who knows the proportions.
A Botox treatment for the lower face is quick. Most people are in and out inside 15 minutes, with no downtime to schedule around.
A typical visit runs like this:
Results don’t show up instantly. You’ll notice change in about 3 to 7 days, with the full effect near two weeks. Booking for an event? Schedule at least two weeks out.
Honest before and after results from Botox alone are subtle: a slight lift at the mouth corners and a softer, less downturned resting face. Anyone showing you a deep crease vanishing from Botox by itself is showing you filler too, or flattering light. For those deeper lines, filler does the heavier lifting, and a 2025 study in the Journal of Cosmetic Dermatology found a hyaluronic acid filler improved marionette lines for nearly 70% of patients at one month.
I’ll say the quiet part out loud. A lot of the jaw-dropping transformations online are combination treatments labeled as Botox, or they’re shot in good lighting with a relaxed “after” pose. That sets people up to feel cheated by a real, honest result.
Match the tool to the line.
If your marionette lines are shallow and movement-driven, Botox alone can give a result you’ll like. If they’re deep and set, plan to combine Botox with filler and to maintain it. And if the real issue is loose, sagging skin rather than a single crease, no injection fixes that. That’s when a skin-tightening treatment or a surgical option does more than any needle.
The patients who walk away thrilled got told the truth at the consultation. The disappointed ones were sold one product as a cure-all. Pick a provider willing to say “Botox won’t be enough for you” when it’s true.
After a good lower-face treatment, people mention a few consistent things.
They look less tired and less unintentionally stern, because the resting downturn eases. A neutral face reads as neutral again, instead of mildly annoyed. Most say the change feels like them on a better day, which is the whole point. Nobody good is aiming for a different face.
The flip side is that it fades. Around the 3 to 4 month mark, the muscle wakes back up and the lines return. Maintenance is the deal you’re signing up for, and anyone who calls it permanent is confused or lying.
The result depends less on the product and more on two things, the injector and what you do between visits.
That injector choice is also a safety call. The FDA has flagged counterfeit Botox turning up in clinics, some of it tied to serious reactions, so a board-certified provider using authentic product is the floor, not a perk.
You can’t out-cream a marionette line, but you can slow how fast it deepens.
Don’t smoke. If you do and you quit, your skin is one of the first things to thank you.
The first day after treatment is the only part that needs care.
After that, the main thing is consistency. Marionette lines respond to a plan, not a one-off, and coming back before the effect fully fades keeps the muscle calm and the result smoother over time. If you’d rather hand that to a board-certified surgeon who’ll be straight about what Botox can and can’t do, the team at Formation in Tampa builds these plans around the face you have, with Dr. Gopal Grandhige overseeing the work.
So, can Botox help with marionette lines? Yes: on the muscle that drags your mouth down, and on early lines. Just walk in knowing it’s one piece of the fix, get it from someone who’ll level with you, and keep it up. That’s the whole honest answer.
It helps, but usually not on its own for deep lines. Botox relaxes the muscle that pulls your mouth corners down, which softens shallow lines and the downturned look. For a deep, set-in crease, most people get better results pairing Botox with filler. A 2025 study found a hyaluronic acid filler improved these lines for nearly 70% of patients at one month.
Most injectors use about 2 to 4 units per side, placed low in the depressor anguli oris muscle near the jaw. It is a small, precise area. Too much product here can affect your smile, so dosing should be conservative and tailored to how your mouth moves.
In this part of the face, Botox typically lasts around 3 to 4 months, a bit shorter than in the forehead. You will start seeing change in 3 to 7 days, with full results near two weeks. A regular maintenance schedule holds the result steady over time.
For most people, filler does more of the visible work because marionette lines are largely a volume problem, while Botox handles the muscle pull. The two are often combined rather than used alone. Botox relaxes, filler rebuilds support, and together they address both causes.
Partly. Significant weight loss, including from GLP-1 medications, drains volume from the face and can deepen these folds quickly. Botox can ease the muscle component, but replacing lost volume with filler usually matters more after major weight loss.
Botox Cosmetic is FDA-approved for several facial areas, but using it on marionette lines is considered off-label, which is common and legal in aesthetic medicine. The bigger safety issue is counterfeit product. The FDA has warned about fake Botox linked to serious reactions, so the source and the injector matter more than the label.
Choose a board-certified provider who uses authentic, FDA-approved product, ask where it is sourced, and confirm how many lower-face treatments they have done. The FDA has issued repeated warnings about counterfeit Botox tied to hospitalizations.
Crunches can only do so much.
You can spend hours strengthening your abdominal muscles, but that doesn’t guarantee visible definition.
A layer of fat sits between the muscles and the skin, and crunches can’t specifically target that fat.
For many people, exercise and reducing overall body fat can help reveal their abs. But even people who are already lean and fit can have stubborn fat that hides their natural muscle definition.
That’s where high-definition liposuction may help.
Dr. Gopal uses HD lipo to selectively remove fat around the natural contours of the abdominal muscles, helping reveal the definition that’s already there.
📍 Formation | South Tampa
Interested in HD lipo? Schedule a consultation to learn more.
#HDLipo #HighDefinitionLiposuction #AbdominalSculpting #BodyContouring
Which one had surgery 1 or 2? 👀
High-definition liposuction goes beyond traditional fat removal. Instead of simply reducing fat evenly, the surgeon strategically removes fat around the underlying muscles to make their natural contours more visible.
But here’s what makes it interesting: HD lipo doesn’t create the same six-pack on everyone. Each person’s anatomy, muscle development, and desired level of definition influence the final result.
Now take another look at these two patients.
Which one do you think had HD liposuction, 1 or 2?
Drop your guess below, then check the pinned comment for the answer!
#HDLiposuction #MaleLiposuction #BodyContouring #Tampa
There’s a story behind every decision.
Cosmetic surgery is a personal decision. Yet people who choose it often find themselves having to explain or defend that choice to others.
Some want to restore changes after pregnancy or weight loss. Others have worked hard to get in shape but still have areas they’d like to improve. And some simply want to feel more comfortable with their appearance.
The reasons are different for everyone. And they don’t have to make sense to anyone else.
At Formation, Dr. Gopal believes the decision to pursue cosmetic surgery should be guided by a patient’s personal goals, realistic expectations, and what’s medically appropriate for them.
Because ultimately, the person making that decision is the one who will live with it.
#Tampa #CosmeticSurgery #BodyContouring #Liposuction
Our first four-legged patient. 🐾
Dr. Gopal takes his liposuction and body contouring very seriously.
Even when his patients have four legs.
From loose skin and neck liposuction to a jawline that deserves its own before-and-after reveal, this might be his most dramatic transformation yet.
And yes, he even got the patient’s permission to share the results. 😂
A little Halloween fun from Dr. Gopal and his two very patient pups! 🎃🐶
No dogs underwent surgery. Just two willing participants and one very committed surgeon.
#SurgeonLife #tampa #necklipo
What weight loss can’t fix.
After losing over 100 pounds, this patient had achieved significant weight loss, but was left with excess skin around his abdomen and back that weight loss alone couldn’t address.
During an 8-hour surgery, Dr. Gopal performed a circumferential body lift, a procedure that removes excess skin around the entire midsection to improve body contour.
In this video, Dr. Gopal walks through the procedure, explaining how he removed approximately 3 pounds of skin from the back and estimated another 4–5 pounds would be removed from the abdomen.
He’s also using a small amount of fat collected during the procedure to add volume to the upper chest, improving its contour without performing a separate chest lift.
For patients who have experienced major weight loss, body contouring can help address the excess skin that remains after the weight is gone.
Considering surgery after weight loss? Schedule a consultation with Dr. Gopal at Formation in Tampa to explore your options.
Actual patient footage. Individual results vary.
#BodyContouring #BodyLift #ExcessSkinRemoval
Only 3 months after surgery. And still healing.
This patient had previously undergone a tummy tuck but wanted to improve his abdominal contour, create more definition, and address the appearance of his existing scar.
Dr. Gopal combined several body contouring techniques, including HD liposuction, skin tightening with Renuvion, fat transfer to the chest, and revision of the previous tummy tuck scar.
The result so far? A more defined abdomen, improved body contours, and a revised scar that’s still in the early stages of healing.
At just three months after surgery, these aren’t the final results. Swelling can continue to decrease, and scars typically soften and fade as healing progresses.
Swipe to see a closer look at the scar revision.
Considering body contouring or looking to improve the results of a previous procedure? Schedule a consultation with Dr. Gopal at Formation Tampa. Link in bio.
Actual patient photos. Individual results vary.
#HDLiposuction #BodyContouring #ScarRevision #SkinTightening #TummyTuck
Your fat is liquid gold.
The fat you don’t want might be exactly what another part of your body needs.
During liposuction, the fat we remove doesn’t always have to be discarded. In fact, Dr. Gopal refers to it as “liquid gold.”
Why? Because that fat can sometimes be transferred to another area of the body to add volume, enhance natural contours, and create a more balanced shape.
For women, that might mean adding volume to the breasts, hips, or buttocks. For men, fat transfer can help enhance the chest or shoulders.
And because we’re using your own fat, we can potentially improve two areas during the same surgery.
Of course, fat transfer isn’t right for everyone. It’s something Dr. Gopal discusses with patients beforehand and incorporates into the surgical plan when appropriate.
Considering liposuction in Tampa? Schedule a consultation with Dr. Gopal at Formation to explore your body contouring options.
#TampaLiposuction #FatTransfer #BodyContouring
Cosmetic surgery isn’t just cosmetic.
We often measure the success of plastic surgery by what we can see in before-and-after photos. But some of the most meaningful changes happen in ways a photograph can’t capture.
How someone feels about themselves. The confidence they carry into everyday life. The freedom of no longer feeling uncomfortable in their own skin.
For Dr. Gopal, that’s what makes this work so meaningful.
A patient who underwent body contouring in 2025 recently reached out to share how much the experience continues to mean to her.
She didn’t talk about measurements or how her body looked. She talked about how much better her days had become.
And that’s something Dr. Gopal has always believed: Cosmetic surgery isn’t simply about changing how someone looks. It’s about understanding what that change means to the person choosing it.
#Tampa #CosmeticSurgery #BodyContouring
A flatter stomach without a tummy tuck? 👀
Pregnancy, and sometimes increased pressure from fat deep inside the abdomen, can cause the abdominal muscles to separate down the middle. This is called diastasis recti, and it can make your belly stick out even if you’re otherwise lean.
Traditionally, repairing that separation often meant undergoing a tummy tuck. But what if you don’t have much loose skin to remove?
For the right patient, Dr. Gopal can use robotic-assisted surgery to bring those separated muscles back together through three small incisions, without the long scar associated with a traditional tummy tuck.
That’s exactly what he did for the patient in these before-and-after photos. No tummy tuck. No additional procedures.
**But this approach isn’t for everyone.** If you have significant loose skin or excess fat, a different treatment may be more appropriate. That’s why understanding what’s causing your belly to protrude matters before deciding on surgery.
Curious whether you’re a candidate? DM us or schedule a consultation with Dr. Gopal at Formation Tampa. Link in bio.
Actual patient results. Individual results vary.
#DiastasisRecti #MuscleSeparation #DiastasisRectiRepair #RoboticSurgery #Tampa
Why does fluid sometimes collect after surgery?
After certain surgical procedures, fluid can accumulate beneath the skin, forming what’s called a seroma.
In this video, Dr. Gopal demonstrates how he drains a seroma in a patient recovering from diastasis recti repair.
This is one of the reasons postoperative follow-up matters. It allows Dr. Gopal to monitor healing, identify any issues, and address them when necessary.
Considering surgery? DM us to schedule a consultation with Dr. Gopal at Formation Tampa.
#DiastasisRecti #Seroma #TampaSurgeon #AbdominalMuscleRepair
