How to Treat Marionette Bags: Identify All Types + 9 Common Aesthetic Treatments Explained

Marionette bags, also nicknamed “squirrel cheeks,” “chipmunk cheeks,” or “puffy corners,” refer to the small bulges of tissue at the corners of the mouth. These not only affect facial contour and depth visually, but also exaggerate signs of aging around the mouth, reducing overall attractiveness.

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1. Seven Main Causes Of Marionette Bags

Marionette bags result from multiple factors:

• Sagging and aging skin: Natural loss of collagen and elastin reduces skin elasticity and support, leading to sagging and pouch formation. Collagen loss is a key factor.
• Poor posture: Constantly looking down at phones or computers strains chin and neck skin, accelerating sagging.
• Facial habits: Frequent pouting or pursing of the lips repeatedly pulls on muscles and skin around the mouth, deepening lines and encouraging fat sagging.
• Diet habits: High sugar and oily diets accelerate skin oxidation and collagen breakdown, reducing elasticity and speeding up aging.
• Genetics: Some people naturally have less collagen or thinner skin, making them prone to early marionette bag formation.
• UV exposure: Long-term sun exposure damages collagen and elastin, speeding up aging and promoting marionette bags.
• Significant weight changes: Rapid weight gain or loss disrupts skin tension, causing uneven fat distribution and sagging.

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2. 9 Aesthetic Treatments To Improve Marionette Bags

1. Thermage (Thermage FLX)

Uses patented monopolar radiofrequency to heat the dermis, stimulating collagen regeneration and remodeling. Fifth-generation devices include intelligent tips for enhanced comfort and precision. Benefits: no downtime, natural results, lasting 12–18 months.

2. Ultherapy (Ultrasound lifting)

Focused ultrasound reaches the SMAS layer, stimulating deep collagen growth to lift and contour the face. Benefits: non-invasive, long-lasting (18–24 months).

3. Radiofrequency lifting

High-frequency energy gently heats the dermis, mildly stimulating collagen for gradual tightening. Benefits: non-invasive, no downtime, multiple sessions needed.

4. Thread lifting

Absorbable threads are inserted to mechanically lift sagging skin while stimulating collagen. Benefits: noticeable effect, short recovery, lasts 12–18 months.

5. Hyaluronic acid fillers

Target the visual impact areas like cheeks, nasolabial folds, or chin to support sagging tissue. Benefits: immediate effect, low risk, but requires periodic touch-ups.

6. Botox injection

Injected into the depressor anguli oris muscles to relax tension, improving mouth corner sagging. Benefits: quick results, simple procedure, lasts 4–6 months.

7. Fat-dissolving injections

Enzymes break down localized fat, reducing fat-type marionette bag volume. Benefits: non-surgical, quick recovery, multiple sessions may be required.

8. Liposuction

Micro-liposuction removes fat from fat-type or combined marionette bags quickly but should be combined with tightening treatments to avoid sagging. Benefits: significant results, but requires several weeks of recovery.

9. Surgical facelift

For severe sagging, surgery reconstructs deep tissue and skin tension to address overall drooping and wrinkles. Benefits: most dramatic results, long-lasting, but long recovery and higher risk.

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3. Pre- And Post-Treatment Precautions For Marionette Bag Treatments

Before treatment:

• Cleanse and disinfect the treatment area; avoid irritating skincare and makeup.
• Inform your doctor about skin condition, allergies, and medications.
• Avoid other aesthetic treatments (laser, exfoliation) for one week prior.
• Avoid smoking and alcohol for two weeks before treatment to aid recovery.

After treatment:

• Avoid alcohol- or acid-containing products for 48 hours to prevent irritation.
• For redness or bruising, follow doctor’s instructions for ice or healing ointments; do not press the area.
• Depending on treatment, avoid intense exercise, hot springs, or saunas for several days.
• Follow up with your doctor for results tracking or additional sessions if needed.

Worthy Solution: Perfect Medical Thermage FLX

For the best aesthetic solution for marionette bags in Hong Kong, try Perfect Medical’s Thermage FLX 5th Generation Face Lift Treatment. This non-invasive, painless treatment safely addresses signs of aging, even for young people aiming to prevent early sagging, while improving skin quality, hydration, and firmness.

The patented monopolar RF energy reaches the 4.3mm SMAS layer, gently heating skin to tighten and lift, stimulate collagen production, restore oil-water balance, and correct sagging or marionette bags. It also brightens and evens dull, sallow skin. Register now to enjoy a professional skin analysis + Thermage FLX treatment!