Marionette or puppet lines or oral commissures, are facial lines that extend down from either side of the mouth. These lines can create a serious or sad expression even when the face is at rest. They are due to muscles that repeatedly pull at the corners of your mouth and volume loss with age. They are best treated utilizing Botox to relax the pulling muscles and fillers or fat transfer to fill the lines. The combination of Botox and filler is crucial for long-lasting correction of this problem.