Carruthers et al developed a simple scale for grading marionette lines. This can aid in the evaluation of a patient requesting plastic surgery. The authors are from multiple institutions in Canada, the United States and Germany.
Marionette lines are curvilinear wrinkles that extend downward from the oral commissures. These mimic the appearance of the lower jaw in marionettes.
The severity of facial wrinkles depends on:
(1) history of smoking
(2) exposure to ultraviolet light
(3) other environmental exposures
(4) disorders of collagen and elastin fibers
(5) genetic predisposition
The appearance of marionette lines may be affected by:
(1) contraction of perioral muscles and facial expressions
(2) lighting
(3) application of cosmetics and "anti-wrinkle" creams.
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Scale
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Skin Folds
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Facial Appearance
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0
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none, skin continuous
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normal
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1
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shallow
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slight
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2
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moderately deep
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3
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very long and deep
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prominent
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4
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extremely long and deep
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detrimental
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The examination should be standardized as much as possible, especially if the patient is to be followed over time. Photographs under the same lighting condition can improve the consistency of grading.
