If the corners of your mouth turn down, even when you feel perfectly cheerful, people may tell you that you look sad, tired or cross. Part of that downturn often comes from a small muscle pulling the corners down, and a low dose of Botox can ease that pull. At Shield Dental Care in Burke, VA, Dr. Ghorbani treats downturned mouth corners as part of our Botox service.
What pulls the corners of the mouth down
On each side, a triangle-shaped muscle called the depressor anguli oris, or DAO, runs from the jawline up to the corner of the mouth. Its job is to pull the corner down, as when you frown or grimace. When it is strong, it can hold the corners in a slight downturn at rest and deepen the downward lines that run from the corners toward the chin, sometimes called marionette lines.
How Botox helps
A small dose placed in each DAO, a little to the side of and below the mouth corner, reduces its downward pull. With less pull, the muscles that lift the corners have less to work against, and the corners can sit a little more level. The change is subtle. The aim is a more relaxed, neutral look, not a fixed smile.
What Botox will not do here
This is where honesty matters most. Botox only helps the part of the downturn caused by muscle pull. Deep marionette lines, folds and shadows around the mouth are usually caused mainly by loss of volume and support in the lower face, and sagging skin along the jaw adds to them. Botox does not replace lost volume or tighten skin, so on its own it may make only a small difference to deeper lines. Those usually need other kinds of treatment. We will tell you at the consultation how much of your concern Botox can realistically address, and if it is not much, we will say so.
An off-label use
No botulinum toxin product is FDA-approved for the mouth corners. BOTOX® Cosmetic is approved for frown lines, forehead lines, crow’s feet and neck bands, and Dysport and Daxxify for frown lines only, so treating this area with any of them is off-label. That is legal and common, and we explain it as part of consent before treatment.
What to expect
- Consultation. We look at your mouth at rest, smiling, talking and frowning, and review your medical history and medicines.
- Treatment. One small injection on each side, near the jawline below the mouth corner. It takes a few minutes.
- Afterwards. You can go straight back to your day, with written aftercare that includes not rubbing or massaging the area.
The change starts to show within a few days and builds over about two weeks. Movement then gradually returns over the following months. Treatment should not be repeated more often than every three months.
Side effects
Small bumps, redness or a bruise at the injection points are the most common. The side effect specific to this area is an uneven smile. The DAO sits next to the muscle that pulls the lower lip down, and if the product reaches it, the lower lip can move unevenly when you smile or talk, and some people find it harder to sip from a cup. This is the most common complication reported for DAO treatment. It wears off, and it is the reason precise placement and a low dose matter here.
All botulinum toxin products carry an FDA boxed warning: rarely, the effect can spread away from the injection site, causing trouble swallowing, speaking or breathing, vision problems or general muscle weakness, hours to weeks after treatment. These are medical emergencies. If they happen, get help immediately.
Who should wait
- Anyone pregnant or breastfeeding. Cosmetic botulinum toxin has not been adequately studied in pregnancy, so we recommend waiting.
- Anyone allergic to a botulinum toxin product, or with an infection or skin problem where the injections would go.
- Anyone with a nerve-and-muscle condition such as myasthenia gravis, Lambert-Eaton syndrome or ALS.
- Tell us if you take blood thinners, have recently taken aminoglycoside antibiotics, or have had any botulinum toxin treatment in the last four months.
The mouth corners can be treated at the same visit as a dimpled chin or lip lines. To book a consultation, contact us.
Frequently Asked Questions
Will Botox get rid of my marionette lines?+
Usually not on its own. Botox can ease the muscle pull that turns the corners down, but deep marionette lines are mostly caused by volume loss and skin changes, which Botox does not treat.
Will it change my smile?+
It should not stop you smiling. If the product reaches the muscle next to the DAO, the lower lip can move unevenly for a while. We use a low dose and careful placement to avoid this.
How much will my mouth corners lift?+
A little. The aim is for the corners to sit more level at rest, not to create a fixed smile. We will talk through what is realistic for your face at the consultation.
Is Botox for downturned mouth corners FDA-approved?+
No. It is an off-label use for every brand. That is legal and common, and we explain it before treatment.