I like a combination of Botox and fillers for the oral commissure

James F. Boynton, MD answers: Botox and fillers for marionette lines beginning to show?

I am 44 but have been doing Thermage, Refirme ST, and Microcurrent for several years periodically. I have no wrinkles anywhere now except the very slight beginnings of a depression where marionette lines will form (my mom has them terribly). Will fillers work? i have had fillers migrate to other areas before. How do I know what to inject and who to have inject? I am really worried since I have had filler issues in the past. Could Botox help in minimizing the smile muscle at the corners of my mouth right beneath the bottom of the nasolabial fold? I would love specific advice. Thanks!


James F. Boynton, MD
6 months ago

The area you are describing is loosely referred to as the oral commissure that forms the "beginning" for the Marionette line that can start there and "travel" vertically downward on the lateral chin. This can be a very challenging area and I have found that a "combination therapy" works well in this area. 

Often the patients have some loss of volume and this shows as a dimple or dimple with line. Many times, the lips have some deflation as well and there is "downturning" of the actual anatomic oral commissure (where the lips come together at the side). If the lips have significant deflation it is reasonable to consider adding some volume to them as well for proper facial balance and harmony.

Something I have quite a bit of experience with is Botox injections into the DAO (Depressor Anguli Oris) muscle which can elevate the oral commissures. Doing this in combination with a filler can give a great result, essentially lifting and filling the corners of the mouth. I have found success with both Perlane, Restylane, and Juvederm but another excellent option for filling this area and achieving even longer lasting results is Radiesse.

I hope this helps!

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