Botox for Droopy Mouth?

Dear Fanny
It is a shame that we make people practice medicine on themselves. It is certainly possible that you issue is an over active depressor angulii oris muscle. Or not. A photo would be helpful. Given your age, you should be very careful with "permanent" solutions. Beware that quite commonly when someone enters a plastic surgeon's office with a diagnosis in hand and a desired treatment, they often get that service right or wrong. Unfortunately, the cure can be worse than the disease.
By far the first thing to do is find someone you can trust. Then have them assess your aesthetic concerns. They may or may not agree with your assessment and proposed treatment. So listen to what they are telling you. If you disagree, it is OK to seek another opinion. However, if every one is telling you the same thing and it differs from what you initially thought, you should consider revising your diagnosis.
For these types of issues, fillers last much longer than the BOTOX and are a much more practical solution.

Without the benefit of a picture, I can discuss several options to treat droopy corners of the mouth:(1) Injecting filler into the marionette lines to improve volume and lift the outer lip corners.(2) Injecting Botox into the Depressor Anguli Oris.(3) Surgery to removing the upper lip corner -- this may cause scarring.(4) Surgical incision of the DAO itself -- this muscle may still reattach and your corner drooping may recur.I commonly use a combination of the first two techniques -- Botox and filler.   In your case, however, fillers may not help since, at your young age, you are unlikely to have significant skin folding there, and as you stated, repleting volume is not likely the issue. Botox might be your best option...Be sure to seek the services of an experienced physician injector. I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, how deep beneath the skin the actual muscle resides, and the patient variability therein. As an aesthetic-trained plastic surgeon, I am intrinsically biased since I operate in the area for browlifts and facelifts, and have a unique perspective to the muscle anatomy since I commonly dissect under the skin, see the actual muscles themselves, and learn "first-hand" the incredible variability between patients -- live, "on the OR table" -- as opposed to via lectures or a cadaver dissection. For me, this helps guide where to inject and where not to. However, with that said, I know many non-aesthetic trained plastic surgeons and other physicians who know the anatomy well despite not operating in that area, and get good results.Good luck.Dr Markarian

Is it your entire lower lip that curls forward and hangs down? Or is it the corners of the mouth that have fallen down making it look like you're sad? This is an important distinction. If it is the latter, then you may be quite correct and the DAO can be treated well with Botox. If you don't have a significant fold then fillers may not be a good substitute. It is possible that surgical cutting of the muscle might not prevent it from reattaching itself. Botox may need to be retreated every 4 to 5 months

Although surgical release of the DAO could be performed technically, it is rarely performed due to the proximity of the muscle to nerves in the region and the diffficulty with guaging precise release or a graded release.

Dear Fanny, I would try the Botox first to weaken the muscle pulling down on the corner of the mouth- this may be the depressor angulii oris or the quadratus or a combo of both. The treatment with Botox will helo with the diagnosis and then you can decide if there is a more reasonable long term solution such as surgery or selective denervation.
With Warm Regards,
Trevor M Born MD

Hi Fanny,
Get your Botox injections into your DAO muscles frequently (every 2 to 3 months) for 2 years.  If you can keep the muscles from moving for 2 years, studies have shown that muscle permanently weakens (atrophy).
Good luck and be well.
Dr. P

The drooping corners of the mouth are usually from activity of the depressor anguli oris muscle, or DAO. When Botox or Dysport is injected into the muscle, it allows the muscle that elevates the corner to take over and cause elevation. This may last about 4 months.
Another way to elevate the corner is with fillers, injected in an X-like fashion will also elevate the corners. The fillers last longer, maybe 9 months, or so. Sometimes I perform both Botox and fillers, when people have a very droopy mouth.
The final option is a surgery that removes a triangle of tissue from the corner of your mouth to permanently elevate the corners. It leaves a scar, and although it is an acceptable scar cosmetically, I would not recommend it for an 18 year old.
I would recommend trying fillers first, and adding Botox or Dysport if fillers don't give you enough lift.

Correction of the droopy mouth from an overactive DAO (depressor anguli oris) muscle is best treated with botox. With time you may get some prolonged weakening and not require as much botox. Even though you have sufficient volume another option would be to place filler in the labial commissures and right at the edges of the upper lip. This would draw up the upper lips and ameliorate a lot of the downward effect of the depressor muscles. You can have a small amount placed in without significantly altering your existing facial volume in those areas. Typically, if your mouth pulls down then you could use some volumes in the lateral or outside edges near the white cutaneous upper lip without distorting your lip structure. Fillers can last from 9 to 12 months. I would advise against any procedures to cut the muscle permanently or other surgical procedures at your age.

People who have an over active DAO muscle could have a portion of it cut.  However, most people would instead opt for periodic Botox or Dysport injections as they have very little downside and virtually no recovery.

Overactive depressor muscles can pull down the corners of your mouth.  But they also allow you to speak and smile normally.  Careful use of botulinum toxin (botox cosmetic, xeomin, dysport) can relax those muscles without completely paralyzing them.  The effect is temporary but just as a cast will weaken the muscles of the casted limb, toxin will weaken those muscles and help break your frowning habit.  This isn't a surgical issue.See your dermatologist and talk about your options.Best wishes.