The reason my mouth droops is because of a hyperactive DAO. Unlike most other people who have this problem, I'm very young (18) so while my mouth droops, I don't have a volume problem. I've so far heard of Botox only. Is there any way to permanently take care of this?
Botox for Droopy Mouth?
Doctor Answers 14
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.
Web reference: http://www.lidlift.com
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
(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
I would use a combination of Botox and injectable fillers to correct this problem. Thereis really no permanent solution that I know of
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Good question. As you can see from many of the earlier answers that Botox/Dysport can be used to relax the muscles that pull the corners of the lip downward. This is an easy treatment to try and perhaps the first that I might suggest.
Another option is to use a filler in the marionette lines which can be used to lift the corners of the lip as well. This is also easy and can accomplish more that just lifting the corners of the mouth(can also fill the marionette lines).
Another option is a "corner lip lift". This is a simple office procedure that involves removing a small piece of tissue at the corners of the upper lip that cause a long-term lift of the upper lift.
So you can see that you really do have several choices. As a facial plastic surgeon I like being able to talk to my patients about all options -- both surgical and non-surgical.
Good Luck!
Robert F. Gray, MD, FACS
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.
Web reference: http://www.bodysculptor.com/botox.html
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
DOA (Depressor Anguli Oris) muscles can be easily treated with Botox. Botox injections into your DOA muscles consistently (every 2-3 months) for two years can help permanently weaken the muscle. Using a filler will also help lift the mouth and will last between 9-12 months. These are the two non-surgical ways to treat this issue. Being that you are 18 I would start with Botox to see what kind of results you get, then opt for a filler if your looking for more improvement. I would consider surgery as a last resort.
Titrated Botox treatment into the Depressor Anguli Oris (DAO) muscles is CLEARLY THE way to reduce their pull on the corners and elevate the corners of the mouth. This is frequently combined with either Restylane or Juvederm placement.
Injury to the marginal mandibular nerve is associated with paralysis of the DAO muscle but I know of no surgeons who intentionally paralyze these muscles or attempt to excise them.
Peter A Aldea, 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
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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