Botox Units for DAO Muscle to Correct Droopy Mouth Corners?

Question

How many Botox units would you suggest putting in the DAO muscle to corrct droopy mouth corners? Will it affect my smile or speech?

Amir M. Karam, MD · Answer

A few units of botox into the DAO muscle can help raise the corners of the mouth. This is often subtle when done alone. If combined with a filler to the corner of the mouth, it will have a more dramatic effect. I agree with the other comments, this something you want to have done by a board-certified Facial Plastic Surgeon or Plastic Surgeon or Dermatologist. Good Luck.

Mark K. Markarian, MD, MSPH, FACS · Answer

To improve the drooping mouth corners, I commonly use both of the following techniques -- (1) injecting filler into the mouth corner, and (2) injecting 2.5 to 5 Units of Botox into the muscle that normally depresses the corner of the mouth, the Depressor Anguli Oris.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, 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 and see the actual muscles themselves. For me, this helps guide where to inject and where not to. However, with that said, I know many Dermatologists who know the anatomy well despite not operating in that area, and get great results.Good luck.Dr Markarian

Tanveer Janjua, MD · Answer

The droopy corners of  the mouth respond well to about 5units of Botox in each DAO. You can also use 10-15 unis of Dysport in each DAO.
It is better to start with a smaller dose for the first time. This minimizes the chance of any effects on speech or smile.
Regards

Otto Joseph Placik, MD · Answer

Two to 4 units per DAO muscle is a typical starting dose.
In 15% of people this can be due to hyperactivity of the platysma muscle.
Fillers are a reasonable alternative or supplement to help correct a downturned mouth.
Surgical options include a corner lift or facelift

Kenneth D. Steinsapir, MD · Answer

The Carruthers invented this treatment. There is actually a US Patent describing this treatment. The typical dose is 2 to 4 units of BOTOX per side in the depressor anguli oris muscle. It is possible for this treatment to create muscle imbalance if it is not properly placed. However, generally, I find that it is much better to fill this area to lift the corner of the mouth. Treatment usually lasts about 3 or 4 months with BOTOX but if the corners are filled with Perlane, treatment can last over a year and a half.

William Ting, MD · Answer

2-3 units in the hands of experienced board-certified dermatologist or plastic surgeon. You do want to be conservative as excessive amount can lead to subtle change in your phonation and speech. You can always do touch-up later if you are getting the lift along the marionette lines. I totally agree that filler and botulinum toxin is a great combination for marionette lines.

Wayne F. Larrabee, MD · Answer

One must asses whether the problem is a volume problem or one caused by muscle action. This can be relatively easily determined on physical exam. For a downward pull cause by an active muscle Botox in small doses is usually effective. Volume problems of course require fillers.

Anifat Balogun, MD - Account Suspended · Answer

Depending on the bulk of the depressor (DAO) muscle, you need a conservative 2 to 4 units of Botox per side.

Usually, injecting a dermal filler into the marionette lines in addition to the Botox, yields a better result for those with well formed, or deep lines.

John E. Gross, MD (retired) · Answer

The "droopy mouth corner" you describe may be a result of a combination of several things.  
One of the contributing factors may be over activity of a muscle referred to as the DAO(depressor anguli oris).  BOTOX, used "off label" in conservative amounts may make a nice change in the position of the corner of the mouth.  The number of units would range from 2-5, and starting at the low end of the range.
There may also be volume loss in the area just below the corner of the mouth.  The addition of a "filler", such as JUVEDERM, in many patients makes a beautiful difference. The use of a filler in this location is also considered "off label".
Some patients may have both factors contributing and may get the most natural and beautiful result from combination therapy.
A consult with an experienced provider can help you sort it out.

Arnold R. Oppenheim, MD (retired) · Answer

My preference is to drop 4 units into each DAO muscle. This should be practiced by a physician with some experience since if the orbicularis oris  or DLI (depressor labii inferioris) muscles are inadvertently hit, the appearance can be unsightly and you possibly could drool...not good. 
    This technique, along with fillers, is excellent for correcting Marionette lines.

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