Filler or botox to the depressor anguli oris muscle?

 Thank you for sharing your good question. In my practice, I ike to perform a combination of both treatments to achieve the maximal benefits. Either technique alone is useful. Make sure an experienced physician performs the treatment.Good luck,

Thanks for your great question!  The short answer is that both doctors are correct.  As our facial skin begins to sag with time and gravity, the angles of the mouth can be pulled downward, creating the "frowned" appearance you describe.  This appearance is not caused by an overactive DAO muscle, but from the natural atrophy (shrinking) of the fat, muscles, and tendons of the face, combined with decreased skin elasticity, which comes from time on the earth, sun exposure, toxins, and smoking.  Injecting the DAO with Botox or similar products will weaken that muscle slightly, resulting in an elevation of the corners of the mouth.  It doesn't always work, by the way.  Adding fillers will help provide a lift.  Most likely, you would do best with a combination of both fillers and toxin.  Another option (short of a face lift) is a product called InstaLift.  The InstaLift procedure is minimally invasive, meaning that it does involve local anesthesia (numbing) and a few needlesticks.  Several sutures or threads are used on each side of the face to lift the tissue.  If these threads are placed near the corners of the mouth, they should do an excellent job giving you the lift you are looking for.  Take a look at the link for a short video from the TV show, "The Doctors."

Depending on your age and the depth of the Marionette line, either Botox (4-5 units per side) into the depressor anguli oris (DAO) and or filler (which one depends on several factors and would be best decided by your physician after examining you in person) into the Marionette area (or even into the cheek bones) will help you upturn the corner of the mouth. The most important thing is to find a highly trained and experienced dermatologist that you get along with and can trust to decide what is best in your scenario.

You can actually use both Botox and fillers to elevate corners of the mouth. Botox is neuromodulator which can decrease the tonus of the muscle that pushes the corners of the mouth down, which lets the opposing muscles lift them up. At the same time, injection of small amount of filler just beneath the corners of the mouth helps to support them and make them point upwards. In my practice, I often use both modalities at the same time with great results.

This is hard to answer without a photo but I like the results of a combination treatment with both toxin (like Botox) along with a filler (like Juvederm Ultra Plus, Voluma or Restylane Defyne). Hope this helps.