Botox on the Depressor Anguli Oris?

Question

Hi! I had botox done for the very first time 6 d ago to help with the downturned corners of my lips. I look fine when I am not talking/moving but my lips turn awkwardly upward when I take a bite of food, try to sip from a straw or am holding liquid in my mouth. My face muscles freeze up in a very uncomfortable and unsightly way which makes me very self conscious. Is this normal? Will this go away anytime soon or stay this way for the next 3-4 months? Is there any exercise or any tips anyone has?

Martin Jugenburg, MD · Answer

Using botox to treat turned down mouth corners is usually very effective.  Unfortunately it's a tricky area to inject and sometime side effects can occur.  The botox will wear off in about 3-4 months.

Michael J. Denk, MD, FACS · Answer

Sorry to hear about your situation. In my opinion, you should wait at least 10 to 12 days after your treatment to be certain of the final result. Botox can migrate causing unwanted effects to the surrounding muscles. In my experience, DAO injections have been very beneficial. Please return to see your injector so that he/she may more accurately evaluate you. Best of luck.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question 28thin. I am sorry to hear
about your situation. Botox
is a purified protein used to address wrinkles associated with facial
expressions. In the lower face a small amount of Botox can be placed in the DAO muscle which pulls down on the corners of the mouth. Relaxing this muscle with Botox will elevate the corners of the mouth. If it spreads to the nearby DLI or orbulicaris oris muscles it can lead to a temporary asymmetric smile or difficulty eating or drinking. These effects normally wear off in 3-4 months. Please consult with a doctor for specific
recommendations.  Good luck!

Shaun Patel, MD · Answer

Sorry to hear about your experience with Botox. Small doses of Botox can be injected in the depressor anguli oris muscle (DAO)  to improve downturned corners of the mouth. However, this is an advanced injection technique and requires an experienced injector who understands the relevant anatomy. Over injection into this muscle can result in an unnatural appearance, a "joker's smile". Also, if the Botox is misplaced, it could affect the depressor labii inferioris muscle and result in an asymmetric smile. When this does occur, unfortunately, the best option is just to wait the 3-4 months for the Botox to wear off.

Victor Chung, MD · Answer

Botox is a medication injected into muscles to decrease how hard the can contract.  The depressor anguli oris muscles is one targeted to improve the frowning corners of the mouth.The mouth is a complex area to treat. It's involved in different complex expressions (smiling and frowning) and functions (keeping the lips closed while eating and holding a straw in the mouth). Weakening one set of muscles can create an imbalance with other muscles groups. You may look good at rest, but it may look strange when moving the mouth or vice-versa. Fortunately, it only lasts 3 months. I recommend being conservative when pursuing injections around the mouth. Safety comes first.

Corey Frucht, MD, PhD · Answer

Hello, and thanks for your question. I'm sorry you did not get the result you had hoped for. This is a tricky area to inject with Botox. The effect should slowly improve over the coming 3-4 months. Best of luck, Dr. Frucht.

Botox on the Depressor Anguli Oris?

Answers (6)