Will Botox in my 'Marionette Lines' and Corners of Mouth Help to Uplift the Profile of my Mouth in General? (photo)

Botox to the muscle that pulls the corners of the mouth downward (depressor anguli oris), can help decrease the appearance of the "marionette lines," but depending on the depth of these lines, I typically couple the botox with fillers. You should be assess by a board-certified Dermatologist or Plastic surgeon, to ascertain whether this muscle is causing the appearance you don't like.

At one time, all we had for sagging, furrowed and wrinkled skin was aggressive plastic surgery. Then came nonsurgical wrinkle treatments that merely chased after individual wrinkles, but did not address skin laxity. When, during the last fifteen years, we started to realize the important contribution of fat, bone and cartilage loss to facial aging, we began to use volumizing fillers with excellent results. Today, for pronounced smile lines, droopy marionette lines ("Howdy Doody" or "sad lines"), and jowls along the jawline, my first approach would be The Nonsurgical 3D Vectoring Lift.

A vector describes a magnitude and direction of force. Aging skin is characterized by a negative downward and inward vector of sagging. To counter this, surgeons traditionally pulled skin upward and outward--i.e. using a positive vector. The key difference between the outcomes of traditional surgical correction and nonsurgical 3D vectoring, both of which lift upwards and outwards, is the Nonsurgical 3D Vectoring Lift's additional corrective dimension of ‘forward projection’. This 3D effect is the result of volumizing with the use of injectable agents designed for this purpose, such as Radiesse, Voluma, Restylane SQ, and Stylage XXL.

The Nonsurgical 3D Vectoring Lift is predicated upon the fact that the face and portions of the neck differ in their degree of mobility. The region directly in front and behind the ears is a fixed, denser, relatively immobile area, in contrast to the mid-cheek region (hence the greater tendency of this region to sag with the passage of time). These anatomical differences are exploited in the Nonsurgical 3D Vectoring Lift by making the fixed areas serve as anchoring points for the mobile tissues.  In determining the positive vectors for the mid to lower face, the tissues that require lifting are identified by pulling the skin directly in front of the ears in a direction perpendicular to the area that requires correction. If the pulling results in lifting of the desired tissue, then the vector has been correctly identified and is then marked in accordance with 3D vectoring protocol. A similar approach is used in the region of the angle of the jawbone when dealing with neck laxity.

Once the proper vectors are marked, the volumizing agents are injected in a series of radiating bands that serve as support struts to the skin and that impart the necessary 3D outward projection--the lift--that distinguishes and defines this nonsurgical approach. The high viscosity and elasticity of the volumizing fillers serves to hold and re-support the overlying tissue and restore more youthful contours.

Although volumizing fillers are reabsorbed over time, they do promote new, native collagen synthesis, which may continue to provide structure, firmness and improved skin quality while continuing to lift tissues. A typical Nonsurgical 3D Vectoring Lift of the face takes about fifteen minutes to perform. Bruising and swelling tend to be minimal, and most people can return to work or social activities immediately following treatment.

Often, The Nonsurgical 3D Vectoring Lift provides such gratifying results that no further treatment is necessary. However, should some fine tuning be required, say in the case of marionette lines, a small amount of volumizing filler may be added to buttress the corners of the mouth and a few tiny droplets of Botox (or Dysport or Xeomin) may be placed in the appropriate areas to the sides of the chin to suppress the downward pull of the muscles there and allow the corners of the mouth to be pulled upward. This having been said, I have seldom found the latter two supplementary procedures necessary following The Nonsurgical 3D Vectoring Lift.

 

 

 

This is a very challenging indication for Botox, and I have seen few doctors capable of achieving a truly upturned corner of mouth using just Botox.