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

The reason the mouth turns down at the corners are a combination of loss of fat and bone in the area.  As fat and bone is lost, there is poor support of the corner of the mouth and it turns down.  To replace the lost support, I perfer to place fillers, Restylane or Perlane, in the area.  There is also a muscle that pulls down the corners of the lip, depressor anguli oris.  If this is weakened with Botox, Dysport, or Xeomin, it can cause the corner of the mouth to lift.  

 

I hope this helps!

Based on your photo, you would likely obtain some lift to the corners of your mouth to having Botox treatment in the appropriate muscles, paired with a dermal filler (Juvederm, Restylane, Perlane) to help support the corners and fill in some volume loss. Be sure you understand the effect of the treatment prior to having it done.

Juvederm or Restylane would be a more appropriate treatment for your needs. Both are hyaluronic acid fillers that bind to the collagen and elastin within the skin while also hydrating. This adds tissue volume and firmness to the treated area.  Radiesse, a different type of filler, is also an option to lift the area and give it more structural support. It is relatively less expensive and ideal for large volume filling effect such as cheek lifting etc.

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.

 

 

 

Botox placed in this area is an "off label" use.  Having said that there is literature to support the practice.  Some patient will benefit from Botox placed in the DAO muscle.  Often, a filler will also be used.  Please seek out an experienced and well trained injector.

I often perform a combination of Botox and fillers for the downturned corners of the mouth.  Botox will relax the muscles that pull the corners of the mouth down which will create elevation of the mouth.  It appears you also have volume loss of the upper face/mid cheeks and lateral lips which contributes to the "puppet" lines.  Fillers, such as Radiesse and Restylane, can address this volume loss and help smooth out prominent lines.  Replacing upper face volume will help lift the lower face. I would recommend consultation with an experienced board-ceritified physician trained in fillers and neurotoxins.  Best wishes.

A combination of Botox with a filler like Juvederm will give the best correction. You have to be sure to go to an experienced injector and start with less Botox than you think you may need so that you get the desired effect without affecting your smile or mouth movements. 

Botox is, in general, best for the upper face area, but the lower part of the face (the DAO area, an anatomic area), can sometimes be improved by using botox.  The key point here, though, is that it is a very challenging area to treat and if you do this, you need to go to an expert in botox use and one that does this quite a bit. 

There are many people out there who are using botox and fillers and not all of them are good at it or have experience with this area.  Fillers provide a much easier (although still challenging to the novice injector) area to inject.  Good luck in your process!

You need to fill in the corners of the mouth with fillers such as restylane, juvederm or radiesse or belotero ($550-650) to make a big improvement. Then when you see how great they look, switch over to a more permanent implant ($1500) to keep the happy look.  Botox really does minimal to nothing for the corners of the mouth and may actually worsen it. Sincerely,

David Hansen,MD