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

My mouth naturally turns down at the corners and more so as I have aged. Botox in the Cupid bow area has actually increased this downturn by puffing up the very center of my lip. Would Botox in these puppet lines and outer corners of the mouth help to stop accenting the downward pull of my lips?

Doctor Answers 26

Botox for Marionette Lines

Botox in combination with a hyaluronic acid filler would help create a happier appearance to your face. As we age, the depressor anguli oris muscle (DAO) continues to pull the corners of our mouth down creating a sad look. Relaxing these muscles with a neurotoxin such as Botox will stop this downward progression and allow for a slight upward release of the corners. Hyaluronic acid fillers such as Juvederm and Restylane would be placed in and around the marionette lines to add physical support to the corners of the mouth.


San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

You Have Great Non-Surgical Options to Improve Your Smile and Mouth Area

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!

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Botox for Marionette Lines

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.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 128 reviews

Botox in Marionette Lines. Viable Option?

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.

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

Corners of Mouth and Botox

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.

Kristin Baird, MD
Longmont Dermatologic Surgeon
5.0 out of 5 stars 10 reviews

Combination of botox and filler

Botox, if correctly injected, can help raise the corners of your mouth a few millimeters at most. Fillers, in actuality, are going to be the real work horse in raising the corners of your lips. You will need fillers injected around your mouth to "push up" the corner of your mouth and in your cheeks "pull up" the corners of your mouth. I like larger particle hyaluronic acid fillers (Juvederm ultra plus, Perlane) for this purpose.

Ramona Behshad, MD
Saint Louis Dermatologic Surgeon
5.0 out of 5 stars 6 reviews

Corners of mouth downturn corrected with Botox and Filler

The extent of your downturn requires both Botox and fillers (Radiesse or Restylane).  I also notice people that have similar issues have a habit of making an expression of turning their corners down.  You need to recognize you are doing it and try to stop.  You have built up these muscles over the years and it will take time to make them weak.  Botox is injected in the DAO's and filler is injected into the corners of the lips and marionettes.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

Droopy Mouth

This is a very common request in my clinic and I am often able to achieve excellent results using a combination treatment.  I use a neurotoxin such as Botox, Xeomin, or Dysport, to treat the depressor anguli oris muscles and a filler to treat the age related volume loss below the corners of the mouth.  My filler of choice in this region is Radiesse because of its longer duration than the typical hyaluronic acid filler.  

Best Regards,

Jacque LeBeau, MD


Jacque P. LeBeau, MD
Pensacola Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

Marionette lines and Botox

For lines like yours I would use a combination of Botox or Dysport to the muscles that depress the corners and a filler such as Restylane or Radiesse to elevate the corners. My choice of fillers would depend on what else I was doing at the time for you as either would do fine, as would Juvederm or Belotero. 

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 18 reviews

Botox and Puppet Lines

Yes, Botox  at the corners of the jawline can stop your mouth corners from turning down. Sometimes this is all you need to get those mouth corners up.

However, you still may need some filler such as Juvederm or Restylane to complete the look. You can do the Botox first and evaluate in 2 weeks. If it is not completely fixed then you can add the filler. However, I have lots of happy patients that are able to fix the problem with only Botox or Dysport. Be sure you are going to an experienced injector for this treatment.


Esta Kronberg, MD
Houston Dermatologic Surgeon
5.0 out of 5 stars 29 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.