Botox on the Depressor Anguli Oris Muscle?

Hello! I am 21 years old yet I have downturned corners of the mouth and what seems to be like a very slight marionette line. I was wondering if putting botox on the Depressor Anguli Oris muscle would reduce the marinette line and the downturned corners of my mouth. How much should be injected and how difficult is it? Any side effects or risk of deformation or lumps? Thank you!

Doctor Answers 12

Botox can help improve downturned mouth corners

Yes, a small amount of Botox can be injected into each depressor anguli oris to reduce some of the downward pull on the corners of the mouth.  This is an area where precise injection is very important so that the surrounding muscles are not affected which could result in some asymetry of the mouth.  It is a fairly common off label use of Botox and I recommend that you choose an experienced injector.  You can find a list of board certified plastic surgeons on the website for the American Society for Aesthetic Plastic Surgery.

Orange County Plastic Surgeon
4.8 out of 5 stars 33 reviews

Botox on the Depressor Anguli Oris Muscle?

First, this is an advanced injection so please seek an experienced injector. Injection in the wrong area can give you a highly asymmetric smile. Usually the treatment requires 3-5 units of Botox per side. Whether you are a good candidate would require an examination to determine if your concerns result from excessive muscle activity in that area. I hope this information is helpful. Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Botox for the corners of the mouth.

Botox treatments in the depressor anguli oris muscle is often an effective treatment for a subtle improvement in downturned corners of the mouth.  This is an advanced injection technique, so it is very important to see an injector who has experience with this treatment.  The muscle is very close to another muscle, the depressor labii inferioris.  If that muscle is weakened, it can give you an unpleasant asymmetry around your mouth.  Generally the dose is about 2-3 units per side.  Hope this is helpful.

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Down turned lips

Botox in the DAO will help your down turned lips, although it will not do much for marionette lines. Approximately 3 units (2-4 units range) of botox can be used on each side. In experienced hands, it is an easy injection. Care is taken to be certain of injection into the DAO muscle and not into the nearby levator labaii muscle. Inadvertent paralysis of the levator labii muscle can result in a lip asymmetry. FIller in your marionette lines and your mouth corners will further improve the results.

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

Turn the frown upside down with fillers and Botox

You are correct, a small amount of Botox into the DAO muscle can diminish the downward pull on the corners of the mouth and allow the muscles that elevate the corners to take over. I would suggest trying that first and waiting about 2 weeks to assess the results. If more correction is needed, you can have filler like Restylane  placed. The risk of incorrect placement of Botox is an irregular smile or even oral incompetence. Therefore, it is crucial that you are injected by a well-trained individual.

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

Botox and peri-oral injections

Be sure to discuss your treatment with a well-trained and reputable provider for best results. Treating the DAO's will relax the muscles and won't allow you to purposefully make the down-turn of the corners of your mouth. Treatment is typically conservative. If the injections are not in the proper muscle or too aggressive, you'll have issues with your bottom lip and could have an unnatural look and feel until the product wears off.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Putting Botox in DAO helps with downturn of corners of mouth and slight marionette lines

But....the combo with Restylane is better.  When you are putting a total of 5-6 units of Botox in the DAO's and spending about $60, you can't expect huge changes.  If you keep up with it about every 3 months and consciously avoid that "frowny" motion, it will gradually improve.  

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

Botox on the Depressor Anguli Oris Muscle?

Thank you for your question. Botox and fillers can help minimize the appearance of marionette lines. It is a common area to be treated with Botox and fillers and side effects usually is bruising, swelling etc. I would recommend being treated under the supervision of a Board Certified Dermatologist or Plastic Surgeon for safest and best treatment option. I hope this helps.

Sonia Badreshia-Bansal, MD
Bay Area Dermatologist
3.9 out of 5 stars 12 reviews

Botox to lift corners of mouth

Yes, Botox works well in the DAO muscles to lift the corners of your mouth.  It typically takes 2 weeks to see the full benefit of Botox.  After that time frame and you still see marionette lines you might consider an injectable filler to smooth out the lines.

Ben Hugo, MD
Virginia Beach Plastic Surgeon
4.7 out of 5 stars 14 reviews

Botox can soften deepened corners of the mouth

Botox works by weakening the muscle that pulls down the corner of the mouth. To demonstrate this, look in the mirror and grimace and at the same time pull down your lower lip with your teeth. Relaxing this muscle softens this area. Using a small amount of filler such as Restylane or Juvederm helps get an even better result.


Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 126 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.