Botox on the Depressor Anguli Oris Muscle?

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.


 

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.

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.

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.

Thank you for your question RevisionDone. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.Although Botox is most commonly used in the upper face, it can also be used in various areas in the lower face. Botox can be placed in the depressor anguli oris (DAO) muscle to elevate downturned corners of the mouth which sometimes produce a sad face appearance. In this area 2-4 units are used per side. The improvement from such a treatment is minimal. About 1-2 millimeters of lift can be seen.This treatment is often combined with other treatments such as Voluma in the upper cheek or Vollure in the marionette lines to lift the lower face and smoothen out the marionette lines. Botox itself will unlikely affect the appearance of the marionette lines. If I had a patient with the concern described here I would recommend a formal consultation for best assessment.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

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.

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.

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.
 

I agree with D . Weiner. A combination of a filler and a little Botox would probably give you the best results. 

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