DAO Botox Pros and Cons - will this help the downturn in my lips? (Photos)

Question

I had a lip lift which resulted in a crease and downturn (frown line) in my lips. I am not interested in filler. I do anticipate getting a facelift at some point, but in the meantime I am considering DAO botox but I have read that sometimes it can create smile issues (asymmetry) and/or increase joweling.

Nick Slenkovich, MD · Answer

Hi, I’m Lauren, the aesthetic injector at Colorado Plastic Surgery Center. The DAO muscle pulls the corners of the mouth downward. Injecting Botox into this muscle can soften the downward pull and slightly lift the mouth's corners.

Ozge Ergun, MD · Answer

Dr. Özge Ergun,
For frown lines, Botox injections into the depressor anguli oris (DAO) muscle can be an effective treatment. If you do not have any facial asymmetry before the procedure, it is unlikely to develop after the injection.
I hope this helps! If you have any other questions, please feel free to ask.

Ran Y. Rubinstein, MD · Answer

Hello and thank you for your question. Botox to the DAO muscle helps to minimize the downward pull on the corners of the mouth giving a subtle lifting effect. When placed precisely by an experienced provider smile asymmetry would be rare and jowling is typically not associated with DAO treatment. Temporary smile asymmetry can occur if the Botox is inadvertently injected or diffuses into the nearby DLI muscle. Again this would be a very rare occurrence when treated by a skilled injector. Hope this helps! Esther Litenatsky AGACNP-BC on behalf of Dr. Ran Y. Rubinstein, facial plastic surgeon in Newburgh, NY and Montvale, NJ.

Ella Fedonenko, MD · Answer

DAO Botox injections will help with the downturn of the lips but they won’t help with the crease. To correct the crease you may consider Skinvive injections. Asymmetry and jowelling are always possible but should not be an issue if injections are administered correctly.

Anna Petropoulos, MD, FRCS · Answer

Hello and thank you for your question! DAO (Depressor Anguli Oris) Botox is often used to address downturned corners of the mouth, which can give the face a sad or frowning appearance at rest. In your case, following a lip lift that left a crease and downturn, DAO Botox could offer a subtle improvement without the use of filler. One of the main advantages is that it's minimally invasive and temporary—typically lasting 3 to 4 months—making it a low-risk way to test whether this type of correction helps your concerns. When injected carefully, it can soften the frown lines and improve facial harmony. However, there are some drawbacks to consider. Over-relaxation of the DAO can lead to smile asymmetry or changes in how the mouth moves, particularly during speech or eating. In some cases, it may even contribute to increased jowling, especially if there's preexisting laxity in the lower face. It’s important to manage expectations as the effect is modest and won’t provide the dramatic results of a facelift. If you choose to proceed, it’s best to start conservatively and work with an experienced injector who understands facial balancing—especially given the changes from your previous lip lift. Combining DAO Botox with treatments in nearby muscles, such as the mentalis or platysma, may also enhance the outcome depending on your facial anatomy.
Best of luck!
Genie Alexander, RN BSN 
for Anna Petropoulos, MD FRCS 
Center for Classic Beauty
Boston & Danvers, MA

Mark Berkowitz, MD · Answer

Hello, thank you for your inquiry. The downward turn in the mouth is a result of natural aging from decreased cheek volume, bone resorption and the DAO muscle pulling the corners of the mouth down over time. Optimally, Botox, fillers and laser can be used to treat the area. If fillers are unwanted, DAO Botox can be used to prevent the area from worsening. There is a risk that the DLI muscle, a muscle that is used to smile, can be injected because it is so close to the DAO muscle. However, if this happens, the other DLI muscle can be hit to make the smile appear more even. Increase jowling would potentially come from masseter Botox because if we slim the jaw, skin laxity can still persist. Overall, DAO Botox has significant benefits but you may need more intervention depending on how much correction you are looking to achieve.

Anna Chacon, MD, FAAD · Answer

Using Botox to target the Depressor Anguli Oris (DAO) muscles can be an effective way to address a downturn in the corners of the lips. Here are some pros and cons to consider:

Pros:

Improves Lip Appearance: By relaxing the DAO muscles, Botox can help lift the corners of the mouth, reducing the appearance of a frown or downturn.

Non-Invasive: Botox is a minimally invasive procedure with no downtime, making it a convenient option for those seeking temporary improvements.

Quick Procedure: The treatment is fast, typically taking only a few minutes to perform, with results visible within a few days to a week.

Temporary Effects: The effects of Botox are temporary, lasting about 3 to 4 months, allowing for adjustments in future treatments based on results.

Cons:

Potential for Asymmetry: If not administered precisely, Botox can lead to asymmetry in the smile, which may require additional treatments to correct.

Risk of Increased Jowling: Relaxing the DAO muscles can sometimes lead to a slight increase in jowling, as other muscles may compensate for the reduced activity.

Limited Duration: The temporary nature of Botox means that regular maintenance treatments are necessary to maintain the desired effect.

Possible Side Effects: As with any injectable treatment, there is a risk of side effects such as bruising, swelling, or unintended muscle relaxation.

Considering these factors, it may be beneficial to consult with an experienced dermatologist or plastic surgeon who can assess your specific needs and provide guidance on whether DAO Botox is the right choice for you.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. In your case, since you're experiencing a downward turn or frown-like appearance of the lips following a lip lift and you're not interested in filler, I recommend DAO Botox to help soften the downward pull. The depressor anguli oris (DAO) muscle is responsible for pulling the corners of the mouth downward, and relaxing this muscle with Botox can help lift the corners slightly, creating a more neutral or pleasant resting expression. While it's true that over-treatment or incorrect placement can lead to smile asymmetry or contribute to jowling, when performed conservatively, DAO Botox can offer a subtle and natural-looking improvement. It's a minimally invasive option to consider while you plan for future surgical interventions like a facelift. I hope this helps and best of luck!

Glenn Murray, MBBS · Answer

Botox in the depressor anguli oris muscles can relax their pulling down action and in turn may aid in a less down-turned mouth. 
The risk of this treatment does include asymmetry but with a small dose to start with and if placed in the correct muscle by an experienced injector, the risks of this is lessened.

Good luck!

Camille Cash, MD · Answer

Botox injection to the DAO area can help improve the appearance of a downturned mouth and marionette lines.  To keep risk low of undesirable effects be sure to see an experienced injector and discuss your concerns prior to treatment.

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