Botox for downturned mouth. Is Botox for this issue fairly foolproof?

Question

I am 41 with a slightly downturned mouth. The aesthetics nurse at PS office recommends Botox followed by filler. Is Botox for this issue fairly foolproof (with an experienced injector)? She said best case Botox will neutralize downturn; it will not have a poor outcome. Unless this is entirely accurate, perhaps filler only is a safer option?

Jerome Edelstein, MD · Answer

In medicine there is nothing that is foolproof. But yes, if you have an experienced injector, the combination of Botox and filler should give you very good results.

Kevin M. Robertson, MD, FACS · Answer

It seems like you are getting accurate information and guidance from your providers.  Botox can be used in the depressor muscles of the corner of the mouth, which allows the lips to take on a more neutral position at rest.  With animation, other muscles elevate the mouth, so smiles are not affected.  Most patients describe it as a nice softening of the mouth, while still looking natural.  It's simple, requires modest amounts of the drug so is not very expensive, and has no down time.  It is not foolproof though, as any intervention can still leave bruising, asymmetry, or an effect that is too subtle or shortlived.  That truthfully is rare though.  If the mouth still has a downward shape, or if you also have folds running inferiorly from the corner of the mouth, the addition of fillers adds another tool to improve the aging mouth.  The combination of botox and fillers can be done sequentially, or at the same time.  It just depends on how aggressively you want to address the oral commissure position and the melolabial folds.  Both are very straightforward, effective, and natural.  Botox does break down faster though, so some patients opt for fillers just because of duration concerns.

Nelson Lee Novick, MD · Answer

I have been using Botox for aesthetic reasons since 1991 and have a great deal of experience with it (as well as with the use of the other neuromodulators Dysport and Xeomin) for treating many regions of the face, neck and decollete, including  downturned angles of the mouth. There is no question that in the hands of an experienced injector able to place the correct amount of Botox within the precise muscles that pull the angles of the mouth down that the results of this treatment can lift the angles and straighten the sides of the mouth.That being said, this is ordinarily not be my first choice of therapy for a number of reasons. For one, Botox effects last only about three to seven months before retreatment is required. For another, the lift that can be obtained by properly injecting a volumizing filler, such as Perlane L (which would be my choice in my Upper East Side Manhattan practice) and Emervel Volume (my first choice in my Israel satellite facility, where a far greater number of regulatory agency approved fillers and volumizers are available) is more dramatic and the overall aesthetic improvement greater. In my experience, the results of this approach are more dramatic and last longer--about a year. Not uncommonly, to further refine the correction and to prolong the life of the results, I will add a couple of droplets of Botox to the appropriate muscles, but only after I have first used the volumizing filler.

Anh-Tuan Truong, MD, FACS · Answer

I have injected Botox to the depressor anguli oris with good result.  This is not a common muscle to be injected so I would agree with getting it done by an experienced injector who knows the anatomy.  Depending on your anatomy and severity of the downturn, a filler like Juvederm to the "marrionette lines" and oral commissures may improve the downturn.  Often I use both of these modalities in combination to achieve the desired result.  Best of luck!

Michael A. Zadeh, MD, FACS · Answer

Knowledge of the anatomy of the muscles which are responsible for creating a downturned smile is crucial in preventing complications from this injection. I would definitely choose an experienced physician injection to perform these injections rather than a nurse. Starting with a conservative dosing is also important in order to avoid the "joker" smile. Often, fillers are also needed to give the best result. Best of luck to you.

Peter J. Capizzi, MD · Answer

For this particular area, I would recommend using a Filler over Botox.  I have not seen or assessed you in person; however, typically I would treat the oral area with filler.  Juvederm is a great filler and when used correctly it gives excellent results that could last up to 6 months or longer.  Research injectors in your area, find out how long they have been injecting, what their credentials are, and if they have any before and after photos of their actual patients for you.  Good luck!

Suzanne Kilmer, MD · Answer

I love botox for the downturned
corners of the mouth but it is NOT foolproof! I assume everyone that I do this
on is a “cheap date”. In other words I undertreat them with only a few units
with correct placement (very important as well). If you go too medial it can
affect the lower lip. If it is too much you can have trouble moving food around
in your mouth.  I wait a full 2 weeks before I inject any more as it can
take that long to kick in and I ask specific questions to see if they are having
any side effects and if they need a touch more, then I add only a bit more and
wait another 2 full weeks. Once we get it right where there are no side effects
and good upturned corners then I have a feel for how that individual person
does and we can plan for the next time.  However I ask those same questions
everytime I see the patient as people’s tolerance can change over time. Having said
that I have MANY happy patients with perioral botox and it can take years off
your lower face. And yes, filler is a great adjunctive treatment, but doing the
botox often decreases the amount of filler you will need and botox is much
cheaper than filler. One final caveat, the two together can both cause weakness
in the lips as the filler decreases the pliability of the skin (a good thing!)
but can make it harder to pucker, whistle, say peanut butter etc….all things an
experienced injector will know.

Stephen Weber MD, FACS · Answer

No facial injectable treatment is foolproof, unfortunately. In experienced hands, injection of the DAO is very straightforward but this requires a fair amount of experience. I do like the effect of the DAO injections in people with excess muscle activity at the corner of the mouth. I think the results look very natural and subtle. However, the overall affect on one's appearance can be significant. The key to a good result is to find a highly experienced injector. It sounds like you are in good hands. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Mark Mandell-Brown, MD · Answer

Buyer beware.  Botox is not indicated for that area and the  outcome can be unpredictable.    There are better options like Juvaderm or Restylane for the mouth area.

Chad Robbins, MD · Answer

I agree with the aesthetic nurse, Botox can help with preventing movement of those muscles from depressing/lowering ,  however, filler would be needed as well to get an optimal cosmetic result.

Botox for downturned mouth. Is Botox for this issue fairly foolproof?

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