What can be done for a lifelong permafrown? (photos)

I've had a permafrown (permanent frown) my whole life (32 years), the corners of my mouth remain down-turned at all times, even when smiling (see attached image). Is there anything that can be done so that I can actually smile? Thanks in advance for the help!

Doctor Answers 3

Injectable treatments like a Botox lip lift,or fillers for balance can help your downturned lips and smile

Thank you for the question. You provided a single photo referring to your condition with your mouth as having a permanent frown that’s present even when you are smiling. I suspect you are referring to the way the outer corners kind of point downward even when you smile, and you are looking for a solution.

I can give you some guidance on how I explain the options to my patients with a similar type of situation, whether it’s genetic or a result of facial aging. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and helping people maximize and improve their appearance non-surgically and surgically are the core of my practice. I’ll discuss a little the relevant anatomy on how we address this type of issue.

In terms of movement of the mouth and the relative position of the outer corners of the lips, there are basically two approaches: one is to use a neurotoxin such as Botox®, Dysport®, Xeomin® to relax muscles to allow unopposed action of other muscles, which I’ll explain more; the second is to use fillers to provide volume in places to create the perception of a subtle and significant enough change.

With the neurotoxin concept, there are several muscles around the lips that determine the position at different areas or times of expression. One of the things we do is a Botox® lip lift where injections are placed in an area from the outer corner of the mouth and near the jawline to relax some muscles. This muscle is called the depressor anguli oris muscle, which depresses the outer corners of the mouth, and when relaxed the outer corners slightly elevate, so when you are smiling, the outer corners come up a little. This is something that has to be done consistently as the neurotoxin does wear off anywhere from 3-6 months, so consider factoring in the frequency.I think it’s reasonable to try out because if you don’t like it or if things don’t go the way you want, it wears off, which is pretty nice about non-surgical procedures.

The second option I would consider is the use of a filler to try to soften the depth of the line, and create a little fullness at the junction. I typically use a softer hyaluronic acid filler, something in the Restylane or Juvederm family. That can create a little support, almost like a pillar to lift the outer corners of the mouth. I think that combination will give you a little more of a smile than without anything. It doesn’t make a total change, but I think it will make enough of a change so you can see if you like it, then you can do it with some consistency.

There are surgical procedures and different types of suspension procedures that are more permanent, but from my perspective, I don’t find those to be that beneficial and consistent. I still feel injectable fillers have the most significant and reproducible role in this, which is not surgery, so it can be done in an office visit.

There are a lot of ways to enhance the area around the mouth and the different areas outside of the outer corners, so a more global look at your whole face and the anatomy may open up some opportunities to consider. Meet with qualified, experienced doctors who perform these types of injectables, learn more about your options, and take the first step in trying something out so you can see if you like the result, and if you are willing to keep that type of procedure ongoing to maintain a certain look. I hope that was helpful, I wish you the best of luck, and thank you for your question.

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New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews


Thank you for including a picture.  I agree that you would be best served seeing someone that is an expert injector to have a bit of Botox injected to relax the lip and a filler such as Restylane injected in the corner of the mouth to upturn the appearance of a "frown".  Good Luck!

Botox and Fillers

Thanks for the question and photos! There is something that can be done. In my opinion, i would try have some botox injected into your depressor anguli oris (DAO). It's a muscle that pulls the corners of your mouth down. Relaxing this will bring the corners up. The next thing to try is a little filler in the corners of your mouth to "push" them up a little bit, turning your frown upside down. Make sure to see someone with a lot of experience injecting, as there are other muscles around you mouth which if paralyzed will give you a crooked smile for a few months. Best of luck in you area!~Dr. Sieber

David A. Sieber, MD
Bay Area General Surgeon
5.0 out of 5 stars 34 reviews

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