Deep Downturned Lines Corner of Lips - How Can I Address This? (Photos)

Question

I am a 28F and i have started to notice these lines forming near the corner of both lips. Are these marionette lines? My lips have also recently started downturning would lip filler help address both theee issues? Is there anything else I can look into for yhis?

Anna Chacon, MD, FAAD · Answer

At 28, what you're noticing may be the very early development of marionette lines, but it's important to understand that not every line near the corners of the mouth is a true marionette line. In younger patients, these changes are often related to facial anatomy, muscle movement, genetics, or subtle volume changes rather than significant aging.

The downturned appearance of the corners of the mouth can make these lines seem more prominent. In many cases, the muscle that pulls the corners of the mouth downward becomes more dominant over time, creating a slightly sad or tired appearance even when the face is at rest.

As for lip filler, it may help in certain situations, but it is not always the best solution for downturned mouth corners. Lip filler is designed primarily to enhance lip volume, shape, and definition. While a carefully placed filler treatment around the mouth can sometimes provide support to the corners and soften nearby lines, simply adding volume to the lips alone may not adequately address the downturning.

The most successful treatments often depend on the underlying cause. For some individuals, subtle filler placement around the corners of the mouth or lower face can provide support. For others, relaxing the downward-pulling muscles with neuromodulators can improve the appearance of a downturned smile. If skin quality is contributing to the issue, collagen-stimulating treatments, microneedling, or laser procedures may also be beneficial.

One thing I would keep in mind is that at your age, these changes are often mild and highly treatable. Early intervention typically requires much less product and produces more natural-looking results than waiting until the lines become deeply etched.

Based on your description, it sounds like the downturning of the mouth corners may be contributing as much as the lines themselves. Treating the entire perioral area—the lips, corners of the mouth, surrounding muscles, and skin quality—usually provides a more balanced and natural result than focusing on the lines alone.

Carl Truesdale, MD · Answer

The downturned line you're describing (marionette line or oral commissure droop) comes from a combination of muscle pull and volume loss at the corner of the mouth.
What creates the appearance:
DAO muscle (depressor anguli oris): the muscle pulling the corner of the mouth downward. Becomes more active with age and emotional habit. Creates both the downturn and the line running from the corner down to the jawline.
Volume loss at the oral commissure: the small fat pad supporting the mouth corner deflates with age, exposing the muscle pull and deepening the line.
Skin laxity: as the lower face descends, the cheek tissue pushes the mouth corner downward further.
Treatment approach by severity:
For mild downturned corners:Botox to the DAO muscles (2 to 4 units per side). Softens the muscle pull, lets the corner rest in a more neutral position. Lasts 3 to 4 months per treatment.
For moderate (mild + visible line):Botox to DAO + small amount of HA filler at the oral commissure to restore lost volume. Filler is the technique-sensitive part &mdash; should be placed deep and conservative.
For deep, etched lines:The layered combination above plus consideration of microneedling or fractional laser for skin texture remodeling along the line. For significant cases, a lower facelift addresses the underlying descent pushing the corner down.
What I'd avoid:
Heavy filler placed directly in the line (creates a sausage ridge).
DAO Botox alone if there's significant volume loss (corner stays downturned even without muscle pull).
Ignoring the underlying lower-face descent if surgery is on the table.
Realistic expectations:The downturned corners often have multiple contributors. Single interventions usually give 30 to 50 percent improvement. Layered treatment over a year (DAO Botox every 3 to 4 months + filler 1 to 2 times + occasional skin work) can give 60 to 80 percent improvement.
If your photo shows obvious lower-face descent in addition to the corner droop, a surgical consult might give you more durable correction than years of injectable maintenance.
Best move: find an injector who treats this region routinely. Ask to see before/afters specifically of patients with mouth corner droop. Technique varies a lot and patient selection matters.

Paul Flashner, MD · Answer

A neuromodulator, such as Botox or Dysport, would be more effective at treating the downturned corners of the lip than filler. This treatment will relax the muscle that is causing the downturned effect in the area. As for the marionette lines, filler could be used to help with the appearance. The two together combined with anti-aging treatments such as Morpheus8 will give you the best results.

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided any frontal view photographs.  You may or may not benefit from a lip lift.  I would need more photographs to give you a more accurate answer.

Best Wishes,

Gary Horndeski, M.D.

Frank Agullo, MD · Answer

Marionette lines this early are catchable. The corners of your mouth are getting pulled down by a small muscle called the depressor anguli oris (DAO), and the tissue around the corner has deflated a touch. Both pieces are easy to address. I put a few units of Botox into the DAO on each side to take the pull off, then I add a small bit of HA filler at the corner and along the marionette line itself, deep, with a cannula. Restylane Defyne and Juvederm Vollure are both good choices because they move with expression instead of looking stiff. Don't go superficial or heavy. Puffy lower face is the failure mode. Skip threads here, they don't last at the mouth corners. The combo I described is about ten minutes of treatment, no real downtime, and holds about a year. Plenty of time to reassess at 29.

#StayBeautiful,

@RealDrWorldWide

#StayBeautiful,

@RealDrWorldWide

Nelson Lee Novick, MD · Answer

A front view photo would have been additionally helpful to evaluate cheek volume. However, at least from the profile view provided, the use of a robust HA lifting filler would easily straighten the down-turned sad lines at the corner of the mouth. At least from what I can see, there is little upper cheeks volume loss. However, if there were, the use of a robust HA volumizing filler for the cheeks would likely provide the additional lift necessary to further improve the marionettel lines. You would be wise to consult with an experienced, board certified cosmetic dermatologist expert filler injector and best of luck.

Deep Downturned Lines Corner of Lips - How Can I Address This? (Photos)

Answers (6)

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