Advise on sagging mouth and chin (Photo)

Question

Hello, what procedure would you advise to get the under mouth zone "happy " again? Upwards instead of downwards. See picture

Lexie Wang, MD · Answer

YOu have 3 options, all of which are reasonable:
1) botox- get botox to the DAO/platysma to prevent the muscles from pulling the lip downward
2) filler- filler to back of jaw/upper cheek area to pull back/lift on the cheek to lift the corner some
3) lift procedure- face/neck lift to release and reposition everything underneath back to its original position

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concern. From your description and photo, the area that tends to create the “sad” or downward appearance is usually a combination of:

Downturned corners of the mouth
Loss of support in the lower cheek and jawline
Early jowl formation
Volume loss around the chin and marionette lines

For someone wanting the under-mouth area to look more lifted and “happy” rather than pulled downward, I would generally think about treatment in layers rather than trying to fill the crease directly.

The options that usually help the most

1. Botox for the depressor anguli oris (DAO) muscles
A small amount of Botox can relax the muscles that pull the mouth corners downward. This is often one of the simplest ways to create a subtle upward turn to the corners of the mouth.

2. Filler for structural support
Instead of placing filler only in the fold, a better result often comes from adding support to the pre-jowl area and chin. This can soften the marionette shadow and improve the contour of the lower face without making the mouth look heavy.

3. Jawline support
If there is mild sagging along the jawline, strategically placed filler can improve the transition from the chin to the jaw and reduce the “pulled down” look.

What I would avoid

Trying to place a large amount of filler directly into the marionette lines or the crease under the mouth can sometimes make the lower face look puffier or heavier, which is the opposite of the lifted effect most people want.

Based on your photo

Your concern appears to be mild to moderate lower-face descent rather than severe skin laxity, so I would lean toward DAO Botox combined with conservative chin and pre-jowl support as the most natural-looking approach. Procedures such as thread lifts or surgery are usually reserved for more significant sagging.

The encouraging part is that this type of “sad mouth” appearance is often quite treatable with relatively conservative treatments, and the best results usually come from restoring support around the mouth and chin rather than chasing the crease itself.

Advise on sagging mouth and chin (Photo)

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