Botox in DAO muscle did not work. Why might this have happened?

Thanks for the question.Injecting Botox to the lower face is of course "off-label" use but many of us safely offer it in selected patients. It is important to be conservative in injecting the area around the mouth to avoid migration of the Botox/Dysport/Xeomin to muscles that are not the targets for the treatment. A couple of things may explain the apparent lack of effect of the Botox you had injected to the DAO:1. Inexperienced or just plain not a great injector. Is this the same person who injected you in the past?2. Conservative use of product - the injector may have been taking extra precautions in injecting the area for the reasons above and perhaps you need more product3. Habituation to Botox - your body may require slightly more units than you previously required even with identical injection technique, though I am not sure I truly believe this as a phenomenon 4. (most likely) The issue you are trying to correct is not correctable anymore with Botox but may instead require fillers. As we age, the corners of the mouth turn down and our jowls and nasolabial folds become more prominent. This is a combination of gravitational changes and skin laxity. You may have too much "overhang" or "etching of the creases" around the corner of the mouth to be fully corrected with Botox in the first place. In person exam with a board-certified plastic surgeon, facial plastic ENT surgeon or dermatologist would be preferable to a nurse injector in most cases, in my opinion. At minimum, you should at least get a second opinion from another experienced injector as to what your options are in person.

Thank you for your question pompbeauty. I understand
your concern. Congratulations on the birth of your baby. Botox is a purified protein used to address wrinkles associated
with facial expression.In the lower face Botox can be placed in the DAO muscle which pulls down the corners of the mouth. This will lead to a slight elevation of the corners of a downturned mouth and improve a sad face appearance. It is important to use low doses in the lower face because there are many muscles nearby that are required for eating, speaking, smiling, and general lip movement. If the product spreads to nearby muscle side effects may occur. The most common side effect when Botox is placed in the DAO is spread to the nearby DLI, the muscle that is responsible for pulling down on the lower lip. When this happens it may lead to the temporary appearance of an asymmetric smile. This can also occur when treating the cobblestone appearance on the chin from the mentalis muscle.It is difficult to make an assessment without before and after photographs. Also, you did not state the results after the second treatment. Was there improvement? Also was this the same injector as before? Every injector has a slightly different technique and some work better for certain people than others.
Please consult with a doctor for specific
recommendations. Good luck!