Will lower face Botox help with mild facial accordion lines?

Question

Will lower face Botox help with mild facial accordion lines? I know it helps DAO but looking to for lower face treatment. Tried fillers and rf microneedling and didn't like it. 37 years old.

Anna Chacon, MD, FAAD · Answer

Yes, Botox can sometimes help with mild “accordion lines,” particularly when those lines are caused or made worse by repetitive muscle movement. The lower face has several muscles that can contribute to these creases, so treatment needs to be individualized rather than simply injecting the DAO. Botulinum toxin has been studied and used for several lower-face concerns, including perioral wrinkles, marionette-type lines, and mentalis activity.

The important distinction is whether your accordion lines are dynamic or static. If you mainly notice them when smiling, talking, or moving your mouth, a small amount of Botox may soften the muscle activity responsible and make the lines less pronounced. If the lines are visible even when your face is completely relaxed, Botox alone is less likely to eliminate them because there may also be a component of skin laxity, collagen loss, or volume changes.

Since you have already tried filler and RF microneedling and did not like the results, a conservative neurotoxin approach could be reasonable, depending on exactly which muscles are creating the folds. However, I would be particularly cautious around the mouth. The muscles in this area are important for speaking, eating, smiling, and keeping the lips properly sealed. Too much toxin or injection in the wrong location can temporarily affect lip movement, smile symmetry, or oral competence.

At 37, I would generally favor very subtle treatment rather than trying to completely freeze the lower face. The goal would be to reduce the repetitive muscle forces that are creating the creases while preserving your natural expressions.

So, yes, lower-face Botox may improve mild accordion lines, especially if they are predominantly movement-related, but it is unlikely to completely erase established lines. The exact muscles responsible matter much more than simply treating the DAO, and lower-face injections should be performed conservatively because of the functional anatomy in this area.

Nelson Lee Novick, MD · Answer

You are quite correct that DAO Botox would not be appropriate for what sounds like parallel laugh lines or what you are calling lower facial "accordion" lines, which typically are located parallel to the mouth in the lower face and become more pronounced with smiling. And there is also little surprise that microneedling did not work, since its primary value is for treating superficial, surface color and textural and is of little value for deeper lines or for lines that arise from the dynamic motion of the underlying muscles of facial expression. (As an aside, and for the benefit of other readers of this response, there is especially little benefit from RF microneedling, since the RF, due to the heating of the skin, primarily adds to the expense and to the risks for adverse reactions). The use of an appropriately low viscosity, cohesive, malleable filler fanned properly and in the correct direction beneath the accordion lines can work quite well for this condition. I have been using this approach with satisfying results for quite a few years already. You would be wise to make sure to consult an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin. This is a great question. I highly recommend scheduling an in-person consultation in order to better assess your areas of concern and discuss an appropriate treatment plan to help achieve your aesthetic goals. Our office phone number is: (312) 944-0117. I hope this helps and best of luck!

Camille Cash, MD · Answer

I encourage you to visit with an expert injector for an evaluation to determine appropriate options for you.  Typically fillers or Morpheus8 treatments are beneficial but you stated they did not work.  Botox is not typically used for this purpose.

Will lower face Botox help with mild facial accordion lines?

Answers (4)

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