Third Botox injection in the DOA muscle, still no results (Photo)

Botox injection to the DOA muscles is best performed in a subtle fashion.  A heavy hand with Botox in the perioral region will lead to a 3-4 month problem which is best avoided.  Perhaps a filler to the marionette lines/ oral commissures will provide more benefit and higher satisfaction.  Sculptra in the cheeks is a separate issue, which requires time, patience, and multiple injection sessions.

Sorry to hear about your lack of results with Botox and Sculptra. If you have had 3 attempts without any results, then I would not attempt anymore as you are putting yourself at risk for complications. I would go ahead with filler to the area. It should help, and results are immediate.

Hello NYCbee,If you haven't gotten the results you need from DAO Botox alone, it may be helpful to add a little injectible filler into the marionette's lines to add volume into this area.  As far as being able to make a frown goes, there are more muscles than the DAO that contribute to frowning.  The problem is that trying to add Botox to all these muscles would cause oral incompetence which is functionally and socially disruptive.  I think filler is the safest option.Good luck,Dr. Shah

I just want to issue some caution with injections of botox around the mouth. Botox can take 72 hours to kick in. Even when injecting the DAOs, this can distort the normal movement and smile of the mouth. You may look a little different. My recommendation for marionette lines is filler.Best of luck.- Dr. Bryson Richards

There are many ways to look at the
frown muscle of the mouth and the DAO.
From the photographs you submitted it looks like you have a combination of
volume loss in the chin area (which is very common as we age) as well as the
corners of the mouth turning down. Usually relaxing the DAO with up to six or
seven units of Botox or other products such as Xeomin and Dysport, is one method.
However, improving volume along the jawline and chin as well as relaxing the
chin muscle may give far more improvement. If you continue to be unsatisfied and have waited for the Sculptra to work
seek out a second opinion from an experienced injector. Sculptra is very
effective not only in the cheek area but in the area around the chin and lower
face to create volume and improve the corners of the mouth drooping. However it
is very technique dependent and requires several treatments. That being said,
it seems you would be an excellent candidate for both treatment of the DAO as well as Sculptra. Hope that is
helpful. Best of luck.