Downturned mouth when talking and smiling - Can Botox help? Are there other options? (photos)

Question

Whenever my mouth is moving while talking or unconsciously smiling, it gets downturned like the attached photos. I’m not doing it intentionally and it really bugs me. I heard DAO Botox might help but im curious if there are permanent solutions as well.

Nima Shemirani, MD · Answer

Hi @Calm700774. You can inject a few units of Botox into the DAO muscle. Treatment will cause the corners of the mouth to be slightly lifted, giving the mouth a more relaxed, happy, youthful and pleasing appearance. You would repeat this treatment a few times a year.

Edward Buckingham, MD · Answer

Neuromodulators such as Botox may be helpful with down turning at the corner of the mouth. Intradermal fillers may also improve this area if volume loss is a factor. An in office examination with you provider to discussion treatment options is recommended.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. It is possible that dermal filler injections would produce favorable results for lifting the downturned corners of the mouth. These hyaluronic acid formulas can offer a powerful, yet subtle lift by adding volume to targeted areas of the face. Results from dermal filler injections can last for up to a year or more. 
For a more long-term solution, a corner lip lift can raise persistently downturned corners of the mouth. This surgical approach involves removing a small sliver of skin at both oral commissures, or mouth corners, for an enhanced, long-lasting result. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or injector. They will be able to determine the best approach to help you achieve your aesthetic goals.

Jason Emer, MD · Answer

A downturned smile or permanent frown can be improved with a combination approach, including neuromodulators (such as Botox, Dysport, and Jeuveau), injectable fillers, and radiofrequency skin tightening treatments such as Thermage or Venus Legacy. I recommend getting a formal evaluation with an experienced cosmetic dermatologist to develop a treatment plan that works for you. Best, Dr. Emer.

Chuma Chike-Obi, MD · Answer

Botox helps with this version of 'sad face,' or 'mad face'
Treating the DAO muscles (depressor anguli oris) and the plastysma muscles in this are help to treat this issue.

Dean P. Kane, MD, FACS · Answer

Dear Calm700774,
Thanks for sharing your photos. You appear to have very youthful lips and minimal downward pull of the corners of the mouth.

Much like the center hub and spokes of a bicycle wheel, the mouth and lips are surrounded by circular and radiating muscles to produce the pursing and pulling patterns of expression that we experience.

Any relaxation or weakness along the circle or the radiating muscles will have an effect on the whole.

Tiny amounts of “botox”, an injectable muscle relaxant,  can be used along the circular muscle of the upper and lower lip or the radiating muscles to relax the those muscles and allow the unopposed pull from the other muscles. Relaxation of the DAO (depressor anguli oris) muscle on either side of the chin will release the downward tension of the hub and allow the frown to reverse by the pull of the zygomaticus muscle group in the cheek.

Give it a try or use a properly injected filler  to assist in supporting the commissures in the natural marionette fold.

I hope this helps. Happy Holidays! All the best!

Camille Cash, MD · Answer

You may notice improvement with injections in DAO.  The final results are seen two weeks after injection and the effects will wear off gradually over three to four months.  Meet with an experienced injector to learn more.

Douglas Taranow, DO, FACOS · Answer

Botox in the DOA should have an effect in the corners of your mouth.  Everyone reacts a bit differently, but it is certainly worth a trial session. 
Best wishes 
Dr Taranow

Rita Rakus, MBBS - Account Suspended · Answer

Hello and thank you for your question. A face to face consult and examination is always best however in this scenario yes botox to the DAO's may help and would last around 4 months. It's worth trying this first to see if you like the result. Filler could also be used to support this area and upturn the corners of the mouth slightly. Please always seek treatment from a trained medical professional for any cosmetic treatment. Best wishes

Downturned mouth when talking and smiling - Can Botox help? Are there other options? (photos)

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