Do the corners of your mouth drift downward even when you feel fine? That subtle pull can cast a tired or stern expression, and a few precisely placed Botox injections often lift and soften those corners, restoring a more neutral or gently upbeat look without changing who you are.
Why mouth corners turn down
A downturned mouth usually comes from a mix of muscle dominance, skin laxity, and volume changes. The star culprit is the depressor anguli oris, or DAO, a triangular muscle that pulls the corners of the lips toward the jawline. When it overpowers the elevators of the mouth, your resting expression can skew sad or skeptical. Genetics can make the DAO naturally strong. Over time, repetitive expressions reinforce that pattern.
Aging compounds the effect. Collagen and elastin decline, so skin loses snap. The fat pads that once propped up the lower face thin and descend, which can deepen marionette lines and flare the shadow under the mouth corners. Dental changes, like tooth loss or shifting bite, can alter support for the lips and lower-third. Lifestyle factors matter too. Chronic clenching or bruxism tightens the lower-face complex. Even phone posture that pushes the chin forward can subtly recruit the DAO.
Clinically, I have seen patients in their late twenties with hereditary DAO dominance and minimal skin aging, and patients in their sixties where the DAO is part of a broader architecture shift. The approach differs, but the goal is the same: rebalance the system so the corners rest at neutral or with a slight lift.
How Botox helps
Botox, a neuromodulator, relaxes targeted muscles by blocking the nerve signals that trigger contractions. In the lower face, small doses into the DAO reduce its downward pull on the mouth corners. Pairing this with conservative injections into nearby muscles, such as the depressor labii inferioris when indicated, can fine-tune symmetry without impairing speech or eating.
Think of it as easing the tug-of-war. By softening the downward force, the natural elevators — zygomaticus major and minor, levator anguli oris — can do their quiet work. The result is not a stiff upper lip, but a softer resting shape. The effect typically appears in 3 to 7 days, peaks around 2 weeks, and lasts about 3 to 4 months on average. Some patients hold results closer to 10 to 12 weeks, others up to 5 months depending on metabolism and muscle strength.
When patients ask whether Botox can also treat the etched lines that travel from the corners downward, I clarify that Botox is most effective for dynamic pull, not fixed folds. For deep marionette lines or nasolabial folds, fillers, biostimulators, or energy-based tightening can complement treatment. That combined approach often provides the most natural, lifted result.
The art and anatomy of DAO injections
Anatomy knowledge matters more here than in almost any other facial zone because the margin of error is small. The DAO lies lateral to the chin muscle and above the mandibular border. Precise placement stays superficial and lateral to avoid unintended weakness of the depressor labii inferioris, which could cause asymmetry of the lower lip during speaking or smiling.
I evaluate mouth corners from several angles. With the patient at rest, I assess symmetry, the depth of marionette lines, and the lower dental show. I then ask for a slight smile and a gentle frown to see the DAO fire. Palpation helps find the muscle belly. For most faces, two points per side, with micro dosing, give control without heavy-handed change.
Those coming in for a quick refresh — the kind of lunchtime Botox many people prefer — often worry about over-smoothing or lip incompetence. Proper dosage avoids both. In strong DAOs, I start conservatively and schedule a follow-up in two weeks to add one or two units if needed. That approach prevents the “over-corrected” look and leans into a subtle botox natural finish.
What a session looks like
A typical visit begins with photos in neutral lighting, then mapping points with a white cosmetic pencil. The skin gets cleansed, and if you are sensitive, a quick ice press helps. The injections take under five minutes. You might feel a tiny sting or pressure. Afterward, there is minimal bleeding, and most patients return to work or errands immediately.
I give straightforward aftercare: keep your head up for four hours, avoid heavy sweating or massages on the area that day, and skip aggressive facials for 24 to 48 hours. Makeup is generally fine after a couple of hours if the skin looks calm. Bruising is uncommon but not impossible. If you have a big event, schedule at least two weeks prior so results settle and any tiny marks fade.
Many of my regulars pair this with other micro botox touch points for a balanced glow — a few units in the glabella to lift the brow tail, a light sprinkle across forehead lines, or baby botox around the crow’s feet for a refreshed look. One patient calls it her botox refresh session, saying it keeps her face looking rested through tough workweeks without telegraphing that she had anything done.
Dosing philosophy: less, then layer
Lower-face Botox rewards a minimalist mindset. The mouth is expressive and functionally busy. Over-relaxation here can feel odd and appear unnatural. My dosing philosophy for DAO work follows three rules: start low, assess function, and layer only when needed. Baby botox or mini botox — small, strategic amounts — makes sense here. For first-timers, beginning with conservative micro botox injections prevents surprise changes and helps us learn your muscle response.
I have had patients who needed only 2 to 3 units per side, and others with robust lower-face pull who required 5 to 6 units per side to reach preferred results. The difference often correlates with baseline muscle strength and jaw habits like clenching. Even at the upper end, we stay cautious. I would rather do a second visit for refinement than risk lip dysfunction.
The role of balance and adjuncts
Lifting mouth corners with neuromodulators interfaces with a broader concept: facial balance. Sometimes, a slight eyebrow lift via neuromodulator treatment brightens the upper third, which in turn makes the lower-face changes feel more cohesive. In other cases, subtle filler support along the marionette lines, pre-jowl sulcus, or chin lends structure so the lift reads as natural.
For patients with strong masseters from bruxism, botox for clenching can slim the lower face over time, which may indirectly soften the downward pull by relaxing perpetual tension across the jaw and mouth corner lines. Addressing bruxism also reduces mechanical stress that deepens creases. I often synchronize DAO treatments with masseter reduction if someone complains of grinding-related pain. The combination can reduce morning jaw tightness and create a gentler jawline migration from square face toward a heart-shaped face, when that aligns with the patient’s goals.
Those with visible neck banding sometimes benefit from addressing platysmal bands. Botox for neck bands can relax the vertical cords that tug downward, adding a light lifting effect at the jawline. It is not a facelift, but it can nudge the perception of lift and reduce the downward vector that feeds into mouth corner heaviness. Patients with mild laxity often appreciate how this small upgrade contributes to botox lifting and contouring across the lower face and neck.
What results feel like
Most patients describe the early days as subtle. The corners feel less heavy. Your neutral expression softens. When you smile slightly, the corners no longer hitch downward first. People often comment that you look less tired, less stern. Friends might ask about a haircut or a skincare shift. That is because a successful result looks like you on a good day.
If you are used to exaggerated expressions, the new balance can feel oddly quiet for the first week. Give it time. Function typically feels normal once your brain recalibrates. Skilled placement preserves articulation. Your S and F sounds should remain crisp, and you should be able to drink through a straw. If anything feels off, good clinics provide check-ins and minor adjustments.
Safety, side effects, and red flags
When injected by a trained practitioner with an advanced botox technique, DAO treatment is generally safe. Common minor effects include pinpoint bruising, slight tenderness, or a temporary feeling of tightness. Rarely, diffusion into nearby muscles can create asymmetry of the lower lip or difficulty depressing it. That is typically dose- and placement-related and fades as the neuromodulator wears off.
A few practical safeguards from clinical experience: avoid blood-thinning supplements like high-dose fish oil or ginkgo for several days pre-appointment if your physician deems it safe to pause. Share your medical history, including botox services in NC any neuromuscular conditions. Confirm that your provider uses a known aesthetic neurotoxin and can tell you the vial lot number. A professional botox treatment should also include consent, pre- and post-care guidance, and a plan for follow-up.
Red flags include heavy-handed dosing promises, one-size-fits-all mapping, and pushy upselling of unrelated procedures. The lower face demands customization. If your lips or smile are your signature features, protecting their movement is non-negotiable.
Who benefits most
Ideal candidates have a visible downward pull of the mouth corners that worsens when they attempt a small smile or when their face is at rest. The skin still has some elasticity, and the primary issue is dynamic, not purely structural. That said, I have treated patients with mild to moderate marionette lines who saw meaningful improvement after carefully combining DAO relaxation with conservative filler support.
Younger patients sometimes ask about preventative botox or prejuvenation botox in this area. If the DAO is dominant early and you are noticing habitual downturning, small, spaced-out sessions can train the muscle out of its overactive habit, much like catching forehead frown lines before they etch in. The goal with preventative botox is not to freeze expression, but to reduce the repetitive strain that turns movement into a line.
For more advanced aging with sagging skin or deeper folds, neuromodulator alone is unlikely to satisfy. Adding a biostimulator, energy-based skin tightening, or surgical lifting might be the honest path. A trustworthy provider will tell you where Botox ends and other modalities begin.
Planning a personalized approach
Personalized botox treatment begins with a mapping session that accounts for your facial dynamics, jaw function, and goals. We talk about trade-offs, like choosing a slightly subtler lift to protect strong lip movement for wind instrument players or public speakers. We review where you are in your skincare and structural plan. A customized botox plan beats a rote pattern every time.
In many cases, the DAO solution fits within a broader botox rejuvenation treatment that targets small, strategic zones:
- A light eyebrow lift for droopy brows, if your lids feel heavy or you crave a touch more eye openness. Feathering near bunny lines for harmony around the nose when you smile. Smoothing a dimpled chin, especially if mentalis overactivity creases the chin pad and compounds the downward mouth cue.
I keep the total dose low, spreading it smartly. It respects your face’s choreography. As an example, a 42-year-old attorney I treat every four months prefers a barely-there correction. She gets micro botox in the DAO, 1 to 2 units per point, plus a whisper in the chin, and a few units at the lateral brow tail. Her colleagues tell her she looks “refreshed” after big cases. That is the standard I aim for.
Timelines, touch-ups, and upkeep
Results appear within the first week and refine by day 14. I schedule a two-week check. If one side needed more lift or if initial dosing was intentionally conservative, a small add-on finishes the look. From there, expect to maintain with a botox upkeep schedule every 3 to 4 months. Some patients with slower metabolism or lighter activity can stretch to 5 months. Others, especially active athletes or those with high baseline tone, prefer every 10 to 12 weeks.
A steady botox maintenance routine tends to yield the most natural outcomes. Muscles do not get a chance to rebound aggressively, and adjustments remain micro. If life gets hectic and you push past the window, we simply rebuild with the next visit.
Pairing with skin quality improvements
Even subtle corner lifting looks better over a healthy canvas. Skin smoothing botox using microdroplet techniques can soften pore visibility and sebum around the lower cheek for some patients, though I avoid microdroplets too close to the lip line to preserve movement. For those with perioral lines or smoker’s lines, a light blend of neuromodulator and ultra-soft filler can ease barcode etching while keeping lip mobility. If oiliness and enlarged pores bother you, adjunct treatments that refine texture help the mouth corner area appear crisper even when makeup is minimal.
I occasionally meet patients chasing a botox glow for photo-ready skin ahead of events. Done early enough — at least two weeks before — combining a DAO lift with gentle facial wrinkle softening and a low-risk skin polish can create a red carpet look without heavy makeup. One caveat: avoid trying something brand new right before big occasions. Familiar, well-tested protocols yield predictable, calm skin.
Common questions I hear
How many units will I need? It varies. A typical range for DAO work is often low single digits per side, with stronger muscles requiring slightly more. Starting modestly protects function. Your provider should tailor the dose to your face.
Will it look obvious? Not if it is done thoughtfully. The aim is a soft rebalancing, not an artificial upturn. Subtle botox results read as a relaxed, neutral corner, not a cartoonish smile.
What about marionette lines? Botox reduces the downward pull that can deepen them, but etched lines often need structural support. A small amount of filler along the marionette track or pre-jowl region can pair well. In selected cases, a collagen-stimulating solution improves long-term texture and firmness.
Can I combine this with masseter Botox? Yes, especially if clenching drives lower-face tension. Many of my bruxism patients appreciate the dual benefit: reduced jaw pain and a gentler jaw angle over time, with the mouth corner lift completing the picture.
Does it affect eating or speaking? Correct placement should not. Mild, temporary changes in muscle feel are possible the first week. Clear articulation and straw use typically remain intact. If you experience difficulty or asymmetry, contact your provider for assessment.
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When Botox is not enough
There are edge cases where a neuromodulator cannot deliver the lift you want. Heavy skin laxity, significant volume descent, and strong bony recession in the chin or jaw may limit the payoff. If you pinch the skin just beside your mouth corner and lift, and the improvement disappears the moment you release, that hints the issue is structural rather than purely muscular.
In those cases, consider complementary strategies. A conservative chin filler can lengthen support and reduce mentalis strain. Pre-jowl sulcus filler can align the jawline. Energy-based tightening can shrink-wrap mild laxity. In deeper aging patterns, surgical lifting repositions the tissues that no injectable can overcome. The honest conversation is the most valuable part of the consult.
Small technique details that matter
I avoid injecting too medially. Drifting toward the central lower lip risks weakening the depressor labii inferioris. I keep doses superficial, because deep placement can miss the right fibers or spread where we do not want it. I ask patients to gently activate the frown to verify location, then relax fully for the injection. A slight bevel and slow injection minimize discomfort.
Mapping asymmetry matters. Almost everyone has one side that pulls lower. I often treat the stronger side with a hair more product or an extra point. For patients with prior filler migration in the lower face, I palpate for material that could alter diffusion patterns. Though rare, filler presence may change how I plan the injection spacing. These micro-decisions are where professional judgment shows.
Cost, value, and realistic expectations
Pricing varies by region, brand, and practice model. Because dosing is small, DAO treatments are typically on the lower end of a neuromodulator visit. The value hinges on precision and follow-up. You are paying as much for a steady hand and a measured plan as for the product itself. Expect to budget for maintenance if you want steady results. Some patients align sessions with seasonal schedules — a botox rejuvenation session in spring and fall — while others keep a quarterly cadence.
Realistic expectations keep satisfaction high. The effect is a gentle lift, not a smile frozen in place. Think of it as removing the unintended frown from your resting face. If your goal is a dramatic transformation of jowls Cornelius botox or heavy folds, bring that up so your provider can outline a staged approach using multiple tools.
A brief case example
A 36-year-old designer arrived with a complaint that her resting face looked scoldy on Zoom. On evaluation, she had mild DAO dominance and early marionette shadowing, but good skin quality. We started with 3 units per side for the DAO and 1 unit per side in the chin to relax the pebbled texture. Two weeks later, the corners sat neutral, her smile initiated smoothly, and the shadowing softened. She returned at three months for a small touch-up. At six months, we added a single syringe of soft filler into the marionette line entry to support the corner. Twelve months in, her maintenance doses remained modest and her expression stayed easy.
Building your plan
If your mouth corners read lower than your mood, a focused consultation can map the moving parts. Ask for a personalized botox plan that prioritizes natural looking botox with subtle enhancement, and discuss whether adjuncts would add value. Review photos, talk through timelines, and set concrete goals like reducing the downward pull by a degree that still feels authentic on your face.
When the plan clicks, the process is quick. Many of my patients book a weekend botox slot or a lunchtime botox visit, then head back to their day feeling the small lift of confidence that comes from a face that reflects how they feel inside. Done well, a DAO treatment is not about chasing trends. It is about alignment — turning up the corners so your expression meets your message.