Some people naturally have stronger downward pull at the corners of the mouth. Others notice the change more with age.
If your mouth looks downturned at rest, the first question is whether muscle activity is actually causing the appearance.
At LIPS NY by Rainforest Medical Aesthetics, we evaluate the lips, mouth corners, lower face, and facial movement before deciding whether treatment of the depressor anguli oris—or DAO—makes sense.
Botox or Xeomin: $9.50 per unit
10-unit minimum — $95 minimum treatment
There isn’t one single cause.
The corners of the mouth can appear lower because of:
That means Botox or Xeomin is not automatically the answer.
Neuromodulator treatment is most relevant when muscular downward pull is an important part of what we see.
DAO stands for depressor anguli oris.
It is a thin muscle in the lower face that contributes to pulling the corner of the mouth downward.
When DAO activity is strong, it can contribute to a visibly downturned oral commissure at rest or during expression.
Botulinum toxin can temporarily reduce selected DAO activity, allowing the muscles that elevate the mouth corner to work with less opposition.
We look at your face both still and moving.
A DAO evaluation includes more than looking at a photograph.
We consider:
At LIPS NY:
The amount and placement are determined after examining your facial movement and treatment goals.
Because the muscles of the lower face are small and closely related to one another, treatment is intentionally individualized rather than based on a universal number of units.
No.
They can occur in the same part of the face, but they are not the same problem.
Treating the DAO does not physically replace lost volume.
And adding filler does not directly weaken an overactive muscle.
Some patients may have primarily a muscle concern.
Others may have primarily a structural concern.
Some may have both.
We determine which problem we are actually treating before choosing the treatment.
DAO treatment may allow the mouth corners to sit in a less downturned position when excessive muscle activity is contributing to the appearance.
But the degree of change depends on your anatomy and the reason the corners appear downturned.
We would not promise a dramatic “lift” when the appearance is primarily caused by volume loss, skin laxity, skeletal anatomy, or another structural factor.
Botox and Xeomin do not add volume to the lips.
DAO treatment changes muscular activity below the mouth.
If your main concern is:
One mouth. Different problems. Different treatments.
Both are botulinum toxin type A products that temporarily reduce muscle activity, but they are separate prescription products and their potency units are product-specific.
At LIPS NY, both are currently:
$9.50 per unit with a 10-unit minimum
You do not need to choose the toxin before your appointment.
Your provider will discuss the product and treatment plan being considered.
The DAO sits close to other muscles involved in lower-lip position and facial expression.
Unintended toxin spread into neighboring muscles can alter lower-lip movement and produce an asymmetric smile.
That is why lower-face toxin should not be approached as:
“More units will work better.”
The goal is selective reduction of the unwanted downward pull while preserving natural expression.
Precision matters more than quantity.
Facial asymmetry can result from differences in muscle activity, natural anatomy, previous procedures, dental factors, facial nerve conditions, or other causes.
Treating one side of the DAO may sometimes be relevant when muscular imbalance is contributing to the appearance, but the cause of the asymmetry should be assessed first.
We do not want to create symmetry by guessing.
We want to understand how your mouth moves.
The effect develops as neuromuscular activity decreases.
Because DAO treatment is an off-label lower-face use, we prefer to evaluate the result after the toxin has had sufficient time to take effect rather than judge the appearance immediately after injection.
Muscle activity gradually returns as botulinum toxin wears off.
Duration varies among patients, treatment areas, and products.
Repeat treatment should therefore be based on reassessment rather than an automatic calendar schedule.
DAO treatment for downturned mouth corners is not included among the current FDA-approved cosmetic indications for Botox Cosmetic or Xeomin.
Using an FDA-approved medication for a treatment area or purpose not included in its approved labeling is called off-label use.
Off-label treatment is common in medicine, but it should still follow appropriate medical evaluation, informed consent, and discussion of expected benefits and risks.
Because those muscles control different aspects of mouth and lip movement, unintended weakening of a neighboring muscle can affect expression.
Potential unwanted effects can include:
temporary asymmetry of the smile;
altered lower-lip movement;
localized weakness;
bruising, tenderness, or swelling at an injection site; and
other effects associated with botulinum toxin treatment.
Botulinum toxin products also carry an FDA boxed warning regarding the possibility of effects spreading beyond the injection site.
The lower face may involve small injections, but it still requires anatomical precision.
Maybe your mouth looks downturned in photographs.
Maybe people ask whether you are upset when your face is simply relaxed.
Maybe one corner pulls down more than the other.
You do not need to know the name of the muscle.
LIPS NY is the lip-focused destination of Rainforest Medical Aesthetics in East Meadow, Nassau County, New York.
We evaluate downturned mouth corners, lip movement, lip volume, gummy smiles, upper-lip visibility, previous filler concerns, and other aesthetic issues involving the lips and surrounding mouth.
1757 Front St
East Meadow, NY 11554
516-900-7772
Botox or Xeomin: $9.50/unit
You only need to know what you see. If the corners of your mouth seem to pull down when your face is relaxed, show us.
