Question 1

How does botulinum toxin type A for the mouth corner work?

Accepted Answer

Botulinum toxin type A for the mouth corner works by temporarily weakening the muscle that pulls the mouth corner downward (the depressor anguli oris, DAO), allowing the lifting muscles to become dominant. The position of the mouth corner is determined by a tug-of-war between the lifting and lowering muscles. As you age or if the depressor muscle develops habitually, the mouth corner may droop even at rest, giving an angry or sad appearance. Relaxing excessive tension in the depressor muscle can improve the mouth corner to a subtly lifted look.

The effect typically appears within a few days to 2 weeks after the procedure and is generally known to last about 3 to 4 months. The location and strength of the muscle vary from person to person, so accurate muscle diagnosis and dose planning are important. Excessive doses can create unnatural expressions, so starting with a small amount and adjusting is recommended.

Question 2

Can dermal filler help support the mouth area?

Accepted Answer

Yes, when drooping corners of the mouth are accompanied by volume loss, supporting the mouth area with dermal filler can be helpful. As you age, the fat, collagen, and even bone volume around the mouth decrease, causing the area below the corners of the mouth to become hollow and shadowed, making them appear more droopy than they actually are. Supplementing the hollow area with HA (hyaluronic acid) filler can structurally support the corners of the mouth, potentially alleviating shadows and a drooping appearance. While botulinum toxin type A is a treatment that adjusts the "pulling force," dermal filler is a treatment that reinforces the "supporting structure." Because muscle issues and volume issues have different causes, when both are present, combining the two treatments often leads to greater improvement. However, the mouth area is subject to a lot of facial movement, so it is important to fill it naturally with small amounts without overcorrection.

Question 3

Can lifting lift the corners of the mouth?

Accepted Answer

Lifting is a treatment that indirectly helps lift the corners of the mouth by improving sagging of the lower face and skin laxity that pulls the corners downward, rather than directly lifting the corners themselves. When the tissues of the cheeks and jawline descend, their weight shifts toward the mouth area, deepening drooping corners of the mouth and marionette lines. HIFU Lifting (Ultherapy PRIME®) delivers thermal energy to the SMAS layer, while RF Lifting (Thermage® FLX, Alltite) delivers it to the dermal layer to improve sagging. Therefore, if the cause of drooping corners of the mouth is muscle, botulinum toxin type A is the priority; if it is volume, dermal filler is the priority; and if it is overall facial sagging, lifting is the priority. After your 40s, these three causes often appear together, so the treatment plan may be designed in the order of first establishing a foundation with lifting, then refining details with botulinum toxin type A and dermal filler.

Question 4

Is it managed together with marionette lines?

Accepted Answer

Yes, because drooping corners of the mouth and marionette lines share many of the same causes, managing them together is efficient. Marionette lines are wrinkles that run from the corners of the mouth down toward the chin, formed by a combination of descending cheek tissue, volume loss around the mouth, and pulling from the depressor muscles. If you only correct the corners of the mouth and leave the marionette lines, a drooping impression remains; conversely, if you only fill the wrinkles, the pulling of the corners of the mouth can recreate the wrinkles, as they affect each other. Generally, hollowing in the marionette area is supported with dermal filler or collagen-stimulating treatments, the pulling of the depressor muscles is relaxed with botulinum toxin type A, and if tissue sagging is significant, lifting is combined. The results are natural when the treatment is designed based on the "overall structure of the mouth area" rather than a single wrinkle.

Question 5

For drooping corners of the mouth, what combination is used for natural results?

Accepted Answer

The key to natural results is not to overcorrect with a single procedure but to combine small amounts tailored to each cause. Since each procedure plays a different role, the following combinations can be considered based on diagnosis.

Cause	Procedures	Role
Pulling of the depressor muscle	Botulinum toxin type A for the mouth corner	Relieves the downward force
Volume loss around the mouth	HA Filler, collagen-stimulating procedures	Supports and lifts the hollowed area
Lower face sagging	Ultherapy PRIME®, Thermage® FLX	Improves the foundation of sagging

For example, for those in their 40s to 50s with noticeable sagging, a combination of establishing a foundation with lifting and then refining the mouth area with botulinum toxin type A and a small amount of dermal filler may be considered. For those in their 30s with less sagging and primarily muscle pulling, a botulinum toxin type A-focused approach may be considered. The appropriate combination varies depending on face shape, expression habits, and skin condition, so we recommend consulting a specialist to receive a plan tailored to you.

Can downturned mouth corners be lifted with procedures?

How Does Botulinum Toxin Type A Work for Downturned Mouth Corners?

Can Dermal Filler Support Help Lift the Mouth Corners?

Can a Lifting Procedure Raise Downturned Mouth Corners?

Is It Treated Together With Marionette Lines?

What Combination Gives Natural Results for Downturned Mouth Corners?

References