How a “Permafrown”, or Downturned Lips, can be Treated with Botox® or Cosmetic Fillers

How a “Permafrown”, or Downturned Lips, can be Treated with Botox® or Cosmetic Fillers

Thank you for the question. You provided a single photo and you refer
to your conditions/situations with your mouth as having perma-frown or a permanent frown
that’s present even when you are smiling and what I suspect you are referring to as
the way the outer corners kind of point downward even when you smile and you are looking for
a solution. Well, I can certainly give you some guidance
on how I explain the options to my patients who share this similar type of situation whether
it is genetic or result of facial aging. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long
Island for over 20 years and helping people maximize and improve their appearance non-surgically
as well as surgically is essentially the core of my practice. So let’s just discuss a little bit about
anatomy and the relevant anatomy on how we address this type of issue. So in terms of the, let’s say, the movement
of the mouth and the relative position of the outer corners of the lips, there are basically
two approaches: one is to use a neurotoxin such as Botox®, Dysport®, Xeomin to relax
muscles to allow unopposed action of other muscles and I’ll explain more about that. And the second thing is to use fillers and
what do fillers do? Well, fillers essentially provide volume in
places where volume enhancement can actually create the perception of a subtle and significant
enough change. So let’s start with the neurotoxin concept. There are several muscles that are around
the lips that determine the position at different areas of expression or times of expression. So one of the things we do is something called
a Botox® lip lift and what that means is injections are placed in an area from the
outer corner of the mouth and right near the jawline to relax some muscles. This muscle is called the depressor anguli
oris muscle and what that does is because that muscle depresses the outer corners of
the mouth and when it’s relaxed, the outer corners slightly elevate and so that when
you are smiling, the outer corners will come up a little bit so it’s referred to as a
lip lift or using the most common and the most popular neurotoxin, Botox®. Now of course this is something that has to
be done consistently so it wears off, the neurotoxin does wear off anywhere from 3-6
months so consider this in factoring in whether you like to do this with any frequency. But I think it’s reasonable to try out because
if you don’t like it or if things don’t go in the way that you want, it wears off
and that’s pretty nice about non-surgical procedures. The second option I would consider is the
use of a filler to try to soften the depth of the line and to try to create a little
bit of fullness at the junction and typically I would use a softer hyaluronic acid filler
something in the Restylane or Juvederm family. Now that can create a little bit of a support
almost like a pillar to lift the outer corners of the mouth. So I think that combination will give you
a little bit more of a smile than without anything. It doesn’t make a total change but I think
it will make enough of a change and you can at least see if you like that and then you
can do that with some consistency. There are surgical procedures and different
types suspension procedures that generally I’ve been trying to do something more permanently
but from my perspective, I don’t find those to be that beneficial and consistent so I
still feel like the injectable fillers have the most significant and reproducible role
in this and of course it is something that’s not surgery, it’s an office visit. There are a lot of ways to enhance the area
around the mouth and there are many different ways to enhance the different areas outside
of the outer corners and so a more global look at your whole face and the anatomy may
also open up some opportunities to consider. So meet with qualified, experienced doctors
who perform these types of injectables and learn more about your options and then take
the first step in trying something out so you can see if you like the result and if
you are willing to keep that type of procedure ongoing so you may maintain a certain look. So I hope that was helpful, I wish you the
best of luck and thank you for your question.


  • Lindsay Seldon says:

    As someone who is considering treatment for a downturned mouth I found this really helpful. Thank you.

  • Sk Mujahid says:

    Where are you from sir??

  • family tea and lots of yarn. says:

    Would thread lifts work for this? And what is good for hooded heavy brows

  • lola odunsi says:

    Where are you located

  • Exodia the Forbidden One says:

    I took a testosterone and it caused my skin and lips to thicken. They are still full but Is there a way botox can make me lips have sharp thin edges again? So that my lips are full but the edges are like a child's? Or is it Impossible with botox? My skin is thicker and smooth and not thin and smooth like before. I think testosterone has made the muscles in the skin layer thicker due to testosterone. Can botox make the edges of my lips thinner by reducing the muscle in my skin?

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