Corners of the Mouth
This area affects expression and can contribute to a downturned or unhappy appearance when it becomes heavy or pulls downward.
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This area affects expression and can contribute to a downturned or unhappy appearance when it becomes heavy or pulls downward.
get startedThe oral commissures — the corners of the mouth — are controlled primarily by the depressor anguli oris (DAO), a triangular muscle that pulls the mouth corners downward. As the DAO becomes hyperactive or as the overlying tissue loses support, the corners of the mouth descend, creating a downturned appearance that reads as sadness, displeasure, or fatigue regardless of the patient's actual mood.
The marionette lines — the vertical creases running from the mouth corners toward the chin — form as the tissue below the commissure loses support and the DAO continues pulling downward. The combination of downturned corners and marionette lines is one of the most expressive aging changes in the lower face.
When the corners turn down, the whole face looks like it has something to say.
The oral commissures — the corners of the mouth — are controlled primarily by the depressor anguli oris (DAO), a triangular muscle that pulls the mouth corners downward. As the DAO becomes hyperactive or as the overlying tissue loses support, the corners of the mouth descend, creating a downturned appearance that reads as sadness, displeasure, or fatigue regardless of the patient's actual mood.
The marionette lines — the vertical creases running from the mouth corners toward the chin — form as the tissue below the commissure loses support and the DAO continues pulling downward. The combination of downturned corners and marionette lines is one of the most expressive aging changes in the lower face.
When the corners turn down, the whole face looks like it has something to say.
Commissures neutral to slightly upturned; marionette lines absent at rest.
Early downturning in patients with strong DAO; faint marionette lines develop.
Downturned corners and marionette lines established as resting features.
Deep downturning and marionette lines with lower face volume loss compounding severity.
Mouth corners are neutral or slightly upturned. The DAO is active but the surrounding tissue provides sufficient support to maintain a natural, non-downturned position.
Early downturning may begin in patients with strong DAO activity. Subtle marionette lines form from volume loss in the lower face.
Downturned corners become a resting feature. Marionette lines deepen as lower face volume declines and the DAO pulls more unopposed.
Established downturned commissures with deep marionette lines. Lower face volume loss and bone resorption in the mandible compound the appearance.
Restore a neutral mouth position that doesn't read as sad or stern at rest
Soften the marionette lines that compound the heavy lower face appearance
Change the default expression of the lower face to something that matches how the patient actually feels
Treatment at CAMI addresses both components: the DAO muscle with a small wrinkle relaxer dose to reduce the downward pull, and the tissue below the commissure with filler to restore the structural support that used to counteract it.
The DAO relaxer dose is intentionally small — too much creates an unnatural smile. Filler in the marionette lines is placed conservatively to soften the crease without overfilling the lower face. The combination of both approaches typically produces the most natural and complete result.
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