This can occur for several reasons. A common cause is hyper -activity of the muscles which attach to the corners of the and to the chin-line.. This is the depressor anguli oris muscle (DAO). Often, other contributing factors such as jowls, volume loss, collagen loss will co-exist. These may also need to be treated. In severe cases, surgery may be required. This muscle is the "grimace" muscle and it's action can be seen when you show your bottom teeth. The presence of a Marionette line often accompanies this down-turned mouth and may require filler as well as relaxer.
Injection of 2 to 6 units per side can lift the corners of the mouth and improve the appearance. Care must be made to avoid a near-by muscle (DLI) which is responsible for showing the lower teeth during a smile. An uneven lower smile may occur if this muscle is injected.
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