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The natural aging process can affect the appearance of the face in many ways. The creases made from repeated facial expressions become etched into the skin, particularly around the eyes, forehead, and mouth, the skin becomes thinner and more lax, and volume loss occurs in the mid-face. One of the most common areas patients present to Dr. Michele Green to treat in her NYC office is the wrinkles at the corner of the mouth or DAO. In the lower face, the depressor anguli oris muscle – or DAO muscle – which extends from the corner of the mouth down to the lower jaw, starts to weaken from overuse, pulling the corners of the mouth down into a perpetual frown. Overusing the DAO muscle can also emphasize marionette lines that extend down the chin from the corners of the mouth like a marionette puppet. Many patients believe that the only way to restore lift to the lower face is to undergo plastic surgery. However, Botox injections offer a safe and highly effective non-surgical option to lift DAO muscles and restore a youthful appearance at board-certified dermatologist Dr. Michele Green’s dermatology office.

Botox is made of a neurotoxin called botulinum toxin type A that, when injected into a muscle, will essentially “freeze” the muscle by blocking the neurotransmitters there. That relaxes the muscle, smoothing out dynamic wrinkles such as those found around the mouth and extending down the chin. Botox is FDA-approved to treat a variety of cosmetic and medical concerns, including dynamic wrinkles on the forehead, between the eyebrows, and at the corners of the eyes, muscle spasms, and excessive sweating. For a long time, Botox was under-utilized in the lower face. Still, today, it can be safely and effectively used for injection in the depressor anguli oris muscle to lift the corners of the mouth, address asymmetry, and reduce the appearance of jowls. As DAO Botox is an off-label use of Botox injections, it is essential always to seek treatment from an expert injector, such as Dr. Michele Green.

Board-certified dermatologist Dr. Michele Green has been expertly treating patients in her Upper East Side New York City office for more than 25 years. A highly experienced injector, Dr. Green has been treating patients with Botox for many years and is incredibly familiar with planning injection sites based on each patient’s facial anatomy. Dr. Green is a master in many anti-aging treatments, including Botox, Xeomin, Dysport, dermal fillers, laser treatments, microneedling, chemical peels, and more. Well-known for high patient satisfaction, Dr. Green has been voted one of New York City’s best healthcare providers by such publications as Castle Connolly, Super Doctors, and New York Magazine.

What is the Depressor Anguli Oris (DAO) Muscle?

The depressor anguli oris muscle, often abbreviated as the DAO muscle, is found in the lower face and is one of the muscles responsible for the downturn of the mouth or a frown. The DAO muscle is attached to the corners of the mouth and the lower jaw (mandible) and works in tandem with other mimetic muscles, including the mentalis in the lower lip, masseter in the jaw, the platysmal bands in the neck, and the orbicularis oris that surrounds the mouth. As we age, the depressor anguli oris muscle can weaken, resulting in a downward turn of the mouth, leaving patients with a perpetual frown when the face rests. For some patients, this weakening of the DAO muscle leaves them looking unhappy or tired even when they feel no such thing. The DAO muscle will also contract with age, contributing to the deepening of marionette lines, which are the dynamic wrinkles characterized by lines running from the corners of the mouth down the chin towards the jawline, creating a marionette-like appearance. The downward pull of the depressor anguli oris muscles can also contribute to the formation of jowls along the jawline. Luckily, botulinum toxin injections can reverse the signs of aging associated with the depressor anguli oris muscle.

SW 31 yo female before and after botox masseter 1 month apart MGWatermark

Can you use filler for DAO muscles?

Dermal filler injectable treatment is highly effective for various skin conditions and cosmetic concerns, including fine lines, wrinkles, volume loss, and depressed acne scars. Dermal fillers can also address facial asymmetry, contour the cheek and jawline, and add volume to the lips for a naturally pillowy look. Many types of dermal fillers available at Dr. Green’s dermatology office are FDA-approved to address specific areas of the face. When treating the lower face, Dr. Green often turns to Juvederm Vollure or Restylane Refyne, which are injected into the smile lines surrounding the mouth to fill in wrinkles and give patients a naturally youthful appearance. When treating dynamic wrinkles, fine lines, and wrinkles caused by repeated contraction of a facial muscle over time, injecting Botox into the muscle is the most effective solution. With downturned lips resulting from DAO muscle contractions, Botox injections are highly effective at reversing the appearance of a downturned mouth. However, Dr. Green often pairs Botox and dermal filler injections together for even better anti-aging results.

What is DAO Botox?

The neurotoxin Botulinum toxin type A – known most frequently by the brand name Botox – is an injectable treatment used to address various cosmetic and medical concerns. When injected into a muscle, Botox blocks the neurotransmitters, essentially “freezing” the muscle and preventing it from contracting. Botox is FDA-approved to treat many concerns, including forehead lines and crow’s feet, frown lines, blepharospasm, cervical dystonia, chronic migraines, overactive bladder, and hyperhidrosis. One off-label treatment for Botox that has previously been underutilized is Botox injections in the lower face to treat such cosmetic concerns as a gummy smile, thin lips, and a downturned mouth. DAO Botox works explicitly to combat a downturned mouth, improve facial symmetry, and combat dynamic wrinkles around the mouth, chin, and jawline via injection into the depressor anguli oris muscle. As the DAO muscle is responsible for mouth movement, including eating, drinking, and facial expressions, a low-dose injection of the neurotoxin is the best course of action to provide patients with a lift at the corners of the mouth without inhibiting the mouth and jaw’s function. In addition to reversing the effects of a downturned mouth, DAO Botox can smooth fine lines, wrinkles, and dimples around the injection points.

How do Botox injections work for the lower face?

Botox is the brand name for the neurotoxin onabotulinum toxin type A, produced by Allergan to treat many cosmetic and medical conditions. Several different forms of the botulinum toxin exist, including incobotulinum toxin A, known by the brand name Xeomin produced by the company Merz Pharmaceuticals, and abobotulinum toxin A, known by the brand name Dysport. For many years, Botox (and Xeomin and Dysport) were cosmetically used primarily to address dynamic wrinkles on the mid and upper face, including forehead lines, glabellar lines, and crow’s feet around the eyes. Recently, however, research has shown that Botox injections effectively treat cosmetic concerns of the lower face, including a gummy smile, lip flip, asymmetry, and downturned mouth. With many interconnected muscles in the lower face, a highly experienced injector must effectively map out the appropriate injection sites.

EW 28 F botox masseter 2w FRONT

Can Botox treat a downturned mouth?

A downturned mouth occurs when the depressor anguli oris muscle that extends from the corners of the mouth to the lower jaw weakens due to overactivity, pulling the corners of the mouth downwards and creating a perpetual frown or “sad smile.” A downturned mouth can be seen, especially when the face is at rest, causing patients to look frustrated or tired. Due to the overactivity of the depressor anguli oris muscles, a downturned mouth can be treated with Botox injections, which allows the muscle to relax, providing patients with a lift at the corners of the mouth. With careful injections, Botox can reverse the downward pull of the DAO muscles, improve facial symmetry, and erase fine lines, wrinkles, and dimples.

Can you Botox the Depressor Anguli Oris?

DAO Botox, when injected into the depressor anguli oris muscle, is gaining popularity as a treatment for a downturned mouth, marionette lines, and asymmetry of the lower face. The depressor anguli oris muscle stretches from the corners of the mouth, connects to the mandible, and is responsible for facial expressions such as frowning. DAO Botox is an off-label use of Botox, meaning that the treatment has not yet received FDA approval. However, Botox injection into the DAO muscle is a highly effective treatment for a downturned mouth when performed by a board-certified, highly experienced injector, such as Dr. Green. Injectors performing DAO Botox must have a high understanding of facial anatomy to inject it into the right place so that it will not spread to other muscles and affect the workings of the lower face. The risk of severe side effects is much higher if you seek treatment from a less experienced injector, particularly for an off-label treatment like DAO Botox.

What does Botox in DAO do?

Botox is a neurotoxin that works to inhibit the contraction of muscles by blocking the neurotransmitters that tell the muscle when and how to move. This essentially “freezes” the muscle, causing it to relax and smoothing out any dynamic wrinkles that appear when the muscle contracts. The depressor anguli oris muscle is responsible for specific facial expressions, including frowns. It is interconnected with other muscles in the lower face that help with eating, drinking, speaking, and other facial expressions. Over time, overactivity and weakening of the DAO muscle can cause the muscle to pull downwards, creating a perpetual frown even when the face is at rest. When Botox is injected into the DAO muscle, the neurotoxin causes the muscle to relax, which lifts the corners of the mouth and smooths out wrinkles around the injection site.

How does Botox work with facial DAO muscles?

The procedure for DAO Botox will begin with a consultation appointment with Dr. Green, where you will discuss personal data, such as medical history and your aesthetic goals for treatment. During the consultation, Dr. Green will also take note of your facial anatomy, as precise injections based on individual face structure are essential for DAO Botox. In the week preceding your Botox treatment, Dr. Green recommends avoiding blood thinners, such as Advil, to reduce the risk of bruising after treatment. When you arrive at Dr. Green’s Upper East Side office for the procedure, she will apply a topical numbing cream and precisely mark the injection sites based on your unique facial anatomy. The injections themselves are quick – usually only 15-30 minutes – and most patients feel minimal discomfort during the treatment with the application of the numbing cream. No downtime is associated with the treatment, meaning patients can immediately return to regular activities. The risk of serious adverse events is low when you receive treatment from an experienced, board-certified injector like Dr. Green. However, some common side effects may occur after treatment, including swelling, bruising, redness, and pain, which should subside within several days of the procedure.

before after botox female langle b5 a17 MGwatermark

Where to inject DAO Botox

When determining where to inject Botox into the depressor anguli oris muscle, the injector must consider each individual’s unique facial anatomy. Often, recommendations for injection sites are based on the “average” person’s face. However, most people have some degree of asymmetry in their faces, meaning that the “average” is inaccurate, and people will need a different amount of injection on each side of the face. Additionally, the depressor anguli oris muscle is closely connected with many other muscles responsible for chewing, talking, and facial expressions in the lower face. For that reason, it is vitally important to seek out an injector who is board-certified and highly experienced with Botox injections, such as Dr. Michele Green. If injected incorrectly, DAO Botox can spread to the deeper muscles in the lower face, resulting in asymmetry and a frozen smile. Injections into the wrong area of the face can lead to serious adverse events. The ideal injection depth is approximately 5 millimeters, and the ideal placement is in the center of the marionette lines and the base of the marionette lines. When you have your initial consultation with Dr. Green, she will determine the ideal placement for your injections.

How many units of Botox for DAO?

The number of units of Botox necessary for DAO Botox depends on each individual’s facial anatomy and the extent of the downward turn of the mouth. Typically, the number of units is 2-4 per side of the mouth, with some asymmetry between the sides of the face to be expected. After your initial consultation with Dr. Green, she will provide a closer estimate of the number of units necessary for your specific face shape.

How long does DAO Botox last?

Many patients wonder, “How long does Botox in the DAO last?” the answer is that the effects of DAO Botox can be seen for between three and six months post-treatment. While the impact of the treatment is not permanent, patients can maintain the results by scheduling a follow-up and maintenance appointment approximately every six months. Most patients will see the entire treatment results within two weeks of the injections.

What does Botox do to DAO muscles?

The DAO muscles are found in the lower face extending from the corners of the mouth down to the jaw and are responsible for facial expressions such as frowning. As we age, the over-activity of these muscles causes them to weaken and pull down the corners of the mouth, creating a pervasive frown that can make patients look perpetually tired or upset. When Botox is injected into the DAO muscles, the neurotoxin blocks the neurotransmitters, relaxing the DAO muscle and creating a lift at the corners of the mouth, which makes a naturally youthful look.

TH 26 yo female before after botox masseter x1 session 6 months apart MGWatermark 1

Are DAO Botox injections worth it?

Signs of aging, such as fine lines, wrinkles, and the appearance of jowls, can be frustrating for patients. Many patients falsely believe that the only way to create a lifted appearance on the lower face is by undergoing plastic surgery, which is a surgical process that requires significant downtime and a high risk of adverse events. With DAO Botox injections, patients can experience lift around the mouth to combat a downturned mouth, marionette lines, and the formation of jowls, all without the need for any invasive surgery. While the effects of the procedure are temporary, the results of DAO Botox can be maintained with follow-up appointments every 4-6 months.

How to get started with your DAO Botox treatment plan today

Botox injections in the depressor anguli oris muscle (DAO muscle) may be the best treatment option for patients struggling with a downturned mouth, asymmetry in the lower face, and the formation of jowls. Botox is one of the world’s most popular cosmetic treatment options due to the ease of injections, consistently stunning results, and lack of downtime. DAO Botox requires injectors to have a strong knowledge of facial anatomy to inject the neurotoxin into the DAO muscle safely. With her many years of experience, Dr. Green provides patients with safe, effective, and long-lasting treatment results. The first step in creating a rejuvenation treatment plan is to schedule a consultation with board-certified expert dermatologist Dr. Michele Green at her Upper East Side New York City office.

Dr. Michele Green is an internationally renowned board-certified dermatologist with over two and a half decades of experience providing some of the world’s most discerning patients with the best non-invasive treatment options, including Botox. In fact, Dr. Green was among the first dermatologists in NYC to offer cosmetic Botox injections. Embracing a less-is-more philosophy and taking a holistic approach to facial rejuvenation, Dr. Green creates individualized treatment plans to help patients meet their aesthetic goals, providing them with clear, smooth, bright, youthful-looking skin. She is consistently identified as one of New York’s best dermatologists by Castle Connolly, New York Magazine, and Super Doctors for her dedication to her patients and expertise. To schedule a consultation with Dr. Green for DAO Botox treatment, contact us online, or call us at 212-535-3088

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