- 180 East 79th Street, 1C, New York, NY 10075
- 180 East 79th Street, 1C, New York, NY 10075
A downturned mouth can unintentionally make you look sad, tired or discontent — even when you’re feeling the exact opposite.
This frustrating facial feature often develops slowly over time due to aging, volume loss, or an overactive DAO muscle (Depressor Anguli Oris), which pulls the mouth corners downward.
Fortunately, a downturned mouth is not only common, but is highly correctable. Today’s non-surgical cosmetic treatments offer effective solutions, including:
Botox to relax the muscles pulling your smile down,
Dermal Fillers to support and lift the corners of the mouth,
Ultherapy or RF Microneedling to rejuvenate collagen and elastin on the lower face
Platelet Rich Plasma or PRP to naturally repair the skin and improve skin quality and texture around the mouth, chin, jowls and lip area
Whether you’ve noticed your smile drooping with age or have always had a slightly downturned mouth, Our Guide: Downturned Mouth: Botox, Filler or Skin Tightening explains everything you need to know—from causes and effects to the best treatments available for restoring a more balanced, confident appearance, courtesy of the best MedSpa in NYC.
A downturned smile can stem from several factors. Understanding the root cause helps determine the best treatment.
As we age, the face gradually loses collagen, elastin, and fat. This leads to sagging skin, particularly around the mouth and into the jowls.
The corners of the mouth may droop as gravity takes its toll, and Marionette Lines become more pronounced.
Often referred to as Smile Lines or Puppet Lines, these downward-pulling creases run from the mouth corners to the chin and contribute to a frowning expression even at rest.
The Depressor Anguli Oris (DAO) is a muscle that runs from the corners of the mouth to the lower jaw. Its job is to pull the corners of the mouth downward when we frown.
In some people, the DAO is overactive even at rest, causing the mouth to turn downward involuntarily.
Facial volume loss in the mid-face and lower face can lead to a hollowed or sagging appearance around the mouth and into the chin, jowls and jawline.
As the underlying structure diminishes, the corners of the lip area lose support, resulting in a downturned shape to the mouth.
Some individuals are genetically predisposed to have downturned lips, regardless of age or muscle activity. Their natural resting facial structure may give the appearance of a permanent frown and sagging of the lower face.
Factors like excessive sun exposure, smoking, chronic stress, or rapid weight loss can accelerate facial aging and exacerbate drooping around the mouth.
A downturned smile often conveys an emotional tone that doesn’t match how someone feels. Even if they are feeling perfectly happy, they may look sad, stern, fatigued or angry.
This mismatch between expression and emotion can affect self-esteem and the way others interact with them.
There are multiple nonsurgical treatment options for improving a downturned smile.
The right solution depends on what’s causing the downward turn around the lips —muscle activity, volume loss, or skin laxity.
Botox for downturned mouth works by relaxing the DAO muscle. When this muscle is no longer pulling the mouth corners downward, the face can appear more neutral or uplifted.
While Botox can soften the appearance of a downturned mouth by relaxing the DAO muscles, its impact is solely for a downturned mouth, as opposed to for any wrinkles or folds that may be running underneath the mouth.
That’s because DAO Botox is ONLY indicated for skin issues that are caused by the expression of the muscle. In many cases, the downward pull at the corners of the mouth isn’t about targeting muscle activity alone. It’s also about restoring volume in surrounding areas like the midface, jowls, lips, and chin.
In these cases, a Dermal Filler can address structural support and volume loss, helping lift and smooth the area more effectively than Botox alone.
Additionally, when Puppet Lines and Smile Lines have developed into deeper creases and static folds, Cosmetic Filler is often necessary to achieve a noticeable improvement to the lower face, including jawline, lips, chin and mouth.
It’s important to note that, because the DAO muscle is close to other facial and mouth muscles, precise placement and injection technique is key to avoiding Botox complications, such as unintended effects on the highly mobile areas of the lips, mouth and chin.
Fillers restore volume around the mouth, especially in the oral commissures, which sit at the corners of the lips and mouth. The added structure supports the mouth corners and helps turn them slightly upward.
Additionally, fillers work for smoothing and reducing Marionette Lines / Smile Lines, which run from the corners of the lips down to the chin. These lines can accentuate the downturned lips in two ways:
1) by making it appear as if the downturned lips extend into the chin, and
2) by casting a shadow that extends from the lips into the chin area.
A dermal filler will work to correct all of these issues related to volume loss. Popular filler choices for downturned mouth include Hyaluronic Acid (HA) products like Juvederm Vollure, Restylane Refyne, or Restylane Kysse.
If skin laxity is a contributing factor, treatments like RF microneedling, Ultherapy, Platelet Rich Plasma (PRP) can stimulate collagen and elastin, in order to improve firmness and texture around the jowls, mouth and lower face.
They are excellent nonsurgical jawline and jowl contouring treatments that lift the lower face over time, and are often used in combination with injectables for longer-lasting, natural-looking results.
| Treatment | How It Works | Best For | Duration of Results | Downtime |
|---|---|---|---|---|
| Botox | Relaxes the DAO muscle to reduce downward pull on mouth corners | Mild to moderate muscle-related downturn | 3–6 months | Minimal |
| Dermal Fillers | Adds volume and support at corners of the mouth and marionette lines | Volume loss, sagging, structure restoration | 9–18 months (varies by type) | Minimal |
| Ultherapy | Uses focused ultrasound to lift and tighten skin | Skin laxity and lifting | Up to 1 year or more | Mild swelling/redness (1–3 days) |
| RF Microneedling | Combines radiofrequency and microneedles to stimulate collagen and tighten | Texture, laxity, mild sagging | Builds gradually; lasts 6–12 months | 1–3 days of redness |
| PRP Injections | Uses your own platelet-rich plasma to boost collagen and rejuvenate tissue | Skin texture, healing, fine lines | Subtle, builds over months | Minimal |
Many patients see the best results from a combined approach with downturned mouth on the lower face.
Botox can relax the muscle pulling the mouth down at its corner into a permanent frown.
Filler can restore volume, in order to provide support and lift around the lips and into the chin and jowls.
Skin-tightening treatments, such as Ultherapy, RF Microneedling and PRP stimulate collagen production, and can enhance elasticity and tone around the entire lower face, including cheek area, jowl area, mouth area, chin area and lip area.
A consultation with a qualified provider can help determine the right strategy for your facial anatomy and aesthetic goals.
Botox results typically appear within a week and last 3–6 months.
Filler Results are often immediate and can last from 9 to 18 months, depending on the filler.
Ultherapy, RF Microneedling and PRP result in gradual and natural improvement over time with full skin tightening results developing over several weeks to months as collagen production increases.
After Botox, Filler and Nonsurgical Skin Tightening treatments:
Most treatments require little to no downtime and results can last several months to over a year depending on the product used.
Look for a Filler or Botox provider who:
Always ask about the injector’s experience with Dermal Filler or Botox Neurotoxin before treatment.
If you’re considering Downturned Mouth Botox or Filler in New York City, we highly recommend choosing a provider with a track record of precision and safety.
At Smooth Synergy® Medical Spa on the Upper East Side, NYC, you’ll be under the expert care of Dr. George Liakeas, our Medical Director with over 20 years of experience in cosmetic injectables and neurotoxins.
Dr. Liakeas combines medical expertise with an artistic eye, ensuring that your Filler or Botox treatment is both safe and effective. He understands the nuances of facial anatomy, and takes a customized approach to each treatment.
Downturned mouth is highly treatable with non-surgical options like Botox, Dermal Fillers, Ultherapy, RF Microneedling and PRP. Whether you’re looking to lift the corners of the mouth, more confidence when smiling, or simply a refreshed appearance, Smooth Synergy® Medical Spa on the Upper East Side, Manhattan offers the high standards of care that New York City clients have come to know and expect.
Here’s why Smooth Synergy® is NYC’s trusted destination for Botox, Fillers and Nonsurgical Skin Tightening:
Additionally, we offer a complete line of neurotoxins / neuromodulators, including Botox, Dysport, Xeomin and Jeaveau, Dermal Fillers including Juvederm, Restylane, Beletoro and Radiesse, as well as collagen-stimulating treatments, including Ultherapy, RF Microneedling and PRP/ PRF.
With a personalized approach that targets the root causes of downturned mouth — whether that’s muscle activity, volume loss, or skin laxity — you can achieve a more balanced, rested, and confident appearance.
If you’re ready to explore your nonsurgical / noninvasive treatment options, book a consultation with an Expert in Beauty who understands facial anatomy and can tailor a plan that fits your goals.
Call us at 212-397-0111 to discuss which of our treatment or treatment combinations is right for you.
What is a downturned mouth?
A downturned smile refers to the natural or age-related downward turn of the corners of the mouth, often resulting in a sad or tired expression.
Why are the corners of my mouth always pointing down?
This may be due to muscle overactivity (DAO muscle), aging, volume loss, or genetics. Lifestyle factors such as sun damage or smoking can also contribute.
Can Botox fix a downturned mouth?
Yes. Botox relaxes the DAO muscle, reducing its downward pull and subtly lifting the corners of the mouth. It can also help with any facial asymmetry or imbalance, in order to provide a more balanced look to the mouth and face.
Which fillers help with a downturned lips?
Juvederm Vollure and Restylane Refyne or Kysse are excellent for treating marionette lines under the lips and lifting the mouth corners.
Is filler or Botox better for a downturned lips?
Botox targets the muscle pulling the corners down. Fillers restore volume and structure. Most effective results come from combining both on the lower face.
Is surgery required to fix a downturned smile?
Surgery is not required in most cases. A surgical lip lift may be an option for those seeking permanent results or for more severe cases.
How long do the results last?
Botox typically lasts 3–6 months. Dermal fillers can last 9–18 months. Nonsurgical skin tightening treatments offer long-term collagen stimulation but may require maintenance.
What are marionette lines and how are they related?
Marionette lines (aka Puppet Lines or Smile Lines) are vertical lines that extend from the corners of the mouth to the chin. They accentuate a downturned smile and are often treated at the same time, along with any sagging skin along the jowls or jawline.
Can I prevent a downturned smile from developing?
Protecting skin from sun, avoiding smoking, maintaining facial volume with hydration and skincare, and considering early treatment with injectables may help delay its onset.
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