When most people think of Botox® treatment, they think of treating the so called “number 11’s” between the eyebrows or the crowsfeet around the eyes. These are the most common sites where Botox® is used. However, more experienced injectors venture to the lower face to effect significant aesthetic improvement with Botox®.
One of my favorite sites of injection is the depressor anguli oris (DAO) muscle which works to pull down the corners of the mouth. With age, it is common to see the development of a more downturned mouth and “marionette lines”. This can make the person look like they are perpetually frowning or unhappy. Relaxation of the DAO muscles with Botox® results in an elevation of the angle of the mouth, often improving a patient’s smile. My practice has evolved over the years in treating this area. I used to inject the DAO muscles with Botox® and then use dermal fillers to elevate the marionette lines the same treatment session. In my present practice, I inject the DAO muscles the first visit and ask the patients to return in two weeks. At this follow up visit, I find I often use much less filler than was originally anticipated to correct the marionettes and the filler seems to last longer.
Another great area to treat in the lower face is the chin. Many people find as they age their chin develops a deepening horizontal crease and the skin can appear dimpled, much like the skin of an orange, when the muscle is in use. Treatment of the mentalis muscle in the chin can result in a smoother and more even appearing chin, a prominent feature of youth.
Many women complain of vertical lines above and below their lips – the most common thing these women say is “I don’t even smoke!”. Small amounts of Botox® injected into the orbicularis oris muscle around the mouth can result in improvement by decreasing the pursing motion. This is a reminder that women who are developing these lines should avoid drinking out of straws or from bottles – the less pursing the better!
Many people don’t know there is a simple way to improve the appearance of a gummy smile. This is another area where a small amount of Botox® injected into the right spots can make a huge difference.
Finally, the injecting the masseters with Botox® can achieve feminizing effects to women with squaring of the lower face. This is an especially popular technique in Asian countries to achieve a slimming appearance to the face. Treatment of these muscles is also effective for those that tend to grind their teeth while asleep.
The experience of the injector in treating muscles of the lower face is especially important, given the effect of Botox® is achieved by weakening targeted muscles. Misjudgment of injection sites on the lower face can result in asymmetric and obvious, although temporary, alteration of movements involving the mouth.