Do you have droopy mouth corners or a permanent frown? If you do then this article will hopefully help give you some great options for treatment of it.
Some people call this BRF – bitchy resting face. Excuse my language. That was something that’s been made popular on social media.
Some of us, no matter what we do, if we are just at at rest with our face, it makes us look grumpy and typically it’s due to the drooping corners of mouth.
It runs in my dad’s side of family. My grandfather and my father both have the really downturned corners of the mouth and I can see myself developing a little bit as I get older.
This is something that I’m going to need to tackle and if you’re reading this then we have this in common.
Let’s talk a little bit about these droopy corners of the mouth.
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Causes of Droopy Corners of The Mouth
Once again, it’s known as a permanent frown. It is when the corners of the mouth droop with time and with age and there are a number of reasons why this can happen.
Gravity kind of pulls our face down as we get older and that pulling effect of our face down will help also pull the corners of our mouth down with it and that’s one reason why we develop jowls as we get older.
Second thing is sometimes we can get overactive muscles down here and there’s a muscle called the depressor anguli oris (DAO), which is a muscle that comes from your chin up to the corner of your mouth. When that muscle is overactive, it can pull that down. In some people that muscle has have been overactive and creates that appearance.
Typically it’s a combination of gravity with sometimes genetics and that we just have a certain shape that we inherit from our parents along with that depressor anguli oris muscle that pulls it down.
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How to Get Rid of Drooping Mouth Corners
How do you treat it?
The first way and the easiest thing you can do is inject some Botox into that depressor anguli oris and that will then weaken the muscle that pulls the corners of the mouth down.
If you’re not sure if it works for you, just try to frown, do a big frown and look in the mirror.
So injecting a little bit of Botox can help to counteract that muscle and it doesn’t need a lot of Botox fluid, anywhere from two to two-and-a-half units is all we inject on each side. One little poke in the lfet corner, one little poke in the right corner, give it a week and all of a sudden the corners of the mouth lift up a bit.
The results last for about three to four months after which case you do need to repeat it. If you stop doing it then the DAO muscle just comes right back.
This is the first step if you’ve got that the downturned corners of the mouth, if you feel like you have a permanent frown. Start with a little Botox because that may be all you really need, which is less expensive than the other options.
If that doesn’t do it, then the next step is to use an injectable filler.
In my office we recommend hyaluronic acid fillers, starting with Juvederm Ultra or Ultra Plus, Restylane Refyne and Defyne as well as Restylane and Restylane Silk.
All of these types of hyaluronic acid fillers can definitely work for the corners of the mouth. It just depends on how severe they are.
For example, if the corners of mouth aren’t that bad then maybe a little Defyne or Restylane Silk is all you’d really need to pull it up.
If however you’ve got really defined corners of the mouth, they’re really coming down, then using something a bit firmer like the Juvederm Ultra Plus might be a bit better for you now.
All of these last anywhere from about six months up to a year, sometimes a little bit longer.
So the first step would be the Botox and if that Botox doesn’t do it, usually one syringe of the filler is all you need to inject into that marionette line under the corner of the mouth to try to lift it.
Some people benefit from ta combination of both – the Botox with the filler.
Filler injections are really easy to undergo. They’ll take about 15 minutes to perform it in the office. You may get a little bit of bruising afterwards. Typically for this area most the time we don’t use a cannula. We use a needle just because we want to really get in there and get into the dermis, the deeper skin to get that dermis to thicken and to push the corner of the mouth up. Most of time we’re using needles, although a cannula could be used, depending on the patient.
As far as the downtime recovery, it’s very minimal, you may have a little bruising for a few days. that’s about it. If you feel any lumpiness, you press on it and that can usually help settle that out.
The risk of the filler sometimes is that it can feel a little bit firm in that area, which may not feel completely natural. It can give a little bit of a stiffer appearance potentially. The Restylane Refyne and Defyne are meant to decrease or to minimize any stiff appearance. If that’s a concern of yours, that stiff look, then using the Refyne and Defyne may be a better option for you.
There’s always risk of bruising and infection, although it’s very low risk with these types of injectables.
Obviously they do wear off and so at some point you have to redo it again.
Corner Mouth Lift
If a filler doesn’t do it and the Botox doesn’t do it, then the next step is a corner mouth lift or a “Grin Lift.”
This is a surgical procedure when the lifts are really droopy. A surgeon can literally cut a triangle of skin out from above each corner of the mouth, suture it back together and by suturing together, they can suture the corner of the mouth into a higher position.
This can be very effective in people. The negative about this, however, is it does create a permanent scar and that scar typically extends from the corner of the mouth up towards your nasolabial fold on each side. This does not match the natural wrinkles of the mouth and this scar can definitely be visible in some people.
Because of that I only recommend the grin lift or the corner mouth lift in patients who are really over the age of about 60. They tend to scar a bit nicer. If you want to have this done in your 40s, that scar can be quite visible. People who are in their 20s, 30s and 40s, don’t heal with nice scars as people who are in their 60s, 70s and 80s.
Typically I save this for people who are a bit older, where the collagen in their skin isn’t quite as reactive and quite as thick. They tend to scar this better and get a better result.
The other thing is that if you’re a candidate for a grin lift, usually you’ll necessitate two.
The more skin that is removed, the more of a lift you can get, but the longer the scar afterwards. Instead of doing one huge corner mouth lift giving a big long scar, I would prefer two smaller ones to give a shorter scar in the end.
That’s something that you can talk about in a face-to-face consultation if you decide to have this done.
A corner mouth lift can be done in the office. It typically takes about 45 minutes or so, just on under a local anaesthetic. They literally just cut a triangle out from above each coner in the mouth and put some sutures in. Those sutures stay in for about a week and they will be visible for a week. People might look at you funny. So for a week you probably want to hide out. They take those sutures out after a week and it usually heels just fine afterwards.
A grin lift is great for the downturned corners of the mouth but it won’t treat a marionette line. So if you’ve got these lines coming down, a grin lift won’t get rid of it. It will just lift the corner of the mouth. You want to treat that lines using an injectable filler.
The best results are for somebody who uses all three of these treatments: the Botox, the filler and the grin lift. That usually does it for people. The only group it doesn’t do it for, however, are people who have a lot of looseness and things are really pulling down.
If all you do is a grin lift and some injections and the jowls are pulling the corners of mouth, it usually is not enough. You have to add a face lift to it, believe it or not.
This is a sample of a patient:
You can see really downturned corners of the mouth in those marionette lines, especially on your left on the before picture. She used to get food particles stuck in that marionette line, it is so deep.
For her, they performed a lower face lift and that helped to lift all the jowls. Combined with a grin lift and some filler, and you can see the mouth looking so much better afterwards.
This patient did not have a lot of looseness. She did not have big jowls or anything. They were able to lift her up with just two moderate grin lifts. She healed very well. This is a little bit of an older patient, but really did well to shape the corners of the mouth.
She does have a little scar because they did two of the moderate grin lifts, she doesn’t have the big long scar coming up much higher and she did not need a face lift.
This is a patient who actually had a face lift but she didn’t get a grin lift. You can see on her before picture how the corners of the mouth are really drooping and she looks quite angry. It’s the grumpy look that we want to reverse.
She already had face lift, so she didn’t have jowls and all this skin and fat pulling her corners of the mouth down. What they did was they did a series of two grin lifts to lift those corners up to finish the job for her. You could see a really nice improvement there. Once again, the permanent scar coming up from the corners of the mouth.
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If you’ve got droopy corners of the mouth, you’ve got a permanent frown, start with the Botox and then follow that up with the injections of filler. Sometimes they’ll do that at the same time.
If that doesn’t do it, then the grin lift is the next option.
I hope this was helpful for you in your quest to turn that permanent frown upside down.