Nobody wants to look like they're perpetually frowning — but that's exactly what a downturned mouth can do. When the corners of your mouth pull downward at rest, it creates an expression that reads as sad, tired, or irritated even when you're not. The good news: dermal fillers — and in some cases Botox — can correct this concern with precision, lifting the corners and softening the lines around them.
Several factors contribute to the corners of the mouth pulling downward over time:
The wrinkles that form around a downturned mouth are typically static — meaning they're visible at rest, not just during expression. They tend to appear alongside marionette lines, nasolabial folds, and vertical lip lines, since the lower face ages as a connected system.
Filler placed at the oral commissure — the junction where the upper and lower lip meet at each corner — does two things: it replaces the volume that's been lost, and it provides a small but meaningful upward lift to reposition the corner.
The technique is precise. Small amounts of filler are placed at and just below the corner to give it support, similar to propping up a structure from beneath rather than just filling it in from the front. Most providers use a blend of a flexible, movement-tolerant HA filler at the corner with a slightly denser filler in the body of the lower face to provide structural anchoring.
The best filler options for this area:
These are specifically engineered for areas of the face with high movement — which is exactly what the mouth area is. Restylane Refyne is formulated for mild to moderate lines and folds; Defyne handles moderate to severe cases and provides slightly more structural lift. Both use XpresHAn Technology, which allows the filler to flex with your expressions rather than looking stiff when you smile or speak.
Juvederm Vollure (made with Vycross technology) is another excellent choice for the perioral area. It integrates smoothly, moves naturally with expression, and tends to last 12–18 months in this location — slightly longer than Refyne/Defyne in some patients.
For deeper folds or patients who want longer-lasting results, Radiesse (calcium hydroxylapatite) provides both immediate structural correction and collagen stimulation over time. It's denser than HA fillers and delivers results that last approximately 12–15 months. Unlike HA fillers, it cannot be dissolved with hyaluronidase — so it's typically reserved for experienced injectors treating more defined cases.
Yes — and for patients whose downturned corners are primarily driven by an overactive DAO muscle rather than volume loss, Botox (or Dysport/Xeomin) can be highly effective on its own or as a complement to filler.
The treatment is called DAO relaxation or DAO Botox. Small doses — typically 2–4 units per side — are injected directly into the depressor anguli oris muscle to reduce its downward pull. When the DAO is relaxed, the unopposed elevator muscles (including the zygomaticus) can pull the corners up, restoring a more neutral or upturned position. This is the same principle used in Botox for brow asymmetry — relaxing one muscle to allow the opposing muscle to restore balance.
Results from DAO Botox last 3–4 months. Many patients combine it with filler at the first treatment — Botox addresses the muscle component while filler addresses the volume component — for a result that's more complete than either treatment alone.
Vertical lip lines — sometimes called perioral lines or smoker's lines — are the fine lines that radiate outward from the lip border, especially on the upper lip. These are distinct from downturned corners but often appear at the same time, since the same lifestyle and aging factors contribute to both.
For perioral lines, softer HA fillers work best. The skin in this area is thin and highly mobile, so injectors typically reach for:
Perioral lines are often treated in the same appointment as downturned corners. If your concern includes both, let your provider know during consultation so they can plan the treatment approach. For a deeper dive into lip-area treatments, see our guide on lip fillers.
Injectable treatment for downturned mouth corners and perioral lines works best when:
The best outcomes come from a combination approach tailored to whether volume loss, muscle overactivity, or both are driving the concern — which is why a thorough consultation is essential before any treatment.
Frown line and corner-of-mouth treatments are quick appointments — typically 20–30 minutes including consultation, numbing, and injection. A topical anesthetic is applied beforehand, and most modern HA fillers contain lidocaine in the formulation, so the experience is well-tolerated.
Mild swelling at the corners of the mouth is common for 24–48 hours. Bruising is possible but can usually be managed with arnica and vitamin K cream. Most patients return to normal activities the same day. Final results are apparent once swelling resolves, typically within 3–5 days.
DAO Botox is even simpler — a two-minute treatment with onset over 5–7 days and no downtime. Many patients combine it with a filler appointment.
Filler longevity at the oral commissure varies by product and patient. Restylane Refyne and Defyne typically last 9–12 months. Juvederm Vollure often lasts 12–18 months. Radiesse typically provides 12–15 months of correction. Individual metabolism, lifestyle, and treatment volume all affect how quickly the filler breaks down.
Most patients find DAO Botox very comfortable — the injection sites are small and the procedure is brief. A topical numbing cream can be applied beforehand if desired. The injection itself takes less than two minutes.
Yes — and combining them is common. Filler addresses the volume deficit at the corner, while Botox addresses the muscle pulling the corner down. Together, they provide a more complete result than either alone. Your injector can plan both treatments at a single visit.
When placed correctly, filler at the oral commissure should not affect how you smile. The filler is positioned at the structural level — it's providing support, not blocking movement. Patients often find that their smile looks more natural and less effortful after treatment, since the corners no longer start from a downturned position.
────────────────────────────────────────────────────────────
Downturned corners and lines around the mouth are highly treatable — but getting a natural result requires understanding exactly what's driving the concern. Our providers at Evolve Med Spa assess the lower face as a complete system, tailoring treatment to whether the issue is volume, muscle activity, or both. Book a consultation at Evolve Med Spa to get a clear picture of your best approach.properties, such as lifting capacity. The injectables with the highest lifting capacity are Voluma and Restylane.
Our team at Evolve Med Spa is devoted to helping you discover your best look and offer a wide range of today’s top dermal fillers. Call to book your appointment at 800-867-8015.
