Oral commissures turning downward give the patient an unhappy appearance, which affects the psychology of both sexes. An unhappy facial expression does not only affect the mouth area by itself but also the overall facial appearance. Patients with downward-turned oral commissures tend to look older than their actual age. The downward turn of mouth corners might be due to aging, fat pad loss where tissues start to sag, and a powerful downward pull by the depressor anguli oris muscle, located at the sides of the mouth. Injection at this site blocks the muscle activity, allowing the opposing upward pull of the oral commissures by the elevator muscles.
This treatment is not helpful in cases like severely depressed oral commissures and deep marionette lines that appear with aging, and the treatment must be combined with dermal fillers.
A lip lift is a treatment to enhance the visibility of the pink layer of the lips. The injection blocks the circular muscles of the mouth, called the orbicularis oris, that pulls the lips toward the center. Weakening this pull allows the upper lip elevators and lower lip depressors to increase their action, resulting in more visible pink lip and a slight lip lift. The effect is not as significant as fillers, but it will show a slight effect. It can be combined with lip filler treatments for patients with strong mouth muscles and tiny lips.
Smoker lines, mostly caused by smoking and speaking, should be treated as early as possible because they deepen over time, and then they can only be corrected with fillers. Repetitive contraction of the circular muscles around the mouth causes circumoral rhytids. The overactive circular mouth muscles contracting constantly will create the rhytids as the skin cannot tolerate the repetitive movements of the circular muscles.
Reducing the contraction of the sensitive sphincter muscle around the mouth will lessen the pull of the lips, soften vertical lines, and prevent them from worsening and deepening. This treatment will not help with deep vertical lip lines, and patients will require fillers to achieve fully invisible smoker lines.
Some patients lift their upper lip to such an extent that it exposes the gingiva, creating an unpleasant look known as a gummy smile. This happens when the patient smiles and makes the mouth and teeth appear larger than normal. To overcome this, the levator labii superioris alaeque nasi muscle that pulls the upper lip is relaxed to avoid dramatic pulling when the patient smiles.
A dimpled chin occurs mainly in patients who have a chin implant or whose chin is positioned more posteriorly than expected. With aging, the loss of subcutaneous fat in the dermis contributes to the appearance of a dimpled chin. To counteract this, the mentalis muscle is injected to inhibit the upward pull of the lower lip, thereby reducing the chance of a dimpled chin appearance.
