Multiple variables can impact how the face changes as a result of the natural aging process. Repeated facial expressions cause the skin to become etched with wrinkles, especially around the lips, forehead, and eyes. The skin also becomes thinner and more slack, while the midface loses volume over time.
In her NYC practice, Dr. Michele Green frequently treats patients for DAO, or creases at the corners of the mouth. The depressor anguli oris (DAO) muscle, which runs from the corners of the mouth to the lower jaw, begins to weaken due to excessive use in the lower face. This causes the corners of the mouth to sag downward, creating an eternal frown.
Additionally, the DAO muscle can emphasize puppet lines, which resemble marionette puppet strings running from the corners of the lips down to the chin. Many patients believe that plastic surgery is the only option to restore lift to their lower face. However, at Dr. Michele Green’s board-certified dermatology practice, Botox injections provide a safe and effective non-surgical solution to elevate the DAO muscles and restore a youthful appearance.
Botox, made from botulinum toxin type A, works by blocking neurotransmitters in the muscle, effectively “freezing” it upon injection. This relaxes the muscle, reducing dynamic wrinkles, such as those running down the chin and around the mouth.
Botox is FDA-approved for treating muscle spasms, excessive perspiration, and dynamic wrinkles on the forehead, between the eyebrows, and around the eyes. Though Botox for the lower face was not widely used for a long time, it can now be safely and effectively injected into the depressor anguli oris muscle to lift the corners of the mouth, treat asymmetry, and minimize the appearance of jowls.
Since DAO Botox is an off-label application, it is important to always seek treatment from a qualified injector, like Dr. Michele Green.
What is the Depressor Anguli Oris (DAO) Muscle?
The depressor anguli oris (DAO) muscle, located in the lower face, is primarily responsible for causing a frown or the downward drooping of the mouth. Attached to the corners of the mouth and the jawbone, the DAO muscle works in conjunction with other facial muscles, such as the masseter in the jaw, the mentalis in the lower lip, the platysmal bands in the neck, and the orbicularis oris around the mouth.
With age, the DAO muscle can weaken, leading to the corners of the mouth curving downward, creating a permanent frown even when the face is at rest. As a result, some individuals may appear tired or depressed, even if they aren’t feeling these emotions. Alongside the aging process, the DAO muscle contracts, contributing to the formation of marionette lines—dynamic creases that run from the corners of the mouth down to the chin and jawline.
This downward pull of the DAO muscle can also result in the development of jowls along the jawline. The good news is that botulinum toxin injections, such as Botox, can help reverse the aging effects caused by the weakening of the DAO muscle.
Can filler be used for DAO muscles?
Dermal filler injections offer significant benefits for addressing various skin concerns and cosmetic issues, such as wrinkles, volume loss, depressed acne scars, and fine lines. They can also help correct sagging skin, define the jawline and cheekbones, and enhance the lips for a naturally fuller appearance. At Dr. Michele Green’s dermatology practice, numerous FDA-approved dermal fillers are available to treat specific facial areas.
For the lower face, Dr. Green frequently uses Juvederm Vollure or Restylane Refyne. These fillers are effective in smoothing out wrinkles and restoring a youthful appearance by injecting them into the smile lines around the lips.
While Botox injections are the most efficient way to treat dynamic wrinkles, fine lines, and those caused by the repeated contraction of facial muscles, they are particularly effective for addressing downturned lips caused by DAO muscle spasms. Botox injections can reverse the appearance of a frown caused by this muscle.
For even more impressive anti-aging results, Dr. Green often combines Botox with dermal filler injections for a more comprehensive and lasting effect.
What is DAO Botox?
Known most commonly by the brand name Botox, botulinum toxin type A is an injectable neurotoxin used to treat various cosmetic and medical concerns. When injected into a muscle, Botox blocks neurotransmitters, effectively “freezing” the muscle and preventing it from contracting. FDA-approved for treating a range of issues, including forehead lines, crow’s feet, frown lines, blepharospasm, cervical dystonia, chronic migraines, overactive bladder, and hyperhidrosis, Botox is a versatile solution.
While Botox is well-known for treating these concerns, its use in the lower face is a relatively new, off-label treatment for cosmetic issues like a gummy smile, thin lips, and a downturned mouth. DAO Botox specifically targets the depressor anguli oris (DAO) muscle to address a downturned mouth, improve facial symmetry, and reduce dynamic wrinkles around the mouth, chin, and jawline.
The DAO muscle controls mouth movement, including eating, drinking, and making facial expressions. A low-dose Botox injection into this muscle provides a subtle lift at the corners of the mouth without interfering with normal mouth and jaw function. In addition to restoring a lifted appearance, DAO Botox can smooth fine lines, wrinkles, and dimples around the injection site.
How do Botox injections affect the lower face?
Allergan produces botulinum toxin type A under the brand name Botox, which is widely used to treat a variety of medical and cosmetic disorders. Other types of botulinum toxin A include Dysport, also used for similar purposes, and Xeomin, produced by Merz Pharmaceuticals.
For many years, Botox, as well as Dysport and Xeomin, has primarily been used to treat dynamic wrinkles on the mid and upper face, including glabellar lines, forehead lines, crow’s feet around the eyes, and eyebrow lift. However, recent studies have shown that Botox injections are highly effective for addressing cosmetic concerns in the lower face, such as a downturned mouth, lip flip, facial asymmetry, and gummy smile.
Since the lower face involves several interconnected muscles, a skilled injector must carefully map out the injection sites to ensure optimal results.
Can you Botox the Depressor Anguli Oris?
DAO Botox injections into the depressor anguli oris (DAO) muscle are becoming an increasingly popular treatment for marionette lines, lower face asymmetry, and a downturned mouth. The DAO muscle, which runs from the corners of the mouth to the jaw, is responsible for facial expressions like frowning. Although DAO Botox is an off-label use of Botox, meaning it is not FDA-approved specifically for this purpose, it remains an effective treatment when performed correctly.
When administered by a highly skilled, board-certified injector like Dr. Green, Botox injections into the DAO muscle provide excellent results for lifting the corners of the mouth and restoring facial harmony. Proper knowledge of facial anatomy is essential to ensure that the Botox remains localized to the DAO muscle, preventing it from affecting other muscles and disrupting lower face functions.
Choosing an experienced injector is crucial, especially for off-label treatments like DAO Botox, as seeking treatment from an unqualified injector increases the risk of complications.
What does Botox in DAO do?
Botox, a neurotoxin, works by blocking the neurotransmitters responsible for signaling muscle contractions. This effectively “freezes” the muscle, causing it to relax and reducing dynamic folds that form during muscle movement. The depressor anguli oris (DAO) muscle controls frowning and other specific facial expressions.
The DAO muscle is connected to other muscles in the lower face that help with speaking, eating, drinking, and making other facial expressions. Over time, the DAO muscle can weaken and become overactive, causing the corners of the mouth to pull downward, leading to a permanent frown, even when the face is at rest.
Botox injections into the DAO muscle relax it, lifting the corners of the mouth and smoothing wrinkles around the treated area.
How does Botox interact with facial DAO muscles?
The DAO Botox procedure begins with a consultation with Dr. Green, where you’ll discuss your medical history and treatment goals. Since DAO Botox requires precise injections tailored to each patient’s unique face shape, Dr. Green will assess your facial structure during the consultation. To minimize the risk of bruising after the procedure, Dr. Green recommends avoiding blood thinners like Advil a week before your Botox treatment.
When you arrive at Dr. Green’s Upper East Side clinic for the procedure, she will apply a topical numbing cream and carefully mark the injection sites based on your facial structure. The injections typically take between 15 to 30 minutes, and most patients experience minimal discomfort due to the numbing cream.
There is no downtime after the procedure, so you can resume your regular activities immediately. Choosing a skilled, board-certified injector like Dr. Green lowers the risk of severe side effects. However, mild swelling, bruising, redness, and soreness are common side effects and usually resolve within a few days.
Where to inject DAO Botox
Injecting Botox into the depressor anguli oris (DAO) muscle requires careful attention to each individual’s unique facial structure. Many injection site recommendations are based on the “average” face, but because most faces are slightly asymmetrical, this approach may not be accurate. As a result, each side of the face may require a different dosage of Botox.
The DAO muscle is closely connected to several other muscles in the lower face that are involved in speaking, chewing, and making facial expressions. For this reason, it’s essential to choose a highly skilled, board-certified injector, like Dr. Michele Green, who has extensive Botox injection experience. If injected incorrectly, DAO Botox can spread to deeper muscles in the lower face, causing a frozen smile or facial asymmetry.
Proper injection placement is crucial to avoid significant side effects. The middle and base of the marionette lines are the ideal injection sites, with a depth of around 5 millimeters. During your initial consultation, Dr. Green will carefully assess your facial structure to determine the optimal injection locations for the best results.
What does Botox do to DAO muscles?
The DAO muscles, located in the lower face and extending from the corners of the mouth to the jaw, are responsible for facial expressions such as frowning. As we age, these overactive muscles weaken, causing the corners of the mouth to pull downward, resulting in a constant scowl. This can make individuals appear fatigued or irritated, even when they aren’t. Botox, which blocks neurotransmitters, relaxes the DAO muscles and lifts the corners of the mouth, restoring a naturally refreshed appearance.
Are DAO Botox injections worth it?
For patients, aging symptoms like wrinkles, fine lines, and the appearance of jowls can be frustrating. Many believe that plastic surgery—a procedure requiring significant recovery time and carrying a high risk of side effects—is the only solution for lifting the lower face. However, DAO Botox injections offer a non-invasive alternative, effectively addressing marionette lines, jowls, and a downturned mouth without the need for surgery. Follow-up treatments every four to six months can help maintain the results, despite the temporary effects of the procedure.
How Long Does DAO Botox Last?
Every individual is unique, and some people metabolize Botox faster than others. However, DAO Botox typically provides noticeable benefits for up to six months after the initial injections. If combined with dermal fillers, the Botox results can last even longer. If you’re happy with the effects of your DAO Botox treatments, you can maintain these results with regular maintenance injections. To determine the best care plan for your cosmetic goals, it’s essential to consult with your physician.
How many units of Botox for DAO?
Each patient requires a different number of Botox units for the DAO area, depending on the severity of their downturned mouth and individual facial structure. Most patients typically receive up to four units on each side of the mouth, though some may achieve the desired results with just two units per side. Your physician will work with you to determine the right amount of Botox needed to meet your specific treatment goals.
What is the recovery time for DAO Botox?
After the DAO Botox procedure, there is minimal downtime. However, it’s important to avoid strenuous activities for the entire day. On the day of your appointment, plan for light, relaxing activities. Additionally, refrain from touching your face, applying makeup, or using facial products for at least four hours post-treatment. For the best healing results, be sure to follow all aftercare instructions provided by your injector.
Am I a Good Candidate for DAO Botox?
If the downturned appearance of your mouth bothers you, DAO Botox could be a suitable solution. This treatment is also effective if weak DAO muscles are causing your chin to appear dimply or sagging. During your initial consultation, your healthcare provider will discuss the potential for positive outcomes from this procedure.
However, if you’ve had an adverse reaction to Botox in the past, you may not be a good candidate for any Botox treatment. Additionally, if you are pregnant or breastfeeding, this therapy is not recommended. The neurotoxin’s effects on the placenta or breast milk are unknown, so to avoid any potential risks to your baby, it is best to avoid Botox treatment during pregnancy and breastfeeding.
Benefits of DAO Botox
DAO Botox Before and After Photos demonstrate how this straightforward procedure can dramatically improve the appearance of the chin and mouth. By providing a subtle, nonsurgical lift to the lips and chin, DAO Botox can restore a youthful look and reduce the visibility of jowls. Some of the key benefits of this popular cosmetic treatment include:
- A more visually appealing resting expression.
- A non-surgical procedure that leaves no scars or need for scalpels.
- A more prominent and sculpted jawline and chin.
- Reduced visibility of dimples and creases.
- Enhanced definition in the chin and lower lip areas.
- A brighter, more youthful smile.
- Smoother skin and a refreshed appearance.
- Boosted self-confidence.
Feeling confident about your appearance boosts your ability to express yourself boldly and energetically. Moreover, when you’re not stuck with a permanent frown, you project a kinder, more approachable demeanor, making it easier for others to connect with you.
Risks of DAO Botox
Botox is considered one of the safest aesthetic treatments available. However, like any cosmetic procedure, it may cause minor side effects that typically resolve within 24 hours after the injection. Some of the most common temporary side effects include:
- Injection-site tenderness
- Mild swelling
- Minor post-injection bleeding
In rare cases, some patients may experience bruising a few days after their treatment. To minimize the risk of bruising, it is advised to avoid blood thinners before your consultation. Substances like Vitamin E, aspirin, and ibuprofen can thin the blood, increasing the likelihood of bruising. To help reduce bruising and constrict enlarged blood vessels, you can apply a cold compress to the affected area. Additionally, sleeping with your head elevated can help minimize swelling and bruising.
After treatment, a “frozen smile” or lip asymmetry may occur due to the placement of DAO Botox injections. Inexperienced injectors may not fully understand how to minimize these risks, but skilled practitioners can effectively avoid them. To achieve the best results from your treatment, it is essential to work with a qualified injector who has specialized Botox training.
How Can I Schedule DAO Botox Injections?
This is for informational purposes only. For medical advice or diagnosis, consult a professional.
There are several steps involved in scheduling DAO Botox injections.
- Find a qualified injector: Look for a board-certified dermatologist, plastic surgeon, or other medical professional with experience in facial aesthetics and Botox injections. Check their credentials and reviews to ensure they are qualified and experienced.
- Initial consultation: Schedule a consultation with the injector to discuss your concerns and goals. They will assess your facial anatomy and determine if you are a good candidate for DAO Botox.
- Treatment plan: The injector will create a personalized treatment plan, including the number of injection points and the amount of Botox needed.
- Once you have a treatment plan, you can schedule your DAO Botox injection appointment. The procedure is typically quick, taking about 15 minutes.
- Aftercare: Follow the injector’s aftercare instructions carefully to minimize side effects and maximize results.
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