Marionette Lines and Mouth Corner Downturn
Lift downturned mouth corners and soften marionette lines with DAO Botox and structural filler. We address the muscle that's pulling down, not just the line.
Causes and Treatment
Marionette lines run from the corners of the mouth down toward the jawline. They have two contributors:
- Volume loss in the lower face (specifically the pre-jowl area) that allows the mouth corners to drop.
- Muscle pull from the depressor anguli oris (DAO) muscle, which actively pulls the mouth corners down. The DAO is often overdeveloped in patients with chronic stress or jaw clenching.
For meaningful improvement, both contributors usually need treatment. Botox in the DAO releases the downward pull. Filler in the pre-jowl area or directly in the marionette line restores the volume that the DAO is pulling against.
Better's approach is to start with the DAO. The Botox-only result is often surprising: just relaxing the muscle that pulls the corners down can lift the face dramatically without any filler at all. We add filler only if needed after the Botox has settled.
Better Med Spa's Recommended Treatments
Better treats marionette lines with four tools, often combined. Your consultation grades how much is muscle versus volume.
DAO Smile Lift
Small dose of Botox placed in the DAO muscle. Releases the downward pull on the mouth corners. Often the only treatment needed for early to moderate downturn.
RHA Filler (Marionette)
Hyaluronic acid filler placed in the marionette line and the pre-jowl area for immediate volume restoration. Used after DAO Botox if additional softening is needed.
Sculptra (Lower Face Restoration)
Stimulates collagen across the lower face and pre-jowl area. Restores volume gradually for natural results lasting up to 2 years.
Botox
The neuromodulator used in the DAO Smile Lift protocol. Same product, different placement. Standard choice for first-time patients.
Start with the DAO. Better's protocol for marionette lines is DAO Botox first, then evaluate at 4 to 6 weeks. Many patients are surprised by how much lift they get from just the muscle release. We add filler only if needed.
How to Choose Between Them
Match treatment to your dominant cause.
| If you want | Choose |
|---|---|
| Mild to moderate downturn | DAO Smile Lift (Botox only) |
| Deep static marionette lines | DAO Smile Lift + RHA Filler |
| Comprehensive lower face aging | Sculptra + DAO Smile Lift |
| Pre-jowl volume loss | RHA Filler in pre-jowl + DAO |
| Reversible option | DAO + RHA (both flexible) |
| Maintenance every 3 to 4 months | DAO Smile Lift on schedule |
The biggest mistake patients make is filling the marionette line directly without addressing the DAO. The Botox-only result is often dramatic: a 30-second injection in each side and the mouth corners lift visibly within 2 weeks. We almost never start with filler in this area.
Realistic timeline: DAO Botox shows results at 7 to 14 days, lasts 3 to 4 months. RHA filler is immediate, lasts 12 to 18 months. Sculptra builds over 3 to 6 months and lasts up to 2 years.
What to Expect at Better Med Spa
Marionette consultations at Better start with a face-at-rest assessment to evaluate mouth corner position, DAO muscle activity, and pre-jowl volume. We grade severity and recommend a phased plan starting with the muscle.
The DAO Smile Lift injection takes 5 minutes per side. We use topical numbing for sensitive patients. There's no downtime. Expect results at 7 to 14 days. RHA filler injections take 15 to 20 minutes if added.
Dr. Brechner supervises all neuromodulator and filler protocols. Our injectors are trained in conservative, structural approaches.
Ready to talk to one of our providers?
A 15-minute consultation grades your DAO and recommends a starting dose.
Before and After
See real Better Med Spa patient results in our gallery. Individual results vary based on starting point, dosage, and skin quality.
Frequently Asked Questions
Will DAO Botox affect my smile?
No, when dosed correctly. We use a small dose placed precisely in the DAO. Your smile remains fully natural; the muscle that pulls down at rest is what gets relaxed. Most patients say their smile looks bigger because the corners aren't fighting against the downward pull.
How long does DAO Smile Lift last?
3 to 4 months on Botox or Dysport, 6 to 9 months on DAXXIFY. With consistent treatment, the DAO becomes weaker over time and effects can extend.
Will treatment work if I don't get filler?
For mild to moderate downturn, yes, often dramatically. The DAO Smile Lift alone is enough for many patients. Filler is reserved for deep static lines or significant volume loss.
Most patients describe the injections as a series of small pinches. We use the smallest needles available and can apply topical numbing cream on request. The whole appointment is typically under 30 minutes including the consultation.
Can I combine this with my other Botox treatment?
Yes. DAO Smile Lift is often added to a routine upper-face Botox visit. The DAO uses just a few units per side, so the cost addition is small.
How much does DAO Smile Lift cost in Chicago?
DAO Smile Lift uses a small dose (typically 2 to 4 units per side). Pricing scales with units. Often added to existing Botox visits at minimal additional cost. See our Specials.
Related Reading
Where We Serve
Better Med Spa is located in Lincoln Park and serves patients across Chicago, including Old Town, Lakeview, Bucktown, Gold Coast, DePaul, West Loop, and River North.
Ready to lift the corners of your mouth without surgery?
Schedule a consultation and we will build a plan that fits you, your timeline, and your budget.