Drooping corners of the mouth
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Drooping mouth corners are an anatomical feature or an acquired change in the position of the oral commissure, in which the lateral parts of the oral fissure are directed downwards. It can give the face a sad, tired, or stern expression, even when the facial muscles remain relaxed. Drooping of the corners is not a distinct disease, but the result of the interplay of bone structure, muscle activity, fat distribution, skin quality, and the aging processes of the lower face. It should be distinguished from marionette lines, which are grooves running from the corners of the mouth toward the chin. Both issues often occur simultaneously, but they require a different assessment and should not always be corrected using the same method.
Drooping corners of the mouth - why do they droop
The position of the corner of the mouth depends on the balance between the muscles that elevate and depress the oral commissure. Of particular importance is the depressor anguli oris muscle, abbreviated as DAO from its Latin name depressor anguli oris. It originates in the mandibular region and inserts into the fibromuscular node known as the modiolus, where the fibers of several facial muscles intersect. Excessive DAO activity can pull the corners downward, especially during speaking and expressing emotions.
The most important causes include:
- congenital factors, including the shape of the mandible, lip proportions, and the individual arrangement of facial muscles;
- skin aging, associated with collagen loss, changes in elastic fibers, and reduced tissue resistance to deformation;
- adipose tissue changes, including volume loss in certain compartments and the displacement of lower cheek tissues;
- bone remodeling, particularly the gradual resorption of the maxilla and mandible, which weakens the support for soft tissues;
- elongation and flattening of the lips, reduced vermilion exposure, and changes in the orbicularis oris muscle;
- laxity of the lower face, the formation of labiomental folds, and disruption of jawline continuity;
- bite asymmetry, missing teeth, or improper lip support, which can affect the appearance of the perioral area;
- tobacco smoking and chronic exposure to ultraviolet radiation, accelerating the degradation of the skin's extracellular matrix.
Drooping corners of the mouth are therefore a multifactorial process. In one individual, muscle action may predominate, while in another, it may be the loss of structural volume or tissue laxity. This distinction determines the choice of management.
Drooping corners of the mouth - how to recognize them
The primary symptom is a downward turn of the oral commissure at rest or during facial expression. The change may be accompanied by: a shadow below the corner of the mouth, shortening of the lateral part of the vermilion, deepening of marionette lines, loss of a clear lip contour, and asymmetry between the right and left sides.
In clinical evaluation, the face is analyzed at rest and in motion. The patient may be asked to smile, press the lips together, say a few words, and make a sad facial expression. If the corners drop primarily during movement, hyperactivity of the depressor muscles may play a significant role. When they remain turned down at rest, volume changes, skin laxity, or facial skeletal remodeling are more likely to coexist.
The following should also be assessed:
- facial symmetry and lip mobility;
- the presence of marionette lines and „jowls”;
- the volume of the cheeks, chin, and premandibular area;
- dental status, occlusion, and tissue support by the dental arches;
- previous procedures, trauma, surgeries, and neurological diseases.
A sudden, unilateral drooping of the corner of the mouth is not a typical aesthetic issue. If it appears alongside limb weakness, speech disturbance, drooping eyelid, dizziness, or a severe headache, it may indicate a stroke and requires immediate medical attention. Isolated asymmetry may also occur in facial nerve palsy, after trauma, or as a consequence of dental and surgical procedures.
Drooping corners of the mouth - do exercises help
Facial exercises, face yoga, and massages are often presented as non-invasive ways to lift the corners of the mouth. However, their effectiveness in aesthetic facial rejuvenation has not been confirmed in studies of high methodological quality. Scientific reviews indicate that available papers involve small groups and often lack a control group, randomization, or blinded outcome assessment. Therefore, it cannot be concluded that exercises permanently alter the position of the oral commissure or reverse bone, volume, and ligamentous changes associated with aging.
The significance of exercises also depends on the cause of the problem. In the case of dominant DAO activity, intensive strengthening of the depressor muscles can theoretically reinforce an unfavorable mimic pattern. On the other hand, gentle facial expression awareness exercises, relaxing overly tense structures, and neuromuscular re-education can support movement control, but they do not replace the treatment of structural changes.
A different situation applies to facial nerve palsy. In this case, individually tailored physiotherapy, muscle control training, and synkinesis therapy can improve function, but they constitute rehabilitative management rather than aesthetic gymnastics performed without prior diagnostics.
There is no reliable basis for promising that a few-minute daily workout will permanently lift the corners of the mouth. Excessive stretching, pressure, and the repetition of strong grimaces may additionally exacerbate dynamic wrinkles or cause skin irritation.
Drooping corners of the mouth - what treatment lifts them
There is no single best treatment for all patients. The correction plan should result from an analysis of the cause, rather than solely from the appearance of the corner of the mouth itself. In practice, several methods are used.
- Botulinum toxin type A can be administered into the depressor anguli oris muscle if its excessive activity is dominant. Partial and temporary weakening of the DAO reduces the downward pulling force on the commissure. The procedure requires a very good knowledge of anatomy, as unintended effects on adjacent muscles may cause smile asymmetry, difficulty with articulation, incomplete lip closure, or fluid leakage. Treatment in this location should be performed by an appropriately qualified physician.
- Cross-linked hyaluronic acid fillers can improve the support of the corner of the mouth, the lip contour, marionette lines, or volume loss in the prejowl area. Hyaluronic acid lip modeling available at Ambasada Urody can serve to subtly correct shape and asymmetry; however, it should not rely on overfilling the commissure itself. This area is vascularized by branches of the facial artery, which is why the procedure carries a rare but serious risk of vascular occlusion and tissue ischemia.
- In cases of greater laxity, lifting or biostimulating threads are considered, including PDO First Lift threads, barbed threads, and Aptos threads available in the clinic's offer. They can provide mechanical tissue repositioning or stimulate collagen remodeling.
- Energy-based device treatments, such as microneedle radiofrequency, focused ultrasound, and appropriately selected fractional lasers, induce a controlled healing response and collagen remodeling. They can improve the density and tension of the skin in the lower third of the face, but typically do not lift the corners of the mouth on their own if the primary cause of the problem is DAO muscle hyperactivity, significant tissue displacement, or advanced ptosis.
- Biostimulatory treatments, including injectable collagen stimulators and microneedling, activate a controlled regenerative skin response. They can stimulate fibroblasts to produce extracellular matrix components, improving tissue density, elasticity, and tension. However, they do not cause direct weakening of the DAO muscle or significant mechanical lifting of sagging tissues.
- Needle Shaping is a minimally invasive tissue remodeling method in which a thin needle is inserted into the subcutaneous layer and subjected to appropriately modulated electrical currents. This enables the mechanical grasping and reorganization of collagen fibers without administering a classic filler. The treatment can improve skin cohesiveness and provide a subtle tightening effect around the mouth area. However, available clinical and histological studies are scarce, so the durability or superiority of this method over other procedures cannot be unequivocally determined. Needle Shaping does not directly correct DAO muscle hyperactivity and does not replace a surgical lift in the case of significant ptosis.
- In advanced cases, the greatest effect can be achieved with a surgical lower face lift or surgical corner lip lift, although surgical methods leave scars and require an assessment of the risk-benefit balance. Often, the best result is achieved through combination treatment, tailored after a facial examination.
Drooping corners of the mouth - how to lift them with makeup
Makeup does not change anatomy, but it can optically reduce the downward direction of the corners. The most important thing is to limit lines and shadows running downwards.
Correction begins by applying a small amount of concealer to the natural outline on the outer parts of the lips. Using a lip liner, you can end the lower lip line about 1–2 mm before the actual corner, and then direct it gently upwards. You should not extend the lower contour beyond the commissure or trace the downturned part of the natural line, as this reinforces the impression of a sad expression.
It is helpful to:
- subtly brighten the skin directly beneath the corners;
- avoid dark contouring along the marionette lines;
- apply a slightly lighter lipstick in the central part of the lips;
- thoroughly blend the edges so the correction is not visible up close;
- use products that do not settle into perioral creases.
Very dark, matte lipsticks and a heavily defined lower contour can optically diminish the lips and emphasize drooping. Makeup should maintain the natural proportions of the lips. Significantly overdrawing the contour produces an unnatural effect and does not compensate for deep asymmetry or tissue laxity.
