Botox for Marionette lines and sad mouthcorners

•  Marionette lines are grooves or furrows that run from the corners of the mouth downwards towards the jawline.
• Often the corners of the mouth are turned downwards as well, leading to a sad, dissatisfied or scornful look.

Muscles involved in downturned mouth corners and Marionette lines:

• Depressor Anguli Oris. This is the muscle highlighted in the image. The muscle attaches to the corner of the mouth. Excessive muscle tone will pull the corners of the mouth down, resulting in a sad look and also accentuate the so-called Marionette lines.

Technique

• The patient sits back on a bed with the backrest up.
• The area is cleaned.
• The skin overlying the muscles to be injected is marked out with a skin marker. The injection point is about 1cm above the angle of the jaw, in line with the Depressor Anguli Oris muscle.
• Care is taken not to inject too medially (towards the chin), to avoid weakening the Depressor Labii Inferioris muscle.
• Care must also be taken not to inject too superiorly (closer to the lip) to avoid weakening the Orbicularis Oris muscle that surround the mouth.
• The muscles are injected. It takes about 30 seconds.
• Light pressure is applied to the area to prevent bruising.
• The skin marker marks are wiped off.

Botox dosage:

• Depressor Anguli Oris muscle (highlighted in the image above) Botox injection for downturned mouthcorners and Marionette lines:
  • in females: 2 units per side
  • in males: 2-4 units per side

Aftercare:

• Slight bruising can occur, but can be concealed with make-up. It resolves in a few days.
• The effect will kick in after 3-10 days and last between 2 and 7 months, depending on the Botox dosage used and the patients physiology. Some patients dissolve Botox faster than other patients.
• First time patients will sometimes be requested to return after 2-3 weeks for a check-up and top-up if required.
• Most patients have the injections repeated once or twice a year.