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106 High StreetStevenage,SG1 3DW

Dr Harry Singh explains how we can relax this muscle with botulinum toxin to turn your smile from ‘upside down’ to ‘happy clown’!

Do people often ask you if ‘everything is alright?’, or tell you to ‘cheer up’? If so, then this could be a sign that you have a reverse or ‘upside down’ smile, such that the corners of your mouth, even when you are not moving your mouth or lips, have a tendency to point downwards, creating an uphappy look.

The cause of this downwards ‘tugging’ is an overactivity in one of the many muscles that we use to move our mouth so we can speak, eat and make facial expressions.

The muscle in question is called the Depressor Anguli Oris or DAO for short. The clue in its name is the word ‘depressor’, as this is the muscle that is responsible for lowering the corners of the lips and mouth, often used when we wish to express displeasure or repulsion. We have a DAO muscle on each side of the mouth. It is triangular-shaped with an anchor at the corner of the mouth and a flat side along the chin. If this muscle is too active, then it can start to tug down on the corner of the mouth even when we aren’t calling on its services to make faces. This repeated action can lead to the formation of marionette lines, as the overlying skin is constantly being pulled down by the overactive muscle. As we age, these lines will become more and more pronounced.

In another recent blog, I looked at treating deep marionette lines with dermal fillers. Marionette lines are the lines, folds or wrinkles which start from the corners of the mouth and head in a downwards direction, eventually reaching the chin. They get their name from the mouth shape of marionettes or ventrilloquist’s dummies.

If you try to do a sad face, you will be able to see and feel the constriction of the DAO muscle at the jawline and can see how strong it is at tugging down the corners of your mouth.

As well as treating deeper lines and wrinkles in this area with dermal fillers, such as the Restylane range which I use in my clinic in Stevenage, Hertfordshire, the DAO can also be relaxed with the use of botulinum toxin injections. This is a prescription only medicine and isn’t right for everyone, but after a face-to-face consultation with me, I will be able to diagnose if you have an overactive DAO and if injections with botulinum toxin, on its own, or with dermal fillers would be the most appropriate treatment for you. In my clinic, I like to use the Azzalure™ brand of botulinum toxin, other products include Botox®.

Treating the DAO and marionette lines in this way, in fact any injections of botulinum toxin in the lower face, i.e. below the usual areas of crow’s feet and frown lines, is very much an advanced technique and must be performed by someone with significant training and experience. I have been prescribing and performing wrinkle-relaxing treatments of this kind for over fifteen years. In the wrong hands, complications could arise through incorrect placement of the treatment in the muscles which could have an effect on the positioning of the mouth, lips and teeth, and even effect your ability to bite, chew, suck or talk. That’s why it’s important to see someone like me, with years of experience; plus as a dentist, I am very familiar with the anatomy of the mouth.

If you are fed up of everyone asking you to ‘smile’ or thinking that you’re miserable, then please call 0800 006 2266 to book an appointment to see me, Dr Harry Singh at Aesthetics in Stevenage, Hertfordshire.

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