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Drooping Mouth

Drooping Mouth

A drooping mouth is one in which the corners of the lips (the oral commissures) sit downward at rest, often with vertical shadow lines extending from the corners toward the chin — known as marionette lines. This can produce an unintended resting expression of sadness or fatigue even when the patient feels neither. Treatment is usually layered — easing the muscle that pulls the corners down, supporting the structure underneath the corners, and improving the skin quality of the surrounding area.

Medically reviewed by Dr Bhavin Garara, GMC 7155707 · Last reviewed: 7 May 2026

On this page
What it is

What Is a Drooping Mouth?

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The corners of the mouth are a dynamic anatomical intersection of several muscles, including the depressor anguli oris (DAO) which pulls the corners downward, and the lifting muscles that pull them up during a smile. With age, three things tend to happen: the DAO becomes more active or shortened, the structural support beneath the corners is lost, and the surrounding skin becomes less elastic. The result is that the corners sit lower at rest and the marionette lines that border them deepen.

Dr Bhavin Garara’s approach is to address the downward muscle pull first and rebuild the support around the corners — rather than filling the marionette line itself, which usually produces a heavy lower face.

What causes it

What Causes a Drooping Mouth?

  1. 1

    Hyperactive depressor anguli oris (DAO)

    The DAO can become shortened or more active with age and repeated use, pulling the corners of the mouth downward even at rest.

  2. 2

    Mandibular bone loss

    The mandible (lower jaw) gradually loses volume with age, reducing the bony support under the mouth corners. As the foundation recedes, overlying tissue pools and shadow forms.

  3. 3

    Loss of dermal collagen and elastin

    The skin around the mouth becomes lax and less able to resist gravitational pull. UV damage and lifestyle factors accelerate this.

  4. 4

    Mid-face descent

    Loss of cheek volume and descent of mid-face fat pads contributes to the heaviness above and around the corners.

  5. 5

    Skin quality changes specific to the perioral area

    The perioral skin is naturally thin and prone to fine vertical lining — see our barcode lip lines page.

Dr Bhavin Garara
Dr Bhavin Garara, MBBS, BMedSci, PGDip
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Dr Garara's approach

How Dr Bhavin Garara Treats Drooping Mouth

The plan usually leads with easing the DAO, builds structural support around the corners, and adds skin-quality treatments for the surrounding skin.

At the clinics in London, Dr Garara assesses at consultation the activity of the DAO at rest and during expression, the projection of the chin and the mandibular support beneath the corners, the elasticity of the perioral skin, and how the drooping mouth relates to the rest of the lower face.

  • Anatomy-led assessmentTreatment plans built around your unique facial structure and movement.
  • Personalised planCombinations chosen for your skin, goals, and lifestyle — not a one-size-fits-all protocol.
  • Natural resultsA refreshed, well-rested version of you — never a frozen or over-treated look.

Features

Treatment Options for Drooping Mouth

Ease the muscle that pulls the corners down, rebuild support, refine skin quality. Direct fold filler is avoided.

Prescription muscle-relaxing injections (DAO release)

Prescription muscle-relaxing injections (DAO release)

Small, precise doses placed into the DAO reduce its downward pull, so the lifting muscles act with less opposition and the corners rest more neutrally.

Structural support around the corner of the mouth

Structural support around the corner of the mouth

Very small amounts of HA filler placed just below the oral commissure act as a buttress, supporting the corner from underneath. Not placed into the marionette line itself.

Collagen biostimulators

Collagen biostimulators

PLLA or CaHA preparations (including HA + CaHA hybrids) gradually build collagen across the lower face and jawline for firmness over months.

Regenerative skin treatments

Regenerative skin treatments

Polynucleotides (e.g. Rejuran®), PDRN, skinboosters (Profhilo, Sunekos, NCTF, klardie), and autologous PRP / platelet-derived exosomes improve perioral skin quality.

Radiofrequency microneedling

Radiofrequency microneedling

Sylfirm X delivers radiofrequency through fine needles into the dermis along the lower face to encourage tightening and collagen remodelling.

See SkinPen microneedling →
Mid-face support (where part of the picture)

Mid-face support (where part of the picture)

Where mid-face descent is contributing, restoring cheekbone support helps — addressed alongside the lower-face work.

We layer treatments to address the downward muscle pull, the structural support beneath the corners, and the quality of the surrounding skin. Filler placed directly into the marionette line is avoided — it usually makes the lower face look heavier rather than lifted.

Prescription muscle-relaxing injections (DAO release)

  • Best for: Hyperactive DAO pulling corners down
  • Downtime: None — brief redness
  • Lasts: Around 3–4 months

For most patients, the first step is small, precise doses of muscle-relaxing injection placed into the DAO to reduce its downward pull. With less downward tension, the lifting muscles of the face act with less opposition and the corners rest more neutrally.

Prescription muscle-relaxing injections work by temporarily reducing the activity of specific muscles, so the skin above them stops folding with each movement. The active ingredient is botulinum toxin type A, a purified protein delivered in very small, precisely placed doses. These are prescription-only medicines in the UK, which means they can only be prescribed and administered by a qualified medical prescriber following a face-to-face consultation. Whether this treatment is suitable for you, and what specific product or dose would be used, is something Dr Garara will discuss with you at consultation. It is not suitable for everyone.

DAO / lower-face treatment with botulinum toxin is what’s known as “off-licence” — established, lawful practice in qualified medical hands, but not specifically licensed by UK regulators for this particular indication. Dr Garara will explain this fully at consultation, including why he considers it appropriate for your case, and will obtain your informed consent before any treatment.

Structural support around the corner of the mouth

  • Best for: Loss of structural support at the corner
  • Downtime: 1–3 days of mild swelling
  • Lasts: Around 9–12 months

Where the corners need support from underneath, very small amounts of hyaluronic acid (HA) filler placed just below the oral commissure act as a buttress, supporting the corner so it sits more neutrally. The aim is supportive, not voluminous — filler placed into the marionette line itself tends to make the lower face look heavier rather than lifted.

Hyaluronic acid filler is reversible — see our filler removal and dissolving page.

Collagen biostimulators

  • Best for: Gradual rebuilding of lower-face structure
  • Downtime: 1–3 days of swelling
  • Lasts: Around 12–18 months following a course

For longer-term rebuilding of structural support in the lower face and jawline, poly-L-lactic acid (PLLA) or calcium hydroxyapatite (CaHA) preparations (including HA + CaHA hybrids) build collagen gradually over months. They are well-suited to the area around and just below the marionette line, providing firmness over time rather than immediate volume.

Regenerative skin treatments

  • Best for: Thin, crepey perioral skin
  • Downtime: 1–2 days of mild bumps
  • Lasts: Around 6–12 months with a course

For the thin, crepey skin around the mouth, polynucleotides (PN) such as Rejuran®, PDRN, multi-ingredient skinboosters (Profhilo, Sunekos, NCTF, klardie), and autologous PRP / platelet-derived exosomes can improve skin quality, hydration, and resilience over a course of treatments.

Radiofrequency microneedling

  • Best for: Lower-face skin laxity
  • Downtime: 2–5 days of redness
  • Lasts: Long-lasting; collagen remodelling continues for months

Sylfirm X delivers radiofrequency through fine needles into the dermis along the lower face to encourage tightening and collagen remodelling. Treatment for higher Fitzpatrick skin types requires careful device selection and conservative settings.

Mid-face support (where part of the picture)

For patients whose drooping mouth is partly driven by mid-face descent, restoring cheekbone support can also help — see our jowls and facial volume loss pages.

Considering treatment for a drooping mouth?

Book a consultation with Dr Bhavin Garara.

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Compare at a glance

Treatments at a Glance

Muscle-relaxing injection (DAO release)

Best suited for
Hyperactive DAO pulling corners down
Typical downtime
None — brief redness
How long results last
Around 3–4 months
What it does
Eases the downward muscle pull

HA filler around the corner (supportive use)

Best suited for
Loss of structural support at the corner
Typical downtime
1–3 days of mild swelling
How long results last
Around 9–12 months
What it does
Supports the corner from underneath

Collagen biostimulators (PLLA / CaHA)

Best suited for
Gradual rebuilding of lower-face structure
Typical downtime
1–3 days of swelling
How long results last
Around 12–18 months following a course
What it does
Builds collagen over months

Regenerative skin treatments

Best suited for
Thin, crepey perioral skin
Typical downtime
1–2 days of mild bumps
How long results last
Around 6–12 months with a course
What it does
Improves skin quality

Radiofrequency microneedling

Best suited for
Lower-face skin laxity
Typical downtime
2–5 days of redness
How long results last
Long-lasting; collagen remodelling continues for months
What it does
Tightens and remodels the skin

Downtime and duration figures are typical averages only. Individual results vary considerably. Dr Garara will give you a more personalised picture at consultation.

Safety & risk

Is Drooping Mouth Treatment Safe?

The perioral area is supplied by branches of the facial artery and contains the labial arteries close to the surface. Any injection here, particularly with dermal filler, carries a small but recognised risk of vascular complications, which in rare cases can include skin necrosis. The marginal mandibular nerve runs in the lower face and bruising or transient nerve irritation can occur. The area should only be treated by an experienced medical practitioner who understands the anatomy and is equipped to manage complications — including the immediate availability of hyaluronidase to reverse hyaluronic acid filler.

We share this not to alarm you, but because patients deserve full information. Dr Garara is always happy to discuss the specific risks of any treatment at consultation.
  • Qualified medical practitionerTreatment carried out by an experienced doctor with detailed anatomical training.
  • Reversal agents on handHyaluronidase and other complication-management tools are immediately available.
  • Full informed consentRisks, alternatives, and expected outcomes discussed in detail before any treatment.
Dr Bhavin Garara
Reviewed byDr Bhavin Garara

Frequently Asked Questions

Common questions about drooping mouth and marionette line treatments.

Read next

Related Concerns

A drooping mouth connects to other lower-face concerns. You may also want to read about:

Smile lines and foldsWeak chinJowlsBarcode lip linesAgeing lipsFiller removal and dissolving
← All face concerns

For an overview of all the facial concerns we treat, visit our Face treatments hub.

Next step

Ready to take the next step?

Book a consultation with Dr Bhavin Garara.

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Consultation

Begin with a proper assessment.

Tell us a little about what you're looking for and we'll match you with the right consultation — at the clinic or virtually.

  • Your enquiry goes directly to Dr Bhavin's team.
  • We'll be in touch within one working day.
  • All consultations are strictly confidential.

This page is for general information and does not constitute medical advice. All treatments require a personal consultation. Suitability, risks, and expected outcomes will be discussed with you in detail before any treatment is carried out.