When the corners of your mouth pull downward at rest, the effect can make you look sad, displeased, or tired, even when you feel perfectly fine. It’s one of those changes that people notice in photos or on video before they notice it in the mirror.
Downturned mouth corners are extremely common, and they respond well to treatment. Whether the cause is muscle activity, volume loss, or a combination of both, there are effective ways to restore a more neutral, relaxed expression.
Downward pull at the corners of the mouth creating a sad or displeased resting expression
Depressor anguli oris dominance, sad mouth appearance, resting frown, oral commissure drooping, marionette effect, droopy mouth corners, downturned smile
Overactivity of the depressor anguli oris (DAO) muscle, often combined with volume loss, sagging skin, and bone resorption
A more neutral, relaxed mouth position at rest
What Are Downturned Mouth Corners?
Downturned mouth corners occur when the outer edges of the lips angle downward rather than sitting in a neutral or slightly upward position. The result is a resting expression that can look sad, angry, or disapproving, regardless of how you actually feel. This is sometimes described as a “resting frown,” a “droopy mouth,” or a permanently “downturned smile.”
The primary muscle responsible is the depressor anguli oris (DAO), a triangular muscle that originates along the lower jawline and inserts at each corner of the mouth. Its job is to pull the mouth corners downward during expressions of sadness, displeasure, or concentration. When this muscle becomes overactive or dominant relative to the muscles that lift the mouth corners (the levator anguli oris and the zygomaticus major), the downward pull becomes visible even at rest.
The muscles that work in opposition to the DAO are worth understanding. The zygomaticus major originates on the cheekbone and inserts into the modiolus, a small fibromuscular hub at each mouth corner. It pulls the corners upward and outward when you smile. The levator anguli oris sits deeper, originating from the upper jaw and lifting the corners vertically. When the DAO overpowers these lifting muscles, the corners droop.
Dynamic vs. static downturn. In earlier stages, the downturn may only be noticeable during certain expressions or when the face is tired. This is a dynamic pattern. Over time, as aging compounds the muscle pull with volume loss and sagging skin, the downturn can become permanent, creating a static change in the mouth’s resting position. The distinction matters because dynamic and static presentations may benefit from different treatment approaches.
How downturned mouth corners relate to marionette lines. The two are closely connected but not identical. Downturned mouth corners refer specifically to the position and angle of the mouth, while marionette lines are the vertical creases that run from the corners of the mouth down toward the chin. Downturned corners often precede and contribute to marionette lines: as the mouth corners drop, they create a fold in the skin below. Many patients have both, and treating them together often produces the most natural result.
Why Mouth Corners Turn Down
Downturned mouth corners rarely have a single cause. Most patients are dealing with a combination of factors that develop gradually over time.
Overactive depressor anguli oris muscle. This is the most direct cause. The DAO is one of approximately 40 muscles in the lower face, and it specifically pulls the mouth corners downward. In some people, this muscle is naturally stronger or more dominant relative to the muscles that lift the corners. When the downward-pulling muscles overpower the upward-pulling muscles, the corners droop. Repetitive facial expressions like frowning can reinforce this pattern over years.
Age-related volume loss. The area around the mouth relies heavily on a fat pad called the buccal fat pad and deeper structural fat for support. As these fat pads thin and shift downward with age, the tissue around the mouth loses its scaffolding. Without that underlying support, the mouth corners are more susceptible to the downward pull of the DAO. Volume loss in the cheeks above can also contribute, since the mid-face provides structural support to the lower face.
Collagen and elastin decline. By the time most people reach their mid-30s, collagen production has already slowed significantly. The skin around the mouth becomes less resilient and less able to resist the constant pull of the underlying muscles. Elastin loss compounds the effect, reducing the skin’s ability to spring back after repeated movements. This is why a downturned mouth that starts as a dynamic concern during expressions can eventually become a permanent feature at rest.
Gravity and skin laxity. Over decades, gravity gradually pulls facial soft tissue downward. The mouth corners, positioned in the middle of the face with relatively thin skin and active underlying muscles, are particularly vulnerable. As skin loses firmness and begins to sag, the effect of gravity accelerates the downward drift.
Bone resorption. The jawbone itself changes shape with age. The mandible gradually loses volume, particularly in the area around the chin and lower jaw. As the bony foundation recedes, the soft tissue it supports loses its structural anchor, contributing to a downward drift of the mouth corners and surrounding tissues.
Genetics. Facial structure, muscle strength, skin thickness, and the rate of collagen loss are all influenced by genetics. Some people develop downturned corners in their 30s; others may not notice a change until their 50s or 60s. A genetic predisposition to a naturally downturned mouth can also mean this feature is present from a younger age, independent of aging.
Sun damage and lifestyle factors. Chronic UV exposure accelerates collagen breakdown in all areas of the face, but the skin around the mouth is especially thin and vulnerable. Years of sun exposure can make volume loss and skin laxity worse, compounding the downward pull. Smoking restricts blood flow to the skin and further degrades collagen and elastin. Poor nutrition lacking antioxidants can also contribute to premature skin aging around the mouth.
How Downturned Mouth Corners Affect Appearance
The mouth is one of the most expressive features on the face. When the corners turn downward, it sends a visual signal that doesn’t match what you’re feeling. Common effects include:
A resting expression that appears sad, tired, disapproving, or angry
Friends, family, or coworkers frequently asking “Are you okay?” or “What’s wrong?”
A face that looks stern or unapproachable in photos, even when you feel relaxed and happy
Shadows or creases forming below the mouth corners, creating the beginning of marionette lines
An overall impression of aging in the lower face, even when the upper face looks refreshed and youthful
Difficulty looking pleasant or neutral in professional photos, video calls, or social settings
For many patients, this disconnect between how they feel and how they appear is the most frustrating part. You shouldn’t have to smile constantly just to look like yourself.
What to Expect During a Consultation
A consultation for downturned mouth corners at Lazaderm focuses on understanding the specific combination of factors creating the downturn, because the right treatment approach depends on what’s driving it.
Your provider will:
Because the mouth area is complex and highly visible, your provider will take time to explain the anatomy involved, what each treatment option can realistically achieve, and how to approach correction in a way that preserves your natural expressions.
Setting Realistic Expectations
Downturned mouth corners can be significantly improved, but the best approach and expected results depend on what’s causing the downturn.
For muscle-driven downturn (DAO dominance):
For volume-related downturn:
For combined muscle and volume issues:
Important safety note. The mouth area is surrounded by muscles that control essential functions: speaking, eating, drinking, and expressing emotion. Treatment in this region demands detailed anatomical knowledge and conservative, precise technique. At Lazaderm, providers who treat this area are experienced in lower-face anatomy and take a measured, cautious approach to avoid affecting normal mouth function.
Botox and Dysport are often the first line of treatment for downturned mouth corners caused by DAO muscle dominance.
How they work. BOTOX® and Dysport are neuromodulators that temporarily block the nerve signals causing the DAO muscle to contract. By relaxing the muscle and reducing the downward pull, the mouth corners are free to rest in a more neutral position. The opposing muscles that lift the corners (the levator anguli oris and zygomaticus major) are left intact, creating a subtle rebalancing effect rather than a forced upturn.
Treatment details:
Why precision matters. The DAO sits close to the depressor labii inferioris (which controls the lower lip) and the mentalis (which controls the chin). If product migrates to either of these muscles, it can temporarily affect the ability to lower the lip, create an asymmetric smile, or alter chin movement. Injection placement must be exact, and dosing must be conservative. This is an area where less is almost always more.
Best for:
For patients whose downturned corners are related to volume loss, or whose muscle-only treatment didn’t achieve the desired result, dermal fillers provide structural support that lifts and stabilizes the mouth corners.
How they work. Fillers add volume beneath the skin at strategic points around the mouth, physically supporting the corners in a more neutral or slightly elevated position. By restoring the tissue volume that has been lost to aging, fillers recreate the scaffolding that once held the mouth corners in place naturally.
Key treatment areas:
Products used:
Results. Hyaluronic acid fillers produce immediately visible improvement. Sculptra works more gradually over several months. Duration ranges from 6 months to over 2 years depending on the product and placement.
Best for:
When downturned mouth corners are accompanied by broader skin-quality concerns around the mouth, these treatments can complement neuromodulators and fillers:
Microneedling. Stimulates collagen and elastin production in the skin around the mouth, improving firmness and texture. Helps the skin better resist the downward pull of underlying muscles and supports the longevity of filler results.
MOXI laser. MOXI delivers fractionated laser energy to improve skin tone, texture, and resilience with minimal downtime. Can address fine lines and overall skin quality in the perioral (around-the-mouth) area, helping to tighten skin and boost collagen production where it matters most.
Chemical peels. Targeted peels around the mouth improve surface texture and stimulate collagen turnover, which supports a smoother, firmer appearance in the lower face.
Your provider will recommend whether any of these supporting treatments would benefit your specific situation.
Can Botox fix a downturned mouth?
Yes, when the downturn is caused by an overactive DAO muscle. BOTOX® relaxes the muscle that pulls the corners of the mouth downward, allowing them to rest in a more neutral position. It works best for dynamic (muscle-driven) downturn rather than structural volume loss.
How long does Botox last for downturned mouth corners?
Results from BOTOX® or Dysport in the DAO area typically last 3 to 4 months. Regular maintenance treatments help sustain the correction, and some patients find the effects last progressively longer over time as the muscle weakens from repeated treatment.
Is a downturned mouth the same as marionette lines?
No, though they’re closely related. Downturned mouth corners refer to the angle and position of the mouth itself. Marionette lines are the vertical creases that extend from the mouth corners down toward the chin. The two often develop together, since drooping mouth corners create the fold that becomes a marionette line. Treating both concerns together usually produces the most natural correction.
Can you fix a downturned mouth without surgery?
Yes. Most patients with downturned mouth corners achieve significant improvement with non-surgical treatments. Neuromodulators like BOTOX® and Dysport address the muscle pull, while dermal fillers restore volume and structural support. For most people, these non-surgical options provide the natural-looking correction they’re looking for.
What is the best filler for downturned mouth corners?
The best product depends on the specific anatomy and degree of correction needed. Hyaluronic acid fillers like Restylane Defyne work well for the marionette area because they balance support with flexibility. For deeper structural lift, Juvederm Voluma may be used. Sculptra offers a different approach by stimulating the body’s own collagen production for gradual improvement.
How many units of Botox are used for the DAO?
Typically 2 to 6 units of BOTOX® per side. This is a low-dose treatment area. Your provider will assess your specific DAO muscle strength and tailor the dosing accordingly. Conservative dosing is especially important here because nearby muscles control essential functions like speaking and eating.
If downturned mouth corners are making you look sad or stern when you don’t feel that way, a consultation can help you understand what’s causing it and what options make sense. At Lazaderm, consultations focus on education, anatomy, and helping you feel confident in your decisions. No pressure, no upselling, just clear information about what will work for your specific situation.
