A downturned mouth is often perceived as conveying sadness, anger, or fatigue unintentionally, and it can accentuate adjacent wrinkles, such as marionette lines (vertical creases from mouth to chin).
While a downturned mouth refers to the position of the mouth corners, marionette lines are wrinkles caused by skin laxity and volume loss below the mouth. The two often coexist but require different treatment approaches.
What causes a downturned mouth?
A downturned mouth, often perceived as a sad or angry expression at rest, results from a combination of physiological, genetic, and lifestyle factors. Here’s a breakdown of the key causes:
Natural Ageing Process
The loss of collagen and elastin, proteins responsible for skin elasticity, leads to sagging skin and reduced facial volume. Gravitational pull exacerbates this, causing tissues around the mouth and cheeks to droop over time. Fat loss in the cheeks and jaw area also reduces structural support, deepening the downturned appearance.
Overactive Facial Muscles
The depressor anguli oris (DAO) muscles, which pull the mouth corners downward, become stronger with age or repetitive use (e.g., frequent frowning). When these muscles dominate over weaker opposing muscles (like the zygomaticus major, which lifts the mouth), the corners appear permanently downturned.
Genetic Predisposition
Some individuals inherit facial structures or muscle arrangements that predispose them to a naturally downturned mouth, even in youth. Genetic factors also influence how quickly collagen degrades and skin laxity develops.
Lifestyle and Environmental Factors
- Sun exposure (especially here on the Sunshine Coast in Queensland), smoking, and poor nutrition accelerate collagen breakdown, worsening sagging.
- Weight fluctuations, particularly rapid loss, leave loose skin around the mouth, emphasising drooping.
Repetitive Facial Expressions
Habitual frowning or expressions that engage the DAO muscles create permanent creases, reinforcing a downturned appearance.
Muscle Imbalance and Volume Loss
Weakness in muscles that lift the mouth (e.g., zygomaticus major) or volume loss in the midface reduces counteraction against the DAO’s downward pull. This is often compounded by age-related jawline shrinkage.
While ageing is a primary driver, younger individuals may experience a downturned mouth due to genetics, muscle overactivity, or rapid weight loss. Treatments to relax the DAO or fillers (to restore volume) are used to address these causes.
What muscle lifts the corner of the mouth?
The primary muscles responsible for lifting the corners of the mouth are the zygomaticus major and levator anguli oris, working together to create upward facial movements like smiling.
The zygomaticus major originates on the lateral surface of the zygomatic bone and inserts into the modiolus, a fibromuscular structure at the corner of the mouth. It elevates the corners of the mouth upward and laterally, producing a smile and deepening the nasolabial fold.
The levator anguli oris originates in the canine fossa of the maxilla and also inserts into the modiolus. Its action elevates the mouth corners vertically, contributing to more subtle smiles or expressions like grinning. It also works with the zygomaticus major to maintain upper lip tone and dental exposure during smiling.
The zygomatic and buccal branches of the facial nerve innervate both muscles. Supporting muscles include the zygomaticus minor, which assists in elevating the upper lip, and the risorius, which pulls the mouth corners laterally. Although its presence and strength can vary significantly between individuals, all these muscles contribute to the complex interplay of facial expressions.
Is a downturned mouth the same as marionette lines?
A downturned mouth and marionette lines are related but distinct facial features, often occurring together but differing in their anatomical causes and appearance.
A downturned mouth refers to the downward angle of the mouth corners at rest, caused by overactive depressor anguli oris (DAO) muscles, volume loss in the cheeks/midface, or genetic predisposition. It creates a “sad” or stern expression.
Marionette lines are vertical wrinkles extending from the mouth corners to the chin, caused by collagen loss, repeated facial movements, and sagging skin. They resemble puppet strings (hence the name).
Both can result from ageing (collagen/elastin loss), sun damage, and smoking.
A downturned mouth results from Muscle imbalance (strong DAO vs weak lifting muscles). In contrast, Marionette lines result from fat loss in the lower face and repetitive lip movements (e.g., talking, pursing).
| Downturned Mouth | Marionette Lines | |
|---|---|---|
| Appearance | Mouth corners angled downward | Vertical creases below the mouth |
| Primary cause | Muscle activity and volume loss | Skin laxity and volume depletion |
| Treatment focus | Relaxing DAO muscles and lifting corners | Filling wrinkles and restoring volume |
What treatments are available for a downturned mouth?
Several non-surgical treatments are available to address a downturned mouth, primarily targeting muscle activity, volume loss, and skin quality. Here’s an overview of the most common options:
1. Wrinkle Reducing Treatments
The depressor anguli oris (DAO) muscle, which pulls the corners of the mouth downward, can be treated with muscle-relaxing procedures to reduce downward tension and create a subtle, natural-looking lift.
- Procedure: 1-2 applications per side, taking <5 minutes.
- Results: Visible within 1-2 weeks, lasting 3-4 months.
- Ideal for: Overactive DAO muscles causing a “sad” or angry resting expression.
2. Dermal Fillers
HA fillers restore volume and support sagging mouth corners by:
- Lifting drooping tissue.
- Smoothing marionette lines (vertical wrinkles from mouth to chin).
- Longevity: Up to 18 months, depending on the product.
- Combination use: Often paired with wrinkle-reducing treatments for enhanced results.
3. Combination Treatments
When you meet with our Registered Nurses, we can assess your situation and may be able to recommend a tailored approach, such as:
- wrinkle-reducing treatments: For muscle relaxation and structural support.
- Skin therapies: Laser treatments, Genius radiofrequency microneedling, or chemical peels to improve elasticity.
4. Adjunctive Therapies
- Skincare regimens: Peptides and retinoids to boost collagen.
- Thread lifts or LED therapy: For mild lifting or skin rejuvenation.