VouchersBook Now
Edit

Downturned Mouth: Causes & Treatments

Advanced Treatments for Facial Expression Correction

20th February, 2025
Downturned Mouth: Causes & Treatments Advanced Treatments for Facial Expression Correction

A downturned mouth is an anatomical feature where the corners of the mouth angle downward at rest, creating a naturally sad, stern, or displeased facial expression. This occurs due to muscle dynamics, volume distribution, and genetic factors.

Key Takeaways

  • A downturned mouth results from overactive DAO muscles pulling the corners downward, resulting in volume loss and genetic predisposition.
  • DAO muscle relaxation treatments reduce downward tension, creating a subtle lift with results visible within 1-2 weeks.
  • Volume restoration using dermal products lifts drooping tissue and provides structural support lasting up to 18 months.
  • Combining treatments addressing muscle activity and volume loss often enhances the mouth corners.
  • Professional assessment distinguishes downturned mouth from marionette lines, requiring different treatment approaches for best results.

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 MouthMarionette Lines
AppearanceMouth corners angled downwardVertical creases below the mouth
Primary causeMuscle activity and volume lossSkin laxity and volume depletion
Treatment focusRelaxing DAO muscles and lifting cornersFilling 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:

4. Adjunctive Therapies

  • Skincare regimens: Peptides and retinoids to boost collagen.
  • Thread lifts or LED therapy: For mild lifting or skin rejuvenation.

Related Services

Related Areas of Concern

Frequently Asked Questions

Learn More

Here are some FAQ's about Downturned Mouth: Causes & Treatments. If you have any other questions, please give us a call or request a Consultation today.

Call: (07) 5447 4227Book An Appointment

A downturned mouth refers to mouth corners that angle downward at rest, creating a naturally sad or stern expression. This is primarily caused by overactive depressor anguli oris (DAO) muscles that pull the corners down, combined with volume loss in the surrounding area.

Marionette lines are the vertical creases that run from the corners of the mouth down towards the chin. They develop as a result of skin laxity, volume loss and repeated facial movement over time.

The two concerns often appear together and can reinforce each other visually. However, they involve different anatomical factors and respond to different treatment approaches.

A proper clinical assessment is the most reliable way to determine which concern is primary and which treatment plan will address your specific situation most effectively.

Muscle-relaxing treatments targeting the DAO muscles typically last three to four months, with visible results usually appearing within one to two weeks of treatment.

Volume restoration at the mouth corners tends to last longer, with many clients seeing results for up to twelve to eighteen months depending on the product used, the amount required and individual factors such as metabolism and lifestyle.

Combination approaches that address both muscle activity and volume loss often provide the most comprehensive improvement. Your nurse will discuss realistic timelines for your specific situation at your consultation.

Yes. Non-surgical approaches are very effective for improving a downturned mouth, and surgery is rarely required for this concern.

Muscle-relaxing treatment works by reducing the activity of the DAO muscles that pull the corners downward. When this downward tension is released, the natural balance of the face shifts and the corners of the mouth can rest in a more neutral or slightly upward position.

Volume restoration addresses the loss of structural support in the lower face that contributes to drooping corners and hollow areas around the mouth.

Depending on your anatomy and goals, one or both approaches may be appropriate. A consultation with one of our registered nurses will determine the right plan for your face.

Yes. A downturned mouth can affect people at any age, and the underlying causes vary between younger and older clients.

In younger clients, the concern is often driven primarily by overactive DAO muscles and genetics rather than significant volume loss. In these cases, muscle-relaxing treatment alone may produce a noticeable improvement.

In older clients, volume loss, skin laxity and cumulative sun exposure tend to play a larger role alongside muscle activity. A combination approach addressing both factors usually delivers a more complete result.

Your nurse will assess the specific drivers in your case and recommend the most appropriate starting point regardless of age.

A thorough assessment by one of our registered nurses is the most reliable way to determine the primary cause and the right treatment approach.

If your mouth corners angle downward mainly due to strong DAO muscle activity, muscle-relaxing treatment is typically the first step. This is often the case in younger clients or those who notice their expression changes more when relaxed.

If volume loss is a significant factor, particularly if the area around the mouth looks deflated or the corners appear to have dropped over time, volume restoration is likely to play a key role in the plan.

Many clients have a combination of both factors, and the most effective treatment plans usually address them together. Your nurse will assess your anatomy at your consultation and explain the reasoning behind any recommendation.

A downturned mouth at rest is most commonly caused by a combination of muscle activity, volume loss and genetic facial structure.

The depressor anguli oris muscles, which run from the jaw up to the corners of the mouth, pull the corners downward. In some people these muscles are naturally stronger or more dominant, meaning even a relaxed expression can appear sad or stern.

As we age, the fat pads in the lower face gradually diminish and shift. This loss of volume reduces the structural support around the mouth corners, allowing them to sag further.

Genetics also play a significant role. Some people have a bone structure and soft tissue distribution that naturally positions the mouth corners lower, regardless of age or muscle activity.

Understanding which of these factors is most prominent in your case is the starting point for choosing the right treatment approach.

Concerned about your downturned mouth affecting your facial expression?

Our experienced registered nurses will assess your specific muscle activity and volume concerns to create a personalised treatment plan. Book your consultation today to discover how we can help you achieve a more balanced, confident facial expression.

Call: (07) 5447 4227Book A Consultaiton