Aesthetic Treatments

Ask a Plastic Surgeon: Can I Treat My Downturned Mouth?

Emily Orofino
Illustration of Lips

Spotlyte

Even the most beauty-savvy individuals would love to get insider intel from a plastic surgeon. But sometimes, it’s hard to ask a doctor your most burning questions — maybe you believe your concern is too trivial, or you’re embarrassed to get the answer in a face-to-face appointment. That’s why Spotlyte brings you Ask a Plastic Surgeon, a regular column where we have professionals provide the answers to your questions, no matter how big or how small. In this installment of Ask a Plastic Surgeon, Dr. Dilip Madnani shares what causes — and how to treat — a sagging, scowling mouth.

Maybe this refrain sounds familiar to you: “Are you OK? You look unhappy.” Even someone who’s lead the happiest life possible is susceptible to a downturned mouth, causing them to appear consistently annoyed or disappointed rather than joyful. According to New York-based, double-board certified facial plastic surgeon Dr. Dilip Madnani, it’s simply time — rather than any scowls you may have made — that’s to blame.

“Initially we start [aging] by losing volume in our faces, especially in the areas in the upper cheeks, temples, and around the mouth,” he explains. “This, combined with the progressive loosening of our skin, causes the lower face to sag and the corners of the mouth to downturn.” More specifically, that skin laxity affects two specific ligaments in the face where your skin is fixed: around your cheekbone, and below the corner of your mouth on the jawbone. Loss of elasticity and volume causes a sagging, scowling double whammy (while also deepening any marionette lines).

There’s also a muscle that affects the corners of your mouth: the depressor anguli oris (DAO). The DAO is part of the muscle group that is responsible for smiling, frowning, puckering up, and all other movement. “These particular muscles depress the corners of the mouth,” says Dr. Madnani, explaining that regular use of the DAO (which is completely unavoidable!) paired with natural aging will create that sagging, frowning look.

If you’ve observed a downturned mouth as a signature genetic trait as your family members age, but haven’t seen it in your own face yet, you have some preventative options. Dr. Madnani shares that the classic skincare rules all apply, including prioritizing sun protection and moisturizing, and avoiding smoking at all costs. He also recommends keeping your weight stable. Avoiding dramatic gains and losses will help prevent disruption to the volume in your face, and thus help maintain your skin’s elasticity.

However, for those who are already seeing signs of perpetual scowling, your best options are in-office treatments. “Any non-invasive treatment that can tighten the skin is great for this area,” notes Dr. Madnani, “such as Ultherapy® to the lower face, or regular skin treatments [using] CO2 or erbium lasers.” All of these can provide skin tightening and a lifting effect.

If you’re open to invasive options, Dr. Madnani suggests looking into a lower face lift or facial fat transfer. The former will lift the skin on the lower face, thereby lifting the corners of the mouth while tightening the skin overall. As for the fat transfer, it can rejuvenate the treated area and improve contour.

Letting your downturned mouth progress without treatment, however, means that facial jowls could be in your future. We’re not trying to frighten you, but if it’s a concern of yours, it’s important to know that (as is the case with many things in life!) being proactive is key.

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