Oral Commissure (Marionette Lines)

The area at the corner of the mouth where the upper lip meets the lower lip is called the oral commissure.  The oral commissures usually experience a gradual depression over time.  In many individuals, the depression contributes to the formation of wrinkles and lines, as well as contributing to a more angry or stern appearance.  Oral commissure lines may extend downward from the corners of the mouth, giving an individual an unnatural puppet or marionette-type appearance.  In other instances, oral commissure lines may fan out from the corner of the mouth.

Oral commissure lines are almost always treated with advanced dermal fillers.  In instances where individuals have not developed deeper lines or folds, many physicians will place an advanced dermal filler such as Juvedermtm or Restylane® under the lines.  If the oral commissures have developed into deeper folds, the area may be treated with a bulking filler like Juvedermtm Ultra Plus or Radiesse®.  These fillers help push up and buttress the folds.  Dermal fillers placed in other areas of the face (the upper cheeks for instance) may also give a subtle lift to the oral commissure area, which will help alleviate some of the oral commissure lines.

In some instances, BOTOX® is also used to help alleviate oral commissure lines.  BOTOX®, injected properly, provides a subtle enhancement in the appearance of oral commissure lines and lip positioning.  Placement of BOTOX® for oral commissure correction variesfrom patient to patient, depending upon a patient’s particular characteristics.  BOTOX® may be placed in the depressor anguli oris muscle (which extends from the chin to around the corners of the mouth) to help lift the corners of the mouth. This alleviates some of the oral commissure depression.  BOTOX® may in some instances be placed in the origin of the mentalis (chin) muscle for those who express themselves with excessive chin movement.  This may help relax some of the lines around the mouth and chin. 

Like many other aesthetic procedures with liquid face lift products, it is important that a physician have extensive experience with BOTOX® and advanced dermal filler medical procedures.  For example, if BOTOX® is placed in the depressor labii instead of the depressor anguli oris muscle, the patient may experience a temporary facial expression deformity or not be able to close the mouth properly.  Among physicians with extensive experience, the probability of this happening is remote.