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Smiles, Sad Mouth & Other Small Areas.

Updated: Sep 14, 2020

It is important to note that only minimal dose of muscle relaxant can be administered to the above

areas, the normal time of 3-4 months of effectiveness does not apply to these area, especially for

the first few treatments. Some anatomist have lectured on the long-term benefits of muscle relaxant

treatment, basically, viewing it as a ‘prevention’ as well as a short-term ‘treatment’ for wrinkles.

Please book in for a face to face consultation with one of our practitioners for a personalised


Gummy smile

Having a minimal gum line showing is one of the most important factors of a beautiful smile. Most

people find the display of gum tissue to be less attractive because it causes asymmetrical smile. A

gummy smile can be caused by an overactive muscle above the upper lip. The name of this muscle is

called the Levator Labii Superioris Alaeque Nasi. Very few patients have feedback saying that they

did not like the result of their smile after their muscle relaxant treatment. However, this has been

less than 1% of cases and usually these patients would choose to have dermal fillers in their lips

instead to reduce the gummy smile as well as to achieve other aesthetic outcomes.

Smoker lines

For vertical lines just above the lips, treatment with muscle relaxant can be extremely effective in

the early formation of the lines. Patient with a history of cold sore should be cautioned as any

injection to this area can bring on the breakout of a cold sore. Treatment to this area may also

temporarily cause a difficulties in sucking through a straw and whistling, in rare cases, it may also

cause a slight change in the patients’ speech. It is important to point out that these side effects

usually only last 2-3 weeks and it is not generally noticeable by 3 rd parties, mainly just the patient

themselves. If these side effects are concerning you, dermal fillers should be considered for a better


Muscle relaxant in the top lip can deliver a more desirable cosmetic result after a few treatments.

Patients have feedback to have their upper lip more ‘lifted’, pounced and more defined without

having to have dermal fillers.

Depressor correction/Sad mouth

The Depressor Anguli Oris (DAO) muscle is one of the contributors for the ‘sad mouth’ and drooping

appearance of the mouth corners. The action of the pulling down of the outer corner of the mouth is

also referred to as the mouth frown. A small amount of muscle relaxant with multiple treatment can

product a more satisfying result in the long term.

A potential temporary side effect of this treatment is that very occasionally, the muscle relaxant

mediation can diffuse to one of the neighbouring muscles causing a mild asymmetrical smile for 2-3

weeks. However, do not be alarmed, this side effect will past without no long-term implications.

Please inform your practitioner if you have had a facelift, thread lift or any surgeries to around that

area as this could have caused the shifting of DAO muscle, the injection should consider this change

of the muscle position when performing treatment.

Another cause for the ‘sad mouth’ appearance, is the hollowing of the marionette area. The loss of

fat pad to that area can be replaced with dermal fillers with more immediate result and higher

satisfaction for the patient.

Chin dimples (Orange peel chin)

Wrinkles to the chin area are caused by the hyperactivity of the mentalis muscle. The chin wrinkles

might only appear when you are talking, smiling, eating or expressing emotions, however, having

muscle relaxants to this area early can prevent the formation of the permanent wrinkles to the area.

Nasal/bunny lines

These slightly diagonal lines that appear on both sides of the nose bridge. It can appear when

someone is smiling, laughing or making a ‘disgusted’ look. We estimate about 1 in 20 patients

feedback that their treatment either did not work to their satisfaction or did not work at all. This is

due to the complexity group of muscles to this small area. The Nasalis is generally the muscle to

treat according to many medical literature and guidelines. However, other adjoining muscles could

be more dominant and hence causing unsatisfactory result. To improve result, often a follow up

after 2-3 weeks is important so our practitioner and assess and make adjustments. Occassionally,

dermal filler can be used in combination with muscle relaxant to improve patient satisfaction. When

effective, patient often feedback a much smoother look on their nose after a few treatments.

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