Downward Turned Mouth – Causes & Solutions

In this guide17 sections

1. Key Points
2. Why Is My Mouth Downturned? Causes of Downturned Mouth Corners
3. Does a Downturned Mouth Make You Look Sad or Unattractive?
4. How to Fix a Downturned Mouth: What Works for Which Cause
5. Can Botox Lift a Downturned Mouth? Treating the DAO Muscle with Anti-Wrinkle Injections
6. Can Filler Fix Downturned Mouth Corners?
7. Does Fat Transfer Help a Downturned Mouth?
8. Do Thread Lifts Work for a Downturned Mouth?
9. How to Fix Downturned Mouth Corners Naturally
10. Corner Lip Lift for Downturned Mouth Corners
11. Lower Facelift for Downturned Mouth Corners and Jowls
12. How Long Do Downturned Mouth Treatments Last?
13. Risks of Downturned Mouth Treatments
14. Which Downturned Mouth Treatment Is Right for You?
15. Frequently Asked Questions
16. Downturned Mouth Treatment in London
17. References

If your mouth turns down when your face is relaxed, you are far from alone. Searches for a downturned mouth, downturned mouth corners and sad mouth corners keep rising, as the shape is easy to notice in photographs and on video calls and can change how other people read your mood. This guide explains what causes downturned mouth corners, how each cause is treated, what works for which cause, how long results last and what the risks are.

The short version is that the right fix depends on why your corners turn down. A person whose problem is mostly muscle pull has very different options from someone whose cheeks and jowls have descended with age. If your main concern is the surgical route, our guides to the corner lip lift and the lower facelift go into those operations in depth, and if you want the wider picture of how the face changes over the decades, start with facial ageing at 30, 40 and 50.

Why Is My Mouth Downturned? Causes of Downturned Mouth Corners

A downturned mouth is a description rather than a diagnosis. The corners of the lips are pulled, pushed or left unsupported in a lower position than they used to occupy. A French review of facial ageing describes how skin, muscle, fat and bone all change with time and do not age in the same way across the upper, middle and lower thirds of the face^[1]. For the mouth corners, five causes matter most.

Ageing, skin laxity and volume loss

Skin becomes thinner and less elastic with age, and the soft tissue of the cheeks and around the mouth loses some of its support. The result is that tissue drifts downwards, and the corners of the mouth follow it. An anatomical review of marionette lines lists bone resorption, gravity, changes in the fat compartments, muscle compression, ligament tethering and skin ageing as the interacting factors behind the sagging that surrounds the mouth corners^[5]. That is why a downturned mouth often appears alongside marionette lines and deepening nasolabial folds.

The science of exactly how the face ages is still being argued over. A 2025 review of 54 studies found that much of the evidence is of low quality and that the facial skeleton may remodel rather than simply shrink, and that some fat compartments enlarge instead of emptying^[6]. In practice this means two people with the same downturned mouth can have different underlying changes, which is why an individual assessment matters more than a general rule.

Overactive depressor anguli oris (DAO) muscle

The depressor anguli oris is a small triangular muscle that runs from the jawline up to the corner of the mouth. When it contracts it draws the corner down, and it is the muscle we use to express sadness. If it is strong, or if the muscles that lift the corner are comparatively weak, the corner can rest lower than it should. A 2026 Italian consensus of 14 experts found that correcting downturned oral commissures was the strongest aesthetic indication for treating this muscle with botulinum toxin^[2].

Jaw, bone and teeth

The jaw and teeth give the lower face its scaffolding. When teeth are lost or worn, or when the bone beneath the mouth changes shape, the soft tissue can lose support and fall inward, which lowers the corners and deepens the folds around them. If you have had tooth loss or dentures, or a bite that has changed, mention it at your consultation, as it can affect which treatment will work.

Genetics and the shape you were born with

Some people have downturned mouth corners from early adulthood or even childhood. Where the muscles at the corner of the mouth meet, an area called the modiolus, varies between people and between ethnic groups, and a review of marionette line anatomy notes that the structure of the modiolus differs in a way that makes some faces more prone to sagging around the corners^[5]. If your parents or siblings have the same resting expression, genetics is a likely contributor, and treatments are still available.

Weight loss, sun damage and lifestyle

Significant weight loss can leave loose skin and less fat to support the lower face, and long-term sun exposure and smoking accelerate skin ageing. None of these causes a downturned mouth on its own, but each can add to the other causes above.

Does a Downturned Mouth Make You Look Sad or Unattractive?

The corners of the mouth are one of the first things people read when they judge an expression, so a downturned resting mouth can make you look tired, sad or disapproving even when you are neither. A narrative review of lower-face expression notes that this region carries important emotional signals and that lower-face treatments should be planned with that in mind^[3].

Whether downturned lips are attractive is a matter of personal opinion, and many people with a naturally downturned mouth are happy with it. The reason to treat it is that it bothers you, not that it needs correcting. A sensible approach is to look at photographs of yourself in your twenties, which show what your mouth looked like before ageing changed it, and to decide what you would like to change.

How to Fix a Downturned Mouth: What Works for Which Cause

There is no single treatment that suits everyone, as the treatments do different jobs. The list below sets out the match.

• Overactive DAO muscle: anti-wrinkle injections into the muscle.
• Volume loss around the mouth and chin: hyaluronic acid filler, and in some cases fat transfer.
• Excess skin at the mouth corner: a corner lip lift.
• Sagging jowls and lower face: a lower facelift or facelift.
• A combination of causes: often a staged plan, starting with the least invasive option.

Most people start with a non-surgical treatment and move to surgery only if they want a longer-lasting change. The sections below take each option in turn.

Can Botox Lift a Downturned Mouth? Treating the DAO Muscle with Anti-Wrinkle Injections

Anti-wrinkle injections (botulinum toxin, often called Botox after one of the brands) are the usual first treatment when muscle pull is the main cause. A small amount is placed into the depressor anguli oris, which weakens its downward pull and lets the lifting muscles work more freely, so the corner sits a little higher at rest. The Italian consensus reported that most experts (92.8%) preferred an injection into the muscle at a single point just outside the marionette line, which keeps the toxin away from the neighbouring depressor labii inferioris and reduces the chance of it spreading^[2].

The evidence for a measurable effect is reasonable but comes from small studies. In a 2026 double-blind randomised trial in Plastic and Reconstructive Surgery ↗, every injection pattern improved the position of the mouth corner on three-dimensional photographs. Injecting the lower part of the muscle worked better than the upper part, and adding the platysma (the thin neck muscle that also pulls the lower face down) gave further lifting and higher satisfaction, with no severe adverse events^[7]. A separate 2026 randomised trial of 80 patients found that lifting increased with the number of injection points used, but that side effects were higher in the most extensively treated group^[8]. More is therefore not always better.

Placement matters as well. An ultrasound study of 290 patients found that only 20.2% had the muscle where the standard landmark predicted, and in the remaining 79.8% it was displaced sideways by 2 to 5 mm^[9]. Injecting off target can mean less effect or a stray effect on the lower lip, which is why an experienced injector who understands this anatomy matters. You can read about the treatment on our anti-wrinkle injections page.

Anti-wrinkle injections are not a cure-all. They work only for the muscle component, and they will do little if the main problem is loose skin or volume loss. In the prospective study of 51 people, the improvement seen at four weeks had returned to baseline by 12 weeks, and the most severe downturns did not reach a satisfactory result even at the highest dose tested^[4].

Can Filler Fix Downturned Mouth Corners?

Hyaluronic acid filler can help when volume loss is part of the picture. Filler placed in the area below and beside the corner, and sometimes in the chin, supports the tissue that has dropped, softens the shadow beneath the corner and can reduce the look of a droop. It adds volume and does not remove excess skin, so the lift is subtle. Our article on whether lip filler can lift the corners of the mouth looks at this in detail, and the dermal fillers page covers the treatment itself.

We did not find controlled trials that measure how much filler alone lifts the mouth corner. The evidence that does exist concerns neighbouring lines. In a 2026 randomised study of 98 people, a hyaluronic acid filler improved marionette lines by at least one grade in 83.5% of those treated at 12 weeks, and treatment-related adverse events were reported in 24.5%^[10]. That tells us filler can soften the lines that run down from the corner, not that it will turn the corner upwards.

Filler carries risks that deserve plain mention. A 2026 narrative review reports that severe complications occur in fewer than 0.01% of injection sites, but that vascular occlusion, where filler blocks a blood vessel, is the most feared and can lead to skin death, vision loss or stroke, and that prompt recognition and high-dose hyaluronidase are central to managing it^[11]. This is why filler near the mouth should only be done by a trained doctor or surgeon with hyaluronidase available.

Does Fat Transfer Help a Downturned Mouth?

Fat transfer, where a small amount of your own fat is taken from elsewhere and placed in the face, is sometimes used to replace volume that has been lost around the mouth, cheeks and jawline. It is a longer-lasting way of restoring volume than filler for some people, but it is a more involved procedure, and we did not find studies measuring its effect on the position of the mouth corner specifically. It is better thought of as a way to restore support to the lower face rather than as a direct treatment for the corner itself. If volume loss is the main driver, your surgeon can discuss whether fat transfer, filler or a lift is more appropriate.

Do Thread Lifts Work for a Downturned Mouth?

Thread lifts use thin dissolvable or permanent threads to lift tissue and are often marketed for jowls and mouth corners. The evidence for them is mixed. A systematic review of 59 studies covering 14,222 patients found that facial asymmetry, swelling and bruising were the commonest side effects, and that contour irregularities, injuries to vessels or glands, infections and inflammatory reactions did not always resolve by themselves^[12]. A separate meta-analysis of 26 studies reported swelling in a pooled 35% of patients, skin dimpling in 10% and paraesthesia in 6%, and found that long-term satisfaction was lower than satisfaction straight after treatment (88% compared with 98%)^[13].

In other words, threads can give a short-lived lift, but the benefit tends to fade and side effects are common. Centre for Surgery does not offer thread lifts. If sagging of the jowls and lower face is behind your downturned mouth, a surgical lift treats the cause more directly, as described below.

How to Fix Downturned Mouth Corners Naturally

Many people ask whether they can lift their mouth corners without injections or surgery. A few things are reasonable, and it helps to be clear about what they can and cannot do.

• Protect your skin from the sun and avoid smoking. Both speed up skin ageing, and a good skincare routine with daily sunscreen helps to maintain skin quality, though it will not reposition the mouth corners.
• Keep a stable, healthy weight. Repeated large changes in weight can stress the skin of the lower face.
• Be aware of your resting expression. Some people habitually clench the jaw or pull the corners down without noticing. Becoming aware of this can help, and a physiotherapist or doctor can advise if jaw tension is a problem.
• Facial exercises. Exercises and face yoga for downturned mouths are widely promoted. We did not find controlled trials showing that they reposition the mouth corners, so we cannot promise they will help. They are unlikely to harm if done gently, but they should not delay a proper assessment if the shape bothers you.

Skincare and exercises may help the skin and may give a feeling of control, but they do not remove excess skin, replace lost volume or change how the DAO muscle pulls. For a visible and lasting change, one of the treatments above or below is usually needed.

Corner Lip Lift for Downturned Mouth Corners

A corner lip lift is the operation designed specifically for this concern. A small wedge of skin is removed just above and beside each corner of the mouth and the wound is closed so that the corner sits higher. It is also called a smile lift or mouth corner lift. A 2025 review of corner lip lift technique describes it as a treatment for angular depression of the lateral lip and notes that it can be done alone or together with a subnasal lip lift^[14].

The operation suits someone with excess skin at the corner and a clear downward angle who wants a permanent change and accepts a small scar at each corner. It does not shorten a long gap between the nose and the upper lip, which is the job of a bullhorn lip lift, and we explain that choice in our guide to bullhorn versus corner lip lift. If you are also wondering about the nose, read whether a lip lift changes your nose. The two operations can be combined, and the full range of techniques is covered on our lip lift surgery page.

The scar is the main trade-off. It sits at the edge of the mouth, an area that moves constantly, and it usually fades to a fine pale line over several months, though some scars remain visible or thicken. The lip lift is permanent, but ageing continues from the new starting point, as our guide to how long a lip lift lasts explains. Costs vary with the technique and anaesthetic, and your surgeon confirms the figure in writing after assessment, as set out in our lip lift cost guide.

Lower Facelift for Downturned Mouth Corners and Jowls

When the downturned mouth is part of a wider descent of the cheeks, jowls and jawline, lifting the corner alone treats the symptom rather than the cause. A lower facelift (jowl lift) repositions and tightens the tissue of the lower face and neck so that the jowls and the folds beside the mouth are lifted, and this indirectly raises the position of the mouth corners.

A lower facelift is a larger operation than a corner lip lift, with a longer recovery and scars hidden in and around the ear. It suits people whose sagging extends beyond the mouth. Our guide to the lower facelift covers who it suits and what recovery involves, and the facelift page explains the fuller operation for people who also have midface sagging, including sagging cheeks. Where excess fat under the chin adds to the heaviness, chin and neck liposuction may be combined with a lift.

How Long Do Downturned Mouth Treatments Last?

Durations vary between people, so treat any figure as a guide rather than a promise.

• Anti-wrinkle injections: temporary. In the prospective study above, the effect had faded to baseline by 12 weeks^[4], and the randomised trial followed patients for up to 90 days^[8]. Your injector will advise how often to repeat.
• Filler: temporary and gradually absorbed, with the length of effect depending on the product, the site and your own metabolism.
• Thread lifts: satisfaction in a meta-analysis was lower over the long term than immediately afterwards^[13].
• Corner lip lift and lower facelift: the skin and tissue that are removed or repositioned do not grow back, so the change is long-lasting. Ageing continues afterwards, so the face keeps changing from the new baseline.

Risks of Downturned Mouth Treatments

Every treatment carries risks, and you should know them before deciding.

• Anti-wrinkle injections: bruising, headache, asymmetry, and weakness of the lower lip or a change in your smile if the toxin spreads to a neighbouring muscle. Ultrasound mapping of the DAO is being used to improve accuracy^[9].
• Filler: swelling, lumps, bruising and, rarely, vascular occlusion^[11].
• Thread lifts: swelling, dimpling, asymmetry, thread visibility and infection^[13].
• Corner lip lift: a permanent scar at each corner, asymmetry, over- or under-correction, altered sensation and infection.
• Lower facelift: the general risks of a larger operation, including bruising, haematoma, scarring, nerve injury and anaesthetic risks. Our page on the risks and complications of cosmetic surgery sets these out.

A pronounced downturn that has been present all your life is less likely to be fully corrected by non-surgical treatment alone. A thorough consultation should tell you honestly what to expect.

Which Downturned Mouth Treatment Is Right for You?

A practical way to think about the choice:

1. Look at your resting expression in a mirror and in photographs. Does the corner drop when you relax, or is the problem mainly folds and sagging below the mouth?
2. Decide how permanent a change you want. If you want to trial an effect first, start with injections or filler. If you want a longer-lasting change and accept a scar, surgery is the route.
3. Consider the whole lower face. If jowls and cheeks have also descended, a lift will usually give a more natural result than treating the corner alone.
4. Bring photographs from when you were younger. They show what your mouth looked like before ageing, which helps a surgeon plan a natural result.

At consultation, a surgeon will look at your resting and smiling face, work out which of the causes above applies to you, and recommend one treatment or a staged combination. We will also tell you if we think a treatment will not give you the result you want.

Frequently Asked Questions

Downturned Mouth Treatment in London

If your downturned mouth bothers you, a consultation with a plastic surgeon will establish what is causing it and which treatment, if any, is right for you. Find out more about lip lift surgery at Centre for Surgery.

Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation

References

1. Beylot C. Skin ageing: general features of facial ageing and therapeutic choices. Annales de Dermatologie et de Vénéréologie 2019;146(1):41–74. doi:10.1016/j.annder.2018.10.015 ↗
2. Fundarò S, Molinari P, Brunelli G, et al. Italian consensus and review in lower face mimetic muscle treatment with botulinum toxin-A. Toxins 2026;18(8):332. doi:10.3390/toxins18080332 ↗
3. Hopf AGM, Buchheim A, Hopf M, et al. A psychological guide to lower face botulinum toxin injections: baseline emotional functions of facial expressions. Journal of Cosmetic Dermatology 2026;25(4):e70833. doi:10.1111/jocd.70833 ↗
4. He Z, Xi W, Yang F. The impact of dosage and injection site on type A botulinum toxin treatment for oral commissure ptosis: a prospective study. Aesthetic Plastic Surgery 2026;50(11):4230–4239. doi:10.1007/s00266-026-05672-y ↗
5. Hong GW, Kim SB, Park SY, Wan J, Yi KH. Why do marionette lines appear? Exploring the anatomical perspectives and role of thread-based interventions. Skin Research and Technology 2024;30(4):e13676. doi:10.1111/srt.13676 ↗
6. Atiyeh B, Emsieh S, Chrabieh E, et al. Surgical facial rejuvenation techniques: are they all scientifically valid and anatomically justified? Plastic and Reconstructive Surgery Global Open 2025;13(10):e7194. doi:10.1097/GOX.0000000000007194 ↗
7. Zhang M, Yang Y, Zhao N, et al. Optimizing injection sites of botulinum toxin type A for improving oral commissure position: a two-stage, prospective, double-blind, randomized trial. Plastic and Reconstructive Surgery 2026. doi:10.1097/PRS.0000000000013362 ↗
8. Munoz-Lora VRM, Rogerio V, Roschel P, et al. Injection mapping and dose escalation for botulinum toxin treatment on the lower face: a randomized, double-blind clinical trial. Aesthetic Surgery Journal 2026. doi:10.1093/asj/sjag165 ↗
9. Urso SU, Calabria E, Franceschelli A, et al. Determining the position, morphology, and location of the depressor anguli muscle through ultrasound in the Caucasian population. Aesthetic Surgery Journal Open Forum 2026;8:ojag091. doi:10.1093/asjof/ojag091 ↗
10. Gerber PA, da Mota R, Gauglitz G, et al. Effectiveness and safety of Belotero Intense with or without lidocaine for the correction of nasolabial folds, marionette lines, and lip volume enhancement: a randomized post-market clinical follow-up study. Aesthetic Surgery Journal Open Forum 2026;8:ojag031. doi:10.1093/asjof/ojag031 ↗
11. Kamrani P, Cox SE, Beleznay K, Humphrey S. From bruising to blindness: a practical guide to identifying and managing hyaluronic acid filler complications. Dermatologic Surgery 2026. doi:10.1097/DSS.0000000000005380 ↗
12. Pham CT, Chu S, Foulad DP, Mesinkovska NA. Safety profile of thread lifts on the face and neck: an evidence-based systematic review. Dermatologic Surgery 2021;47(11):1460–1465. doi:10.1097/DSS.0000000000003189 ↗
13. Niu Z, Zhang K, Yao W, et al. A meta-analysis and systematic review of the incidences of complications following facial thread-lifting. Aesthetic Plastic Surgery 2021;45(5):2148–2158. doi:10.1007/s00266-021-02256-w ↗
14. Talei B, Danielian A. A simplified algorithm for corner lip lifting. Facial Plastic Surgery 2025;41(5):632–636. doi:10.1055/a-2626-9347 ↗