Lifting the mouth corners: exercise, botox or filler first?
“People ask me if I'm angry when I'm just resting my face.” Conversations about mouth corners nearly always start this way. So a lot of people look up exercises first. But the reason the corners turn down differs from person to person, and so does where to start.
The short answer
If a strong muscle is pulling the corners down, botox fits; if the cheeks have dropped or there's a hollow beside the corners, lifting or filler fits. I couldn't find research showing that mouth-corner exercises alone raised them. In a study of botox in 51 people with drooping mouth corners, there was clear improvement at 4 weeks, but by 12 weeks they were back to where they started, and the most severe drooping wasn't satisfactorily corrected even with a larger dose. In a 290-person ultrasound study, the muscle sat 2 to 5 mm away from the textbook reference point in 80% of people. At Miso Clinic, 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu (Exit 1, Kyungpook Nat'l Univ. Hospital Station), +82-53-428-2700, I sort out the cause first, and if the muscle plays only a small part, I don't recommend botox.
Why do the mouth corners turn down?
The corners of the mouth sit in the middle of a tug-of-war. The muscles you use to smile pull upward; the depressor anguli oris (DAO) pulls downward. Add to that the cheek tissue moving down with age and the area beside the corners hollowing out and casting a shadow. Few people have just one of these; usually two or three are mixed together.
| If you see this | Main cause | Where to look first |
|---|---|---|
| The corners pull sharply down when you talk or make expressions | Strong DAO muscle | Botox |
| Gently lifting the cheeks with your hands lifts the mouth too | Sagging cheeks and jawline | Lifting |
| A vertical fold (marionette line) runs down from the corners | Hollowing, sagging | Filler, lifting |
| The corners have always pointed down | Natural lip and bone shape | Change is small |
This sorting is the first thing I do in a consultation. If the order is wrong, you may have treatment and not notice any difference.
Can exercises lift the mouth corners?
I couldn't find a trial showing that exercising the mouth corners on their own raised them. Even looking at facial exercise more broadly, there's little data. There is a randomised trial (49 people) of DAO massage plus cheek-muscle exercises, 15 minutes a day for 6 weeks, and facial appearance ratings were no different from the control group. Bear in mind it was a trial in people with depression, not a cosmetic one.
That doesn't mean the exercises are harmful. But if the muscle pulling your corners down is already strong, repeating big expressions might just work that muscle more. What I tell people is: practising smiling is good for your mood, but don't count on it to change how high your mouth corners sit.
How much does botox lift the corners, and how long does it last?
| Study | Size | Result | What to watch when reading |
|---|---|---|---|
| He 2026 (China) | 51 people, two methods in the same person | Clear improvement at 4 weeks, back to baseline at 12 weeks | No control group; the most severe drooping fell short even with a larger dose |
| Zhang 2026 (China) | Two phases; first phase randomised and double-blind | Injecting the lower part of the muscle worked better than the upper part; adding the neck muscle raised the corners further | Single-hospital study |
| Urso 2026 (Italy) | 290 people, ultrasound | 79.8% lay 2–5 mm outside the reference point; in 12% it overlapped the lower-lip muscle | Data from Western patients |
Two things I want to point out here. First, mouth-corner botox doesn't pull the corners up; it temporarily weakens the force pulling them down. So a realistic goal is that an angry-looking resting face softens a little. Second, where the muscle sits varies quite a lot between people, so if the botox spreads to the wrong place, your lower lip can look uneven when you smile. I start with a small dose and see how it goes.
→ More: Types of facial wrinkles: does each one need a different fix?
When do you talk about filler for the mouth corners?
When the area below the corners has hollowed and casts a shadow. Resting the muscle leaves that fold in place, so it needs something to support it.
In a post-market study of hyaluronic acid filler placed in the folds around the mouth (98 people), 83.5% had marionette lines improve by at least one grade at 12 weeks. There was no control group, though, and treatment-related side effects occurred in 24.5%. A review of 53 hyaluronic acid filler trials also concluded that the evidence for the mouth-corner and marionette areas is of low quality.
The area around the mouth moves a lot every day, so I look at dissolvable hyaluronic acid filler first and start with a small amount. If the fold comes from the cheeks dropping, I talk about lifting before filler.
→ See also: Jowls: why do they form, and how do you get rid of them? · How to get rid of mouth lines
Lifting the mouth corners FAQ
Will mouth-corner botox make my smile look awkward?
It can if the botox spreads into the lower-lip muscle. It usually comes back as the effect wears off, but that can take a few weeks.
Does taping the mouth corners lift them?
It only holds the shape while the tape is on. I couldn't find research showing the effect lasts after you take it off.
Can I have mouth-corner botox and filler together?
If both the muscle and a fold are causes, I plan them together. Whether to do them the same day or separately depends on your face.
Where can I get a mouth corner consultation in Daegu?
At Miso Clinic, 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu (Exit 1, Kyungpook Nat'l Univ. Hospital Station), +82-53-428-2700. Weekdays 11:00–19:00, Saturday 10:00–16:00, closed Sundays and public holidays.
Read next
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Related care: Lifting · Mouth lines · Types of facial wrinkles
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, director of Miso Clinic, Daegu. The treatment standards and injection design set out here are the ones we use in practice.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Dose and injection site in mouth-corner botox — He Z, Xi W, Yang F. The Impact of Dosage and Injection Site on Type A Botulinum Toxin Treatment for Oral Commissure Ptosis. Aesthetic Plast Surg 2026;50(11):4230-9. PMID 41644821. 51 people.
- Randomised trial of injection site in mouth-corner botox — Zhang M et al. Plast Reconstr Surg 2026. PMID 42554701.
- Ultrasound of the depressor anguli oris — Urso SU et al. Aesthet Surg J Open Forum 2026;8:ojag091. PMID 42388335. 290 people.
- Randomised trial of facial exercise — Wollmer MA et al. FaReWell Depression. Front Psychiatry 2026;17:1798454. PMID 42267161. 49 people with depression, 6 weeks; facial appearance a secondary outcome.
- Post-market study of hyaluronic acid filler around the mouth — Gerber PA et al. Aesthet Surg J Open Forum 2026;8:ojag031. PMID 41859206. 98 people, no control group.
- Review of hyaluronic acid fillers — Cohen JL et al. Dermatol Surg 2013;39(2):205-31. PMID 23164066. 53 studies.
- Korean medical advertising law — Korean Medical Service Act Article 56(2) (no treatment testimonials, no comparisons with other clinics, no superlatives). This is why this column carries no prices, reviews or before-and-after photos.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.