What is corners of the mouth botulinum toxin?
Corners of the mouth botulinum toxin is a procedure based on temporarily reducing the movement of the muscle that pulls the corner of the mouth downwards. Whether any change can occur in the appearance of the corner of the mouth is assessed at the examination. It is also popularly referred to as the sad face or the Mona Lisa smile.
The substance used in this procedure, which is popularly known by a brand name, is botulinum toxin. Botulinum toxin is a prescription-only medicinal product for human use (opens in a new tab) that temporarily reduces the contraction of the muscle to which it is applied. The procedure is carried out with an authorised product, within the terms of use in its authorisation, and by a physician.
The expected change is limited. The position of the corner of the mouth does not depend on a single muscle; the skin structure, the fatty tissue and the neighbouring muscles together determine it. For this reason the contribution expected from this procedure is small, and it may not be seen in every person.
The position of the corner of the mouth is not a disease. The procedure is assessed not because it is a medical necessity, but because the person has requested it.
The procedure is performed at the practice (opens in a new tab) by Dr. Suzan Alp, Specialist in Internal Medicine.
Which factors determine whether the procedure is suitable?
The decision on suitability is made at the end of the examination. The decisive factors in the assessment of this area are as follows:
- Whether the downturned position of the corner of the mouth is related to muscle movement
- The skin structure and the tissue support in the area
- The movement of the corner of the mouth and the lower lip during smiling
- The condition of the neighbouring areas; the chin and the jawline
- Procedures previously carried out in the area
If the appearance at the corner of the mouth arises from the skin and the tissue, what this procedure can address is limited; this is explained at the consultation.
In which patients is the procedure not performed?
- In patients with a disease affecting the neuromuscular junction (myasthenia gravis, Lambert-Eaton syndrome, amyotrophic lateral sclerosis and similar conditions)
- In pregnant and breastfeeding patients
- In patients under 18 years of age
- In patients with a history of allergy to the product to be used or to its components
Situations that require separate assessment
- Muscle disease (an assessment by the relevant specialist physician is required)
- Use of medicines that affect neuromuscular transmission (aminoglycoside antibiotics, muscle relaxants and similar)
- Bleeding or clotting disorder, or use of blood-thinning or anticoagulant medicines
- Active infection or febrile illness (the procedure is postponed)
- A recent procedure in the same area (the timing is adjusted accordingly)
Additional conditions specific to this area
The procedure is not performed if the following are present in the area to be treated:
- Difficulty swallowing
- A complaint of liquid leaking from the mouth
- An active cold sore, infection or open wound around the mouth
In these situations, the procedure is planned subject to the physician’s assessment:
- Existing asymmetry in the movement of the corner of the mouth (the risk of it becoming pronounced is high in this area)
- A history of facial palsy (the opinion of the relevant specialist is sought)
- A speech disorder (the opinion of the relevant specialist is sought)
- Wearing a dental prosthesis
- Previously applied dermal filler in the area (timing and planning are adjusted accordingly)
How is the procedure performed?
- Assessment. The physician determines whether the position at the corner of the mouth is related to muscle movement. The movement of the corner of the mouth and the lower lip during smiling is observed; the skin structure and the tissue support are assessed. A history of cold sores, complaints affecting speech or swallowing, a history of neuromuscular disease, current medication, allergy history and previous procedures are recorded. Blood pressure and pulse are measured.
- Product check. The marketing authorisation status of the product to be used and its compliance with storage conditions are checked.
- Information and consent. The physician explains, in writing and verbally, the procedure, the fact that the expected change is limited, that the effect is temporary, that the possibility of smile asymmetry is high in this area, and the possible side effects; the form is signed.
- Preparation. The area must be free of make-up. It is then prepared with antiseptic.
- Administration. The product is administered at the predetermined points with a fine needle.
- Observation and follow-up. Vital signs and any observations are recorded in the file. A follow-up appointment is arranged at which the result will be assessed.
When does the effect begin, and how long does it last?
The time it takes for the effect to appear varies from person to person; the full result is assessed between a few days and two weeks. The effect is temporary, and how long it will last cannot be stated in advance. The timing of any repeat is determined at the follow-up.
What should you do before and after the procedure?
Before the procedure, report:
- A list of all the medicines and supplements you use (in particular blood thinners, painkillers and antibiotics)
- Your known allergies
- Any history of nerve or muscle disease
- Your pregnancy and breastfeeding status
Please state whether you have a history of cold sores and whether you have any complaint of liquid leaking from the mouth.
Come with no make-up on the area.
After:
- The area must not be massaged or rubbed on the day of the procedure
- In the first few days there may be a temporary change in smiling and in speech
- Care is advised when eating and drinking
- You will be asked to avoid bending forward, staying head-down for long periods and lying face down for the period specified
- Hot environments, saunas, sunbeds and vigorous exercise are to be avoided for a time
- Temporary raised bumps, redness and mild bruising may occur at the injection sites
Recommendations and time periods specific to you are given in writing at the end of the procedure.
Risks and side effects
The risk of smile asymmetry is higher in this area than in the other areas of the face.
Risks specific to this area
- Smile asymmetry (an unwanted outcome frequently reported in corner-of-mouth botulinum toxin)
- Unexpected movement or an uneven appearance at the corner of the mouth
- Leakage of liquid from the mouth
- A change in the movement of the lower lip
- A temporary change in speech
- Difficulty controlling the lips while eating
- The expected change not being seen (the result at the corner of the mouth is limited)
- Triggering of a cold sore in the area
General risks that may occur with any minor procedure
- Pain, redness, swelling and bruising
- Infection at the site of the procedure
- Headache
- A change in facial expression
- Allergic reaction
- Flu-like symptoms
- Vasovagal syncope (fainting)
These side effects are temporary; however, the time they take to resolve varies from person to person and may take weeks. It is not possible to reverse the effect of the botulinum toxin.
Results vary from person to person.
When should you see a physician without delay?
If you experience these symptoms during treatment, contact your physician without delay:
- Marked asymmetry in smiling
- Continuous leakage of liquid from the mouth
- Increasing redness, increased warmth, swelling or discharge at the site of the procedure
- A high fever
- Widespread rash, itching
In the event of difficulty swallowing, disturbance of speech, double vision, shortness of breath, widespread muscle weakness, or swelling of the lips or eyelids, go directly to the emergency department.
Frequently asked questions
How much change can be expected from corners of the mouth botulinum toxin?
The expected change is limited. The position of the corner of the mouth does not depend on a single muscle; the skin structure, the fatty tissue and the neighbouring muscles together determine it. For this reason the expected contribution is small, and it may not be seen in every person.
Will corners of the mouth botulinum toxin change my smile?
Smile asymmetry is the most frequent and most noticeable unwanted outcome in this area; the risk is higher than in the other areas of the face. For this reason, the movement of the corner of the mouth and the lower lip during smiling is assessed before the procedure.
Are corners of the mouth botulinum toxin and chin botulinum toxin the same thing?
No. Corners of the mouth botulinum toxin concerns the muscle that pulls the corner of the mouth downwards. The surface appearance created by the muscle in the chin is described on the Chin Botulinum Toxin page.
I have a complaint of leakage of liquid from the mouth; is the procedure carried out?
No. The procedure is not carried out in those with a complaint of liquid leaking from the mouth; this complaint is also among the side effects reported after the procedure. Please mention your complaint at the consultation.
I am prone to cold sores; is that a problem with corners of the mouth botulinum toxin?
Triggering of a cold sore in the area is among the outcomes reported. If there is an active cold sore around the mouth, the procedure is not carried out. Please mention your history of cold sores at the consultation.
How long does the effect of corners of the mouth botulinum toxin last?
The effect is temporary and its duration cannot be stated in advance. It varies according to the person, muscle strength and the pattern of application. The timing of any repeat is determined at the follow-up consultation.
Is corners of the mouth botulinum toxin carried out during pregnancy?
No. The procedure is not carried out during pregnancy or breastfeeding.
Sources
- Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Beşeri Tıbbi Ürünler Ruhsatlandırma Yönetmeliği, Official Gazette 11 December 2021 / 31686. https://www.resmigazete.gov.tr/eskiler/2021/12/20211211-5.htm (opens in a new tab)
- Ministry of Health of the Republic of Türkiye, Ayakta Teşhis ve Tedavi Yapılan Özel Sağlık Kuruluşları Hakkında Yönetmelikte Değişiklik Yapılmasına Dair Yönetmelik, Official Gazette 7 January 2025 / 32775. https://www.resmigazete.gov.tr/eskiler/2025/01/20250107-3.htm (opens in a new tab)
