Facial expressions are central to how we connect with others. They influence first impressions, everyday interactions, and how we feel in our own skin. A common concern expressed by many women as they age is the involuntary downward pull at the corners of the mouth — often referred to as marionette lines — which can cause the face to appear stern, tired, or unhappy, even when one feels content or at ease.
This particular feature develops over time due to multiple physiological changes in the lower face. As collagen and elastin production declines, skin becomes thinner and less resilient. Supporting fat pads diminish, facial bone structure subtly remodels, and muscle imbalances begin to show. The depressor muscles around the mouth, particularly the depressor anguli oris (DAO), may begin to overpower the natural lift provided by the zygomatic muscles, causing the corners of the mouth to slope downward.
At Monaz Clinic in Harley Street, we offer a gentle and medically led approach to softening this concern through precisely placed anti-wrinkle injections. These are carefully administered into specific muscles to relax downward tension while preserving your ability to smile, speak, and emote naturally. Our clinical goal is to help your resting facial posture reflect your inner sense of calm, openness, and self-assurance — not to freeze your features, but to harmonise them.
How and Why They Form?
Ageing and Volume Depletion: As skin matures, its structural integrity diminishes. Collagen, elastin, and hyaluronic acid — vital components for firm, hydrated skin — reduce significantly. Alongside this, the fat compartments that support the lower face shrink and descend, contributing to tissue sagging and the formation of creases from the corners of the mouth toward the chin.
Muscle Imbalance: The depressor anguli oris muscles, located on either side of the chin, pull the corners of the mouth downward during expressions such as frowning or pouting. Over time, these muscles can become hyperactive or more dominant, especially if the muscles responsible for lifting — like the zygomaticus major — weaken or are less engaged. This imbalance can lead to a fixed downturn in the lips even when the face is at rest.
Genetic and Anatomical Influences: Some women naturally have stronger DAO muscles or facial shapes that predispose them to early development of marionette lines. Genetics influence bone density, skin thickness, and fat distribution, all of which contribute to how the mouth corners age over time.
Lifestyle and External Factors: Smoking, sun exposure, frequent facial expressions, and even dramatic weight loss can exacerbate the appearance of downturned corners. These lifestyle choices accelerate the breakdown of skin-supporting proteins and contribute to earlier or more pronounced sagging in the lower face.
While part of the natural ageing process, many women find that this feature does not reflect how they truly feel inside — leading them to explore gentle, clinically led options for restoring a softer, more serene facial appearance.
When the corners of the mouth droop involuntarily, it can misrepresent a woman’s mood or personality. A face that looks sad or unapproachable at rest can affect confidence, professional engagement, and social comfort.
Treatment benefits :
A Softer Expression Without Surgery:Anti-wrinkle injections offer a refined and non-invasive way to subtly lift the corners of the mouth without altering your natural smile or expression. The result is a softened appearance that looks entirely your own — just slightly more at ease.
Maintain Natural Facial Movement:Only the specific muscles responsible for the downward pull — the DAO — are gently relaxed. The rest of your facial muscles remain fully functional, ensuring that speaking, eating, and smiling remain completely unaffected.
Emotional Harmony:Many patients report that the treatment helps their outward appearance reflect their inner state more accurately. Instead of appearing tense or stern, the mouth adopts a more neutral or positive resting shape, which can have a meaningful impact on emotional wellbeing.
No Surgery, No Downtime:There are no incisions, stitches, or extended recovery periods involved. The injections are quick, require no anaesthesia, and allow you to return to normal life almost immediately.
Supportive Ageing Strategy: When incorporated as part of a long-term aesthetic plan, anti-wrinkle injections can help slow the deepening of marionette lines by limiting the mechanical muscle action that contributes to their formation.
This treatment is suitable for adult patients who would like to soften the appearance of marionette lines (the lines that run from the corners of the mouth towards the chin) in a non-surgical, prescription-led way. It’s often chosen by women who want a fresher-looking lower face while keeping their facial expression natural and recognisable.
You may be a suitable candidate if:
Suitability is always confirmed during a face-to-face consultation with a qualified prescriber, where we review your medical history, current medications, and what you’d like to achieve, so expectations stay realistic and outcomes remain natural. This treatment is offered in a private, female-only setting, designed to feel discreet and comfortable from consultation through to aftercare.
Anti-wrinkle injections are a prescription-only treatment used to temporarily reduce the strength of contraction in selected muscles. In the lower face, they can be used in a very measured way to address muscle pull that contributes to a downturned mouth, which can make marionette lines look more noticeable and affect the overall “resting” expression.
Targeted Use in the Lower Face
For this concern, treatment planning focuses on the depressor anguli oris muscles, which sit near the corners of the mouth and can pull the mouth downward during certain expressions and at rest. By gently reducing the downward pull in carefully chosen points, the muscles that support a more neutral mouth position can act more freely. The aim is subtle: a softer, less downturned look at the corners of the mouth, while keeping speech and expression natural and recognisable. Suitability is confirmed during a face-to-face consultation with a qualified prescriber, where we assess your facial movement, medical history, and the outcome you’d like to achieve.
For downturned mouth corners and marionette lines, the aim is to temporarily reduce the strength of contraction in the muscles that pull the corners of the mouth downward. By easing that downward pull in carefully selected points, the lower face can look more balanced and the resting expression can appear softer, while keeping movement natural and recognisable.
Mechanism of action?
Muscle Identification
We assess your facial movement in motion — smiling, speaking, and resting — to understand what is driving the downward pull. The focus is on identifying the specific points where the depressor anguli oris contributes most to the crease pattern and the mouth-corner position.
Micro-Targeted Injections
Small, carefully placed injections are delivered into selected points using a fine needle. The approach is measured and conservative, with the goal of reducing the pull without affecting normal function. Treatment is planned to preserve natural movement for speech and expression.
Rebalancing Facial Expression
Over the following days, as the treated fibres relax, the downward pull becomes less dominant. This can allow the muscles that support a more neutral mouth position to work more freely, which may soften the look of marionette lines and subtly improve the mouth corners at rest. Results develop gradually and vary from person to person.
Your treatment journey begins with a thorough consultation. We assess your facial structure, muscle dynamics, lifestyle, and personal goals to ensure this treatment is appropriate and effective for you.
Post-treatment, we will provide detailed guidance to help you care for the area and optimise your results. Most women return to their usual activities straight away, without the need for dressings or downtime.
When to Expect Results?
You can expect to see early signs of improvement between 3 to 5 days after treatment. The full effect typically becomes visible by day 10 to 14.
How Long Will It Last?
The effects usually last between 3 to 4 months, although this varies depending on individual factors such as metabolism, stress, and physical activity levels.
Maintenance
To sustain the softening effect, repeat treatments are typically scheduled every 3 to 4 months. With consistent use, some women find the results last longer as the treated muscles gradually weaken in dominance.
Following our aftercare guidance helps reduce the risk of side effects and ensures optimal results.
Common effects include minor swelling, redness, or bruising at the injection site. Rare side effects, such as asymmetry or nearby muscle weakness, are discussed in full during your consultation.
See the transformative effects of our treatments.
Patient A – Age 45 Mouth corners appeared subtly lifted with a softer resting expression. The patient reported feeling more confident in social interactions.
Patient B – Age 55 Visible improvement in the downward slant of the mouth, creating a more refreshed and open appearance. Friends noticed a brighter, more relaxed expression.
Our step-by-step video guide shows the treatment in real time — from consultation through to recovery. It’s an excellent resource to help you feel confident, informed, and prepared for your visit to Monaz Clinic.
Have a question?
No. At Monaz Clinic, our goal is balance — not overcorrection. We only treat the specific muscles causing the downward pull, leaving the rest of your expressions completely natural and responsive.
The injection process takes about 10 to 15 minutes. With your consultation and aftercare discussion included, your entire appointment is usually completed within 30 minutes.
Most women describe the sensation as a slight pinprick. The needles used are very fine, and any discomfort is fleeting. A cold compress can be used post-treatment if needed.
Yes. Many patients choose to pair anti-wrinkle injections with dermal fillers for enhanced support in the marionette area. We will discuss the most suitable plan for you during your consultation.
Please wait at least 12 hours before applying makeup. This allows the injection sites to close and reduces the risk of irritation or product migration.
“I was always asked if something was wrong. After treatment at Monaz Clinic, my expression feels aligned with how I actually feel — calm and confident.”
“The entire experience was professional and reassuring. I now feel like my face matches the way I want to present myself.”
“My resting face used to look stern. This simple treatment made a subtle but meaningful difference.”
“I came for treatment while in London and couldn’t be happier. I still look like me — just less tired and more open.”
Disclaimer
Individual results may vary. All treatments are subject to consultation and assessment by our qualified practitioners.
Note
Anti-Wrinkle Injections are a prescription-only medicine (POM). Before any treatment can be administered, a face-to-face consultation with our qualified practitioners is required.
