Localized injection of depressor anguli oris combined with microbotoxing platysma for the aesthetic of mouth corner: a preliminary report
10.3760/cma.j.cn114453-20250722-00192
- VernacularTitle:降口角肌定点注射联合颈阔肌微滴肉毒毒素注射改善口角形态的初步报道
- Author:
Lehao WU
1
;
Tai WANG
;
Congmin GU
;
Jingning XIE
;
Jiaqi WANG
;
Shan ZHU
;
Tailing WANG
Author Information
1. 中国医学科学院北京协和医学院整形外科医院面颈整形中心，北京 100144
- Publication Type:Journal Article
- Keywords:
Botulinum toxins;
Minimally invasive therapy;
Jowl;
Microbotox injection
- From:
Chinese Journal of Plastic Surgery
2025;41(10):1001-1007
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical efficacy of two-point localized injection of the depressor anguli oris (DAO) muscle combined with pan-platysma microbotox injection of botulinum toxin type A for improving the aesthetic of mouth corner.Methods:A retrospective analysis was conducted on clinical data from patients who received concomitant DAO localized injection and pan-platysma microbotox of botulinum toxin type A for improving drooping mouth corners at the Facial and Neck Plastic Surgery Center and the Limb and Scar Center of Plastic Surgery Hospital, Chinese Academy of Medical Sciences, between December 2022 and June 2025. Botulinum toxin type A was reconstituted to two concentrations: 40 U/ml and 20 U/ml for the combined injection. Patients were instructed to repeatedly perform upward puckering motions to identify the trapezoidal outline of the DAO muscle. Two injection points were uniformly marked slightly medial to the midline of the DAO muscle for dual-target injection (1.5 U each at the middle one-third and lower one-third of the muscle belly). The pan-platysma microbotox for the platysma muscle extended superiorly to a line parallel and 3-4 cm above the mandibular border, innerly to 1 cm beyond the lateral edge of the DAO muscle, inferiorly to the submental area and the anterior neck region above the clavicle, and laterally to the anterior border of the sternocleidomastoid muscle. The injection dose was 0.6 U per point, with 1 cm spacing between points, administered at the superficial subcutaneous layer. Complications were recorded. At 1-month postoperatively, efficacy was evaluated using the global aesthetic improvement scale (GAIS, scores ranging from 5 to 1, representing "much worse" to "very much improved" ) and subjective patient satisfaction (categorized as very satisfied, satisfied, dissatisfied, or very dissatisfied; satisfaction rate was calculated as the percentage of patients reporting very satisfied or satisfied among the total). Patients’ willingness to receive the same treatment in the future was also surveyed. Descriptive statistics were used for analysis.Results:A total of 21 patients were included (1 male, 20 females), with a mean age of (37.1±3.2) years (range: 34-45 years). The treatment procedures were successful. Post-treatment, 4 cases experienced pain and swelling, 8 had neck ecchymosis, and 1 had temporary asymmetry in mouth corner movement, all of which resolved within 2 weeks. The follow-up period ranged from 1 to 6 months (mean: 1.4 months). At short-term follow-up (4-6 weeks after treatment), patients reported a skin "tightening" sensation in the lower face and neck region, noting significant improvement in lower facial and neck contour, sharper bilateral jawlines, and reduced neck wrinkles. Drooping mouth corners were improved. The satisfaction survey showed that 17 patients were "very satisfied" and 5 were "satisfied", resultsing in a subjective satisfaction rate of 100%. Nineteen patients (90.5%) expressed willingness to undergo repeat treatment. The mean GAIS score was 1.45±0.69, with 14 patients achieving "very much improved", 5 patients "much improved", and 2 patients "improved" .Conclusion:The combination of two-point localized injection of the DAO muscle and pan-platysma microbotox injection of botulinum toxin into the platysma muscle effectively improve the aesthetic of mouth corners and lower facial contour through synergistic middle and superficial layer treatment. This approach aligns with anatomical and physiological merits and offers advantages such as minimal invasiveness and rapid recovery, making it applicable for patients with early signs of lower facial aging.
