Nonsurgical correction of drooping mouth corners using monophasic hyaluronic acid and incobotulinumtoxinA

Background Nonsurgical correction of drooping of the corners of the mouth requires a multimodal approach combining botulinum toxin and soft tissue filler injections. Objective To validate a nonsurgical therapeutic approach for correcting a “saddened” appearance characterized by drooping mouth corners, oral commissures, and/or marionette lines. Methods In this prospective, evaluator‐blinded study, monophasic hyaluronic acid (MHA) was infiltrated to correct drooping mouth corners in four steps, deep oral commissures in two steps, and/or deep marionette lines in two steps, in that order. Then, incobotulinumtoxinA was injected along the depressor anguli oris and mentalis muscles. Results The total volumes of MHA used in steps 1‐4 were 0.2 mL (interquartile range [IQR]: 0.19‐0.3) for the right side of the face and 0.25 mL (IQR: 0.2‐0.3) for the left side; total volumes in steps 5‐8 were 0.18 mL (IQR: 0‐0.4) for the right side and 0.15 mL (IQR: 0‐0.33) for the left side. The total mean dose of incobotulinumtoxinA was 26.5 units (IQR: 24‐28). The median degrees of drooping of the mouth corners were −4° (IQR: −7° to −2°) at baseline, −1° (IQR: −3° to 1°) at post‐treatment 2 weeks, and −1° (IQR: −3° to 0°) at post‐treatment 3 months. Median Global Aesthetic Improvement Scale scores were 3 (IQR: 2‐3) at post‐treatment 2 weeks and 3 (IQR: 2‐3.75) at 3 months. Conclusion Our results demonstrated that nonsurgical treatment with MHA and incobotulinumtoxinA provides satisfactory therapeutic outcomes in patients with a saddened appearance by correcting drooping of the mouth corners, deep oral commissures, and/or deep marionette lines.