Hello beautiful people, today’s tip of the day is the sad smile, where the corners of the mouth drop. When you want to fill it, don’t only fill it, because a little botulinum toxin helps the muscle relax and turns a sad smile into a normal one. I am going to explain why filler on its own falls short, and why the amount you place matters if you don’t want a joker smile.
Dr Rami Haidar | 13th April 2026 | Excellence Medical Boutique, Dubai
Filler restores support at the corner of the mouth, but it does not stop the muscle pulling that corner down. If the downward pull is left untreated, product is being added against a force that is still working, and the corner sits lower than the result you were aiming for.
Dr Rami Haidar’s tip is to combine the two. Support the corner with dermal filler, then add a small amount of botulinum toxin to relax the muscle doing the pulling. Filler holds the corner up, the toxin stops it being dragged back down, and together they turn a sad resting expression into a neutral one.
The muscle responsible is the depressor anguli oris, usually shortened to DAO. It runs from the jaw up to the corner of the mouth, and its only job is to pull that corner downward. When it is strong or overactive, the corners sit low at rest, which reads as sadness or fatigue on a face that feels neither.
It does not work alone. In the case shown alongside this tip, the muscles around the mouth were mapped on the patient’s face first: the orbicularis oris around the lips, the depressor labii inferioris and the mentalis below, and the DAO at the corner. Knowing which of them is contributing, and how strongly, is what tells you where the toxin goes and how much is needed.
This is the part of the tip that carries the most weight. Too much botulinum toxin in this area does not produce a better result, it produces a distorted one. Dr Rami Haidar’s warning is direct: you do not want to turn a normal smile into a joker smile.
The muscles around the mouth are small, sit close together, and are directly involved in speaking, eating, and smiling. Overrelaxing the depressors, or placing a dose slightly off target, can lift the corners further than the rest of the mouth moves, which looks stranger than the original problem. The goal is a normal smile, not an exaggerated one, and that means small, accurate doses judged against the individual muscle.
This suits patients whose mouth corners sit lower than they used to, or who are told they look tired or unhappy when they are not. It is often assessed alongside the marionette lines and the chin, since the lower face works as one unit.
It suits others less well. Corners pulled down mainly by heavy skin laxity may not respond well to either filler or toxin, and patients whose mouth movement is already asymmetric need particular care with dosing. Dr Rami Haidar’s background in Oral and Maxillofacial Surgery means the muscles, the dentition, and the underlying structure are assessed before anything is injected.
A downturned mouth corner is structural and muscular at the same time, so treating one half of it rarely gives the result the patient wanted. Filler supports the corner, a small dose of botulinum toxin releases the pull, and the amount is what separates a normal smile from an odd one. If you are comparing clinics in Dubai, ask whether the muscle is being addressed at all.
If the corners of your mouth sit lower than they once did, or your resting expression no longer matches your mood, book a consultation with Dr Rami Haidar at Excellence Medical Boutique in Jumeirah, Dubai. Assessment covers the muscles, the support beneath them, and your skin quality before treatment is recommended.
The main cause is the depressor anguli oris, or DAO, a muscle running from the jaw to the corner of the mouth whose job is to pull that corner downward. When it is strong or overactive the corners sit low at rest. Loss of structural support at the corner and changes in skin quality also contribute, which is why both are assessed.
Filler restores support at the corner but does not stop the muscle that is pulling it down, so used on its own it often falls short of the result the patient wanted. Dr Rami Haidar’s approach is to combine filler with a small amount of botulinum toxin so the muscle relaxes and the corner is not dragged back down. Suitability is decided at consultation.
DAO botox refers to a small dose of botulinum toxin placed into the depressor anguli oris to reduce the downward pull on the corner of the mouth. The aim is a neutral resting expression rather than a lifted one. Dose and placement matter considerably, because the muscles around the mouth are small and closely involved in speaking and smiling.
It describes a smile lifted or distorted beyond what looks natural, usually caused by too much botulinum toxin around the mouth or a dose placed off target. It is avoided by using small, accurate doses judged against the individual patient’s muscle activity after assessment. This is one of the main reasons the area calls for a practitioner with detailed anatomical knowledge.
They are related but not the same. Marionette lines are the folds running down from the corners of the mouth toward the jaw, while a downturned corner describes the position of the corner itself. The two frequently occur together and are usually assessed alongside the chin.
Located in the heart of Jumeirah, Dubai, Excellence Medical Boutique is more than a clinic, it’s a destination. A sanctuary where innovation, expertise and care come together to enhance your natural beauty and confidence. Excellence Medical Boutique is conveniently located on 197 Jumeira St, Jumeirah, Jumeirah 1, Dubai. This makes it easy for patients travelling from across Dubai to visit for consultation and treatment.
