Case Background: The Overlooked Detail of the “Corners of the Mouth”

In the pursuit of facial rejuvenation, patients often focus on large areas such as the forehead, apple cheeks, or nasolabial folds, while neglecting the delicate perioral region. In this case, the patient’s primary concern was the downward drooping of the mouth corners at rest and the lack of舒展 (relaxation/expansion) in lip shape during smiling. This created a visual impression of being “serious” or “sad,” making it difficult to naturally convey approachability despite inner happiness.

Aesthetic Assessment and Treatment Plan

After clinical evaluation, the doctor determined that the downward drooping of the mouth corners was not caused solely by skin laxity but resulted from multiple factors:

Loss of soft tissue volume: Weakened support on the lateral aspects of the oral commissures led to a lack of upward lifting points for the mouth corners.
Muscle tension imbalance: Relative overactivity of the depressor anguli oris muscle caused habitual downward pulling of the mouth corners over time.
Blurred lip contour: Indistinct vermilion border lines further diminished the three-dimensionality of the lips.

Based on this assessment, the treatment plan did not rely on a single filling strategy but adopted a combined approach of “support + refinement.” The focus was on restoring volumetric support at the lateral oral commissures while subtly refining the shape of the Cupid’s bow and the labial tubercle, aiming to improve the direction of the mouth corners rather than simply increasing lip volume.

Treatment Process and Attention to Detail

The procedure involved precise injection using small-molecule, high-viscoelastic hyaluronic acid. Throughout the operation, the doctor strictly adhered to the principle of small amounts administered in multiple sessions:

Deep support: Deep layer placement at the attachment points of the lateral oral ligaments to reconstruct physical support points, addressing the drooping trend from its root.
Superficial refinement: Fine-layer application along the vermilion border to optimize the smoothness of the lip contour, allowing the mouth corners to present a slightly upward curve when naturally closed.
Dynamic observation: Guiding the patient to smile, speak, and make other expressions between injection steps to ensure the filler does not impair normal facial muscle movement and to avoid stiffness.

Post-treatment Results and Recovery

An immediate improvement in the shape of the mouth corners was visible, with previously downward lines becoming flatter. As mild swelling subsided (typically within 3–7 days), the results appeared even more natural. The patient reported that her facial expressions looked softer and more relaxed in daily bare-faced states, eliminating the misconception of appearing “downcast.” During smiles, the lips expanded moderately, enhancing an overall approachable demeanor.

Doctor’s Advice and Precautions

The perioral area is rich in blood vessels and nerves and involves high-frequency muscle movements associated with eating and speaking. Therefore, fillers in this region require the physician to have extensive anatomical knowledge and refined aesthetic sensitivity. We recommend:

Choosing licensed medical institutions and physicians with extensive experience in perioral injections.
Avoiding touching the injection site within 24 hours post-treatment, and refraining from high-temperature environments (such as saunas or hot compresses) and intense facial expression exercises for one week.
Maintaining realistic expectations regarding efficacy; fillers aim to improve shape and proportions rather than completely alter personal features. Preserving natural dynamic aesthetics remains the core goal of medical aesthetics.

4.4 HospitalNotes