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Botox
Will injecting Botox into the depressor anguli oris cause atrophy of the modiolus or weaken the orbicularis?
When done properly, botox treatment for the DAO should not affect the orbicularis. The DAO inserts into the modiolus but the bulk of the muscle is lower along the jawline, so that should be the target injection area, well away from the lip and mouth muscles.
Injecting low and staying superficial keeps the dose localized to the DAO fibers rather than letting it diffuse upward into the modiolus or orbicularis oris. Most patients notice softer downturn of the mouth corners within a few days, with full effect by about two weeks, lasting three to four months as with other botox treatments. True atrophy of the modiolus isn't something we see with correct technique and appropriate dosing. If you notice new asymmetry, trouble pursing your lips, or difficulty with a full smile after treatment, that's worth calling about, and it's a good topic to raise at your consultation so we can discuss injection placement beforehand.
Clinical Context
The depressor anguli oris is a small muscle running along the jawline that pulls the corner of the mouth downward. It meets other muscles at the modiolus, a point near the mouth's corner where several muscles anchor. Botox aimed at the lower, thicker part of this muscle targets it without spreading to nearby muscles that shape lip movement, which is why properly placed injections shouldn't affect smiling or lip closure.
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