Botox and Dysport Below the Frown Lines A Muscle-by-Muscle Look at Wide Jaws, Gummy Smiles, Neck Bands, Pebbled Chins, Downturned Corners, a Dropping Nose Tip and the Lip Flip, and the Point Where Beverly Hills Patients Are Better Served by Surgery

Most people who think about Botox are thinking about the top of the face: the lines between the brows, the horizontal creases across the forehead, the fans at the corners of the eyes. That is where neurotoxin built its reputation, and it is still where most of it is injected. But the same medicine works on any muscle that moves skin, and below the eyes there are a lot of those muscles doing a lot of quiet damage to the way a face looks. They pull the mouth down, push the chin into dimples, tug the jawline into cords, widen the lower face and lift the upper lip too high when someone smiles.

Those lower-face uses are where the skill of the injector matters most and where the margin for a mistake is smallest. A frozen forehead is obvious but fixable in a few weeks. A smile that does not lift evenly, or a lip that cannot hold a straw, is a different kind of problem. This is also where patients most often ask whether an injection can do the job of an operation, and where an honest answer takes more than a yes or a no.

This guide goes through the lower face one muscle at a time. For each one it describes what the muscle does, what the problem looks like in the mirror, what neurotoxin can realistically change, and when something other than an injection is the better answer. It is written for patients considering Botox or Dysport in Beverly Hills, and for anyone who has been told that a feature "can be fixed with a few units" and wants to know whether that is true.

What neurotoxin actually does, and the three things it cannot

Botulinum toxin type A blocks the signal that tells a muscle to contract. The nerve still sends the message, but the chemical that carries it across the gap to the muscle is held back. The muscle relaxes, the skin above it stops creasing as much, and in the case of a muscle that pulls on a structure, the structure shifts. Effects begin within a few days, usually settle at about two weeks, and fade over roughly three to four months as the nerve sprouts new connections. Muscles that are treated repeatedly often become a little smaller and weaker, which is one reason some patients find that results last longer over time.

There are three things it cannot do. It cannot tighten skin, because skin is not a muscle. It cannot remove fat, because fat is not a muscle either. And it cannot change bone. Almost every disappointment with lower-face neurotoxin comes from asking it to do one of those three things. A neck that sags from loose skin will not improve with injections. A jaw that is wide because of bone will not narrow. A heavy lower face from fat will not slim. Knowing which of the three is the actual problem is most of the work, and it is why the evaluation matters more than the syringe.

Brands, units and why the label on the vial is not the point

Most patients arrive with a brand in mind. Botox is the name everyone knows, and Dysport is the other product on the injectables menu at Dr. Harris's office. Other botulinum toxin type A products, including Xeomin, Jeuveau and the longer-acting Daxxify, are also used around the country. They share the same basic mechanism. They differ in how they are formulated, how quickly they start, how far they spread and how long they last, and the differences are real but smaller than marketing implies.

Units are not interchangeable between brands. A "unit" of one product is not the same as a "unit" of another, which is why comparing prices or doses across clinics is a poor guide to anything. What matters is where the product is placed, how much goes into each muscle and how the injector adjusts for each face. Patients comparing the two are often surprised that the experienced answer is that either can work well in skilled hands, with the choice depending on the area, the patient's history and the injector's habits.

In the lower face, the diffusion of the product is a practical matter. A product that spreads further is useful when covering a broad flat muscle and a risk when injecting near the corner of the mouth. Injectors often choose a more localized approach for small, delicate muscles around the lips and a broader one for the masseter.

The masseter: when a strong chewing muscle makes the jaw look wide

The masseter is the thick muscle that runs from the cheekbone to the angle of the jaw. You can feel it by clenching your teeth, and it bulges at the back of the cheek. In some people it is large, either by nature or because of grinding and clenching, and the lower face looks square and wide as a result. Some patients also have headaches, jaw soreness or tight muscles from clenching, and injecting the masseter can ease those symptoms too.

Neurotoxin weakens the muscle, which over a course of treatments allows it to shrink. The lower face can look narrower and softer as the volume reduces, usually after a few weeks and several rounds. It works best in people whose width comes mostly from muscle. It does little for people whose width comes from the bone of the jaw angle or from fat over the muscle, which is why a clinician checks by feeling the muscle as the patient clenches and by looking at the bone in photographs.

There are trade-offs. Chewing very tough food may feel tiring for a few weeks. If the dose is too high or the spread reaches nearby muscles, the smile can look slightly different. There is also an unsettled question about long-term, repeated high-dose treatment and its effect on the underlying bone, an area researchers continue to study, which is one reason many injectors prefer conservative dosing and spacing. Patients whose jaw is wide because of bone should know that jaw reduction is a surgical option that addresses the structure directly. Sorting out whether muscle, bone or fat is behind the width is the heart of jawline contouring planning.

The gummy smile: a lip that rises too far

When someone smiles, a group of small muscles lifts the upper lip. If those muscles pull it too high, a band of gum shows above the teeth. This is a gummy smile, or excessive gingival display, and it can make people self-conscious enough to cover their mouths when they laugh.

Neurotoxin can reduce the pull of the elevator muscles at the side of the nose and upper lip. With tiny doses placed carefully, the lip rises a little less, and the band of gum shrinks. The effect lasts a few months and can be repeated. It works best when the cause is muscle, rather than bone or the shape of the upper jaw.

Not every gummy smile is a muscle problem. A short upper lip, a lip that is longer than average, a jaw that sits too far forward or teeth that are short can all produce the same look. Dentists and orthodontists sometimes treat the underlying structure. A surgeon may suggest a lip lift when the lip itself is too long. A good evaluation looks at the smile at rest, in a natural laugh and in a forced smile, and compares each of those with the underlying structure.

The risk to avoid is a smile that looks stiff or lopsided. Over-treating can weaken muscles that keep the upper lip balanced, and the result is a smile that flattens. The safest approach is to start low and add later.

Platysmal bands: the cords that show when you speak or clench

The platysma is a thin sheet of muscle that runs from the jaw down the neck to the collarbone. In many people, as the skin ages and the muscle separates at the center, two vertical cords appear at the front of the neck. They become visible when the person speaks, clenches or strains. In some, the muscle's pull on the lower face also contributes to jowls and a downturned jawline.

Neurotoxin can soften those bands by relaxing the muscle. In October 2024 the FDA approved Botox Cosmetic for moderate to severe vertical platysma bands in adults, a sign that the approach has been studied formally. In many patients the cords flatten, and some see a subtle lift along the jawline as the muscle's downward pull eases.

What it cannot do is tighten loose neck skin, remove fat under the chin or correct a deep platysma separation. When the problem is skin laxity, excess fat or true muscle separation, a surgical correction does the job properly, and options such as a neck lift address the underlying causes, including how the platysma is released and repositioned. Injections can be a useful bridge for someone who is not ready for surgery, or a refinement after it.

As with the other lower-face areas, the margin matters. Dosing too high or injecting too deep can affect swallowing or neck strength for a short time. This is uncommon in experienced hands, but it is a reason to choose an injector who works in this area regularly and to follow aftercare instructions.

The chin: when the surface looks like an orange peel

A chin that dimples or puckers when the mouth moves is often caused by an overactive mentalis muscle, which lifts the chin pad. The skin looks pebbled, and the chin can appear to push up into the lower lip when someone is thinking or speaking. Some people find it tiring to look at in photographs.

A few small injections can relax the muscle, smooth the surface and let the chin sit more naturally. The result is subtle, and it can improve the look of the chin in photos and makeup. As with the mouth corners, the key is precision. Too much in the wrong place can make the lower lip feel heavy.

Downturned corners and marionette lines: the depressor muscle

The depressor anguli oris pulls the corner of the mouth down. When it is strong, the mouth appears to frown at rest, which gives the face a stern or tired look even when the person feels cheerful. Marionette lines run from the corners of the mouth toward the chin, and they deepen as volume is lost with age and the muscle's pull continues.

Neurotoxin can relax that downward pull, allowing the corners to settle at a more neutral or slightly lifted position. This is a delicate injection, because the depressor lies next to muscles that control the lower lip and smile. Done well, it can lighten the expression, and many injectors pair it with treatment of the mentalis or platysma. It does not fill the line itself. When deep folds are present, they usually reflect lost volume or descended tissue, and fillers, fat transfer or a lift address them. The approach for combined jowl and marionette concerns is a separate decision.

A nose tip that drops when you smile

Some noses look fine at rest and droop when the person smiles. A small muscle called the depressor septi nasi pulls the tip downward, shortening the upper lip and making the nose look longer. A very small dose can relax it, lifting the tip a little during movement.

This is a minor change, useful for people who notice the drop in photographs or video calls. It is not a substitute for rhinoplasty, which changes structure, and a dropping tip can have other causes, such as weak support or a long nasal cartilage. Patients who want a lasting change to the nose can explore rhinoplasty, and those who want a trial of what a slightly lifted tip might look like sometimes find toxin a helpful preview.

The same family of treatments includes the "bunny lines" that wrinkle the sides of the nose when someone scrunches. These respond well to small doses, though they can reappear if the muscle compensates elsewhere.

The lip flip: a subtle change that is easy to misunderstand

The lip flip uses a few tiny injections along the upper lip border to relax the muscle that rolls the lip inward. The lip then turns out slightly, showing a bit more red. The result is subtle: the lip does not gain volume, and the effect is most noticeable when the person is talking or smiling.

It is popular with patients who want a hint of change without filler. It has real limits. The change is small and short-lived, usually lasting a couple of months. It can make some activities awkward for a while, such as drinking through a straw, whistling, or pronouncing certain sounds. It does not help a lip that is too long or too flat. It also does not lengthen or shorten the lip.

A surgical lip lift does something quite different, because it shortens the distance between the nose and the lip and moves the lip permanently. Patients often ask whether a flip can show them what a lift would look like. It cannot, because the mechanisms differ. For choosing among injections, fillers and surgery, the question is whether the concern is volume, position or length.

Crow's feet, the cheek and the small stuff that shows when you smile

The corners of the eyes deserve a mention, because they tie the upper and lower face together. The muscle that circles the eye, the orbicularis oculi, creates the fans at the corners. Relaxing it softens the lines. But the same muscle also lifts the cheeks when someone smiles, and over-treating it can flatten a genuine smile or leave the lower lid looking weak. A restrained approach usually looks better than a smooth one.

Other small muscles in the cheek and around the mouth contribute to smile lines, to lip lines when pursing, and to the lines that radiate from the mouth. These are the most delicate injections of all, because the muscles overlap and because lips depend on these muscles for speech and expression. Many are better served by resurfacing or fillers than by toxin.

When toxin is the wrong tool

A short guide to the boundary between injection and surgery helps.

If the problem is muscle activity, such as dynamic lines, bands or a muscular jaw, neurotoxin can be the right tool. If the problem is structure, meaning lax skin, descended fat, lost volume or bone shape, it is usually not. Patients who have been injected repeatedly without improvement should ask whether the real issue is structural.

A decision tree in words: loose neck skin or jowls point toward a neck lift or facelift, especially a deep plane technique that repositions tissue as a unit. Deep folds around the mouth point toward volume or surgery. A wide jaw from bone points toward jaw reduction. A long upper lip points toward a lip lift. A weak chin points toward augmentation. Muscle-driven features such as bands, a square masseter, a chin that puckers or a gummy smile point toward neurotoxin first.

This is also why the preoperative evaluation for a facelift often includes looking at animation. A surgeon who sees strong platysmal bands, a dominant depressor or a heavy chin muscle will plan for them, sometimes by combining surgery with injections. Treatment is rarely one or the other.

Why an injector's training changes the result

Anyone can buy a vial. What differs is the knowledge of what lies beneath the skin. The lower face is crowded with small muscles whose actions overlap, with nerves and vessels in close company, and with structures that matter for swallowing, speech and smiling. A surgeon who has performed hundreds of operations in the same region carries a three-dimensional picture of that anatomy that a protocol card does not provide.

Dr. Harris trained in otolaryngology and head and neck surgery before his facial plastic fellowship, and he performs most of the non-surgical treatments in his office himself, from neurotoxin to lasers to microneedling. Patients choosing between a physician's office and a med spa should weigh who evaluates the face and who is responsible if something does not go as planned, because the difference lies less in the product than in the person holding the syringe.

In practice the difference shows up in small decisions. The injector watches the face move before placing a single drop, asks the patient to smile, frown, pucker and clench, and marks the spots. The injector adjusts the dose for that muscle's strength and for how much movement the patient wants to keep. And the injector sees the patient again at two weeks, a point at which a small touch-up can balance the result.

What a natural result looks like

A natural result is one in which people notice that you look rested, not that you were treated. The face still moves. The smile still reaches the eyes. The lower lip still holds a straw. Lines are softer, not erased, and the mouth looks relaxed rather than flat.

Natural results depend on restraint. Starting with the lowest effective dose and adding later is almost always safer than starting high and waiting out the effect. Spacing treatments, instead of chasing each line as it appears, preserves muscle function. Matching the plan to the face, instead of to a standard map of injection points, avoids the overly smooth, overly lifted look that has become shorthand for overdone work.

Patients often arrive with ideas about neurotoxin that do not match what it does, and sorting those out is half of the visit. Trends have shifted toward restraint. There is more interest in subtle results and less in dramatic freezing, and patients increasingly want their faces to look like theirs, a few years back, and not like someone else's.

A mirror test you can do before the appointment

Before booking, it helps to look at your own face the way an injector would. Stand in good light and relax your face. Then smile broadly, and note how much gum shows and where the upper lip rises. Clench your teeth and feel the muscle at the back of the cheek; a hard, bulging band suggests a strong masseter. Say the word "ooh" and watch your chin for dimpling. Turn your head to one side and tighten your neck, and see whether cords stand out. Frown with your mouth and look at the corners.

Take a photo of each, with the face relaxed and with the movement. The photographs let you describe what bothers you in specific terms, such as "my lip lifts too high on the left" or "my chin dimples when I talk," which is far more useful than "I want my face to look softer." They also give the injector a record of how the face looked before treatment, so the results can be judged fairly over time.

Side effects and the situations to avoid

Common effects of neurotoxin are mild: bruising, small bumps that fade within an hour or two, tenderness and occasional headaches. A temporary imbalance, such as one side of a smile lifting more than the other, can occur and usually resolves as the product wears off. Droopy eyelids or brows are the best-known complications of upper-face treatment; in the lower face, the equivalents are a smile that does not lift evenly, a lip that is weak for a few weeks, or in the neck a sense of weakness or difficulty swallowing, which is rare but important to report immediately.

Some people should not have neurotoxin. Pregnancy and breastfeeding are reasons to wait. Conditions that affect nerve and muscle signaling, such as myasthenia gravis, are reasons to avoid it. Certain medicines, including some antibiotics, can amplify the effect. An active infection or rash at the injection site calls for a delay. Anyone with these histories should say so at the start of the visit.

Aftercare is simple. Avoid rubbing or pressing on the treated areas for several hours, stay upright for a few hours after injections, and skip strenuous workouts the same day. If something feels wrong in the days that follow, call the office.

How long it lasts, when to come back and what a touch-up is for

Most lower-face results last about three to four months, although the masseter and the platysma often last a little longer, and the effect of regular treatment tends to build. Patients on a steady schedule often find they can stretch the interval between visits as muscles weaken. The first treatment is the one that teaches the most, because it shows how the face responds, and an injector who sees the patient again at about two weeks can fine-tune the result with a small adjustment.

Onset varies. Some injectors find that Dysport tends to start working a little sooner and spreads somewhat more widely, which can help in a broad muscle and is something to manage near the mouth. Individual response varies more than any brand difference, so the real information comes from watching how your own face reacts. Keeping a short record of what was treated, where and how it felt helps the next visit go better, particularly if the injector changes.

A touch-up is not a sign that something went wrong. It is the point of the follow-up. A muscle that is more active than expected, a small asymmetry between sides or a spot that was under-treated is easier to correct with a few extra drops than with a large dose at the start. Patients who stay on the cautious side and plan for a two-week check usually end up with a more natural result than those who try to finish everything in one visit.

The case for combining, in sequence

Injections and surgery are not rivals. A patient who is planning a facelift may be treated with neurotoxin beforehand to see how the lower face behaves once the muscles relax, and may continue afterward to keep strong depressors from undoing a lift. A patient with a wide jaw may use injections for a year to learn whether a narrower look suits the face before considering surgery. A patient who has had a lip lift may still benefit from small amounts of toxin to soften a lip that rolls inward.

Sequencing matters too. Many injectors treat the muscles first and reassess volume about two weeks later, because a face whose muscles have relaxed may need less volume than it first appeared to. Fillers are best chosen after movement has been addressed, which is one reason an overall plan beats a series of isolated appointments.

What to expect at the visit

A thoughtful visit starts with questions about what bothers you and what you want to keep. The injector examines the face at rest and in motion, feels the masseters as you clench, watches the neck as you speak and photographs your expressions. You discuss the plan, including what injections can do and what they cannot. Treatment itself takes minutes. The follow-up, usually after about two weeks, is where results are checked and adjusted.

If you are traveling or want to talk through your options before booking, a virtual consultation with Dr. Harris is a way to start. Bring photographs of your face smiling, frowning and at rest, and be ready to describe what you see in the mirror. The clearer the picture of the problem, the more likely the plan is right.