Mouth Corner Filler (Oral Commissures and Marionette Lines)
BeforeSimulation
Mouth corner filler (oral commissures) aims to soften the look of a "sad mouth": corners that turn downward and marionette lines running toward the chin. Patients often say "I look angry" or "I look sad even when I smile in photos." It is more an expression concern than a volume concern, and that shapes the conversation.
On this page you will find the indication, usual volumes, durability, risks and how to simulate it in Harmy.
What is mouth corner filler?
It is the placement of hyaluronic acid in the commissure area and, when indicated, at the start of the marionette lines, to support the corner of the mouth and soften the hollow beneath it. The goal is for the corner to stop looking downturned at rest.
Drooping commissures have several causes: local volume loss, bone resorption in the lower third, skin laxity and the action of the depressor anguli oris muscle. That is why filler is often one part of the plan, alongside other approaches at the professional's discretion, such as botulinum toxin in the depressor or treatment of the jawline.
Who is mouth corner filler usually indicated for?
Generally, for patients with:
- commissures turned downward at rest;
- a hollow just below the corner of the mouth;
- mild to moderate marionette lines;
- a sad or tired look that does not match the patient's mood.
Deep marionette lines with significant laxity in the area respond poorly to local volume. General contraindications include active infection, active herpes, active autoimmune disease, pregnancy, breastfeeding and allergy to the product. The decision belongs to the qualified professional, in line with the rules of their professional council in Brazil.
Which areas are involved?
The main area is the mouth corners. They relate to the lips, to the nasolabial fold, which ends near the commissure, and to the chin and jawline, which support the lower part of the face.
Which product is used?
Generally, moderately cross-linked hyaluronic acid with good flexibility, since this is an area with a lot of movement. The choice takes into account the support needed and the risk of nodules in an area that is constantly moving. Product, instrument and plan are technical decisions for the professional.
What volumes are usual?
The ranges below are general references; the final volume is set by the qualified professional after assessment.
| Situation | Usual range per side | Usual total range |
|---|---|---|
| Slightly downturned commissure | 0.3 to 0.5 ml | 0.6 to 1 ml |
| Downturned commissure with mild marionette lines | 0.5 to 1 ml | 1 to 2 ml |
| Deep marionette lines with laxity | Assess a combined approach | At the professional's discretion |
How long does mouth corner filler last?
Usual durability is generally between 6 and 12 months. The area takes part in speaking, chewing and facial expression, which tends to shorten how long the product lasts. Volume, product and the patient's metabolism also play a role.
What are the risks and complications?
The most frequent complications are swelling, bruising, local pain, asymmetry and palpable nodules, which are more common in areas with a lot of movement. Cold sore (herpes labialis) reactivation can also occur in predisposed patients.
The area contains branches of the facial artery and the inferior labial artery. An intravascular injection can cause vascular occlusion, with a risk of skin injury. Hyaluronidase must be available whenever hyaluronic acid is used, with a known management protocol. See also safety and complications in facial harmonization.
What care is needed before and after?
Beforehand, the medical history should record anticoagulants, history of cold sores, previous procedures in the area, use of dental prostheses or recent changes in the bite, which alter the support of the mouth. The standardized before photo, with a neutral expression, goes into the patient record, and the informed consent should mention the risks above.
Afterward, usual instructions include avoiding pressure and massage in the area, intense heat and heavy exercise for 24 to 48 hours, and not handling the area when applying makeup or cleaning. Disproportionate pain, pallor or purplish patches call for immediate contact with the professional. A follow-up at about 15 to 30 days allows symmetry to be assessed, including when speaking and smiling.
How do you explain the cause of a downturned mouth to the patient?
The conversation is easier when you separate what is volume from what is movement. A simple way to do it:
- Volume: the hollow just below the corner, which casts a shadow. This is what filler usually softens.
- Movement: the muscle that pulls the corner down when speaking and at rest. Here toxin may enter the plan, at the professional's discretion.
- Support: the loss of structure in the chin and jaw, which lets the lower face "drop." Sometimes this is the first step.
- Skin: laxity and excess skin, which call for other approaches.
Showing the projection of the Mouth Corner point and then a projection with the chin or jaw helps the patient see that difference. To structure this conversation, see how to present before and after in the consultation.
What is not promised to the patient
- That the expression will change from "sad" to "happy."
- That the marionette lines will disappear.
- Absolute symmetry, especially in motion.
- An exact duration.
- That filler replaces treatment for skin laxity.
Simulation in Harmy
The image at the top of this page was generated by Harmy itself, using the fictional person we use across all our pages, marking only the Mouth Corner point with 1 ml. Drag the line to compare. The change is subtle on purpose: the AI alters only the marked area, respecting the volume, and does not apply lipstick, retouch the skin or change the expression. It is an honest projection: the corner looks less downturned, but the person keeps the same resting expression. It is an illustrative simulation, not a promise of results.
The mouth corners are bilateral. In Harmy, the ml is the total: with 1 ml, about 0.5 ml on each side.
How to simulate in 3 steps
- In New projection, enter the patient's name and use a frontal photo with a relaxed mouth, not smiling.
- In the marking screen, tap the Mouth Corner point and set the total volume in the Plan (from 0.5 to 5 ml, in 0.5 steps).
- Tap Create projection and compare on the Before / After slider.
Details and screenshots in how to mark areas and volumes. If the plan includes lips or the nasolabial fold, mark the points together so the patient sees the lower third as a whole.
Frequently asked questions
How long does mouth corner filler last?
Generally 6 to 12 months, depending on the product, the volume, how much the area moves and the patient's metabolism.
How many ml are used in the mouth corners?
Generally 0.3 to 1 ml per side, at the discretion of the qualified professional after assessment.
Does filler fix a downturned mouth?
It can soften the look of downturned corners, especially when there is a local hollow. When the concern comes from muscle strength or skin laxity, other approaches may be part of the plan.
What are marionette lines?
They are the lines that run down from the corners of the mouth toward the chin, like the mouth of a puppet. They often go along with drooping commissures.
Harmy images are illustrative simulations generated by AI from the patient's photo to support the conversation between practitioner and patient. They are not a promise of results. Indication, technique, product and volume are solely the decision of the licensed practitioner. This content is for information only and does not replace a clinical assessment.