Can Fine Lines Around the Mouth and Jowls Be Addressed with Botox Alone?

Hello.

I am Tae-oh Park, the medical director of Relive Clinic, where I conduct research to help reduce skin pain.

When I meet patients in the consultation room, many of them ask for several concerns to be addressed at once while consulting about Botox for the chin, glabella, or forehead:

> “Could the fine lines around my mouth and the jowls sagging beneath my chin improve as well?”

Of course, it is true that controlling excessive movement of the facial muscles with Botox can alleviate wrinkles to some extent.

However, tissue that has already sagged downward or structural wrinkles that have become deeply set after folding for a long time cannot be resolved simply by reducing muscle movement.

That is because facial aging is much more complex than we may think.

Repeated muscle contractions, thinning of the dermal layer, and sagging of fat and retaining ligaments progress simultaneously in different layers beneath the skin.

To achieve satisfactory results, rather than insisting on just one treatment, it is necessary to accurately determine which layer of the skin is aging first and then establish an appropriate treatment direction.

I will explain, in an easy-to-understand way, the key points of layer-specific targeted treatment that I always emphasize in clinical practice.

1. Fine Lines Around the Mouth Where “Dermal Layer Regeneration” Comes First

Some people have many tiny, crinkled lines around the mouth, or their skin folds as thinly as paper.

When we examine the skin of these patients, we can usually confirm that the density of the dermal layer and collagen have decreased significantly.

Botox, which stops muscle movement, has limitations when it comes to making already-thinned skin thicker, firmer, and more voluminous.

In these cases, an approach that restores the environment inside the skin itself in a healthy way is needed.

• Collagen-regeneration treatments such as Juvelook, Potenza, and Radiesse may be needed rather than Botox alone.

• Expected effect: This approach induces the production of the patient’s own collagen within the skin, helping to make thinned skin somewhat firmer. Rather than immediately filling the area, it is closer to a treatment that restores skin density and elasticity over time.

▶ These treatments do not fill the area magically like a filler immediately after injection.

Because the cells must go through a regenerative process over time, the physician needs refined technique to control the injection depth and distribute the product evenly.

2. When Botox Wears Off Quickly, Reinforce “Skin Thickness”

Many people find that their wrinkles quickly recur within two or three months of receiving Botox, or that their skin generally feels soft and lacking in elasticity.

This, too, is because the dermal environment that supports the skin has deteriorated.

When the skin is too thin, it can easily crease even with only slight muscle movement.

• When the skin is too thin, it easily folds again even if muscle movement is reduced only slightly, which is why fine wrinkles appear repeatedly.

• In such cases, treatments for elasticity, such as Rituo, a human-derived dermal treatment, or EVE TITAN and Seref, may be combined to strengthen and firm the skin.

• Medical synergy:

  Compared with repeatedly using Botox alone to control facial expressions, restoring the skin’s physical density at the same time can substantially improve the duration and stability of Botox results.

▶ This is not a one-dimensional approach focused simply on erasing one wrinkle.

It is better understood as a treatment that rebuilds the skin’s basic structural strength so that it can withstand everyday facial expressions and movement on its own.

3. Heavy, Sagging Tissue Requires “Fat Reduction + Lifting”

When the area below the mouth protrudes downward in a jowl-like manner and the mandibular line looks heavy, this is an entirely different issue from the fine lines discussed above.

This is not a problem on the skin’s surface. Rather, it results from a combination of sagging in the deeper fat layer and structural deterioration of the lower face.

Many people expect their jowls to lift after receiving Botox in the chin, but there are clear limitations to lifting heavy, sagging fatty tissue through muscle control alone.

• Lifting treatments such as Onda, Ulthera, Thermage, and Seref can help safely reduce the volume of excessively accumulated and sagging fat, while lifting devices help bring loose soft tissue and the fascia (SMAS) into close contact with the bone.

▶ Particularly in cases where the chin, mandibular line, and jawline begin to deteriorate with age, it is necessary to approach the muscle (Botox), dermis (collagen), and fat layer (lifting devices) separately.

Only through this precise approach can a smooth, natural-looking jawline be created without an unnatural appearance.

♧ Summary of Aging Causes and Solutions by Skin Layer

Aging concern	Main cause (target layer)	Relive Clinic treatment approach	Key treatment objective
Fine lines and vertical lines around the mouth	Decreased collagen in the dermal layer, thinning skin	Juvelook, Radiesse, etc.	Induce the regeneration of the patient’s own collagen; improve skin density and fine lines
Reduced skin elasticity and recurring wrinkles	Weakened dermal structure, reduced skin elasticity	Rituo, etc.	Reinforce the dermal layer; restore skin elasticity and density
Jowls, bulldog cheeks, and sagging lower face	Descent of the fat layer, loosened retaining ligaments	Onda, Seref	Bring sagging tissue into closer contact; reduce fat and define the jawline
Reduced elasticity throughout the face	Reduced elasticity of the SMAS and dermal layer	Ulthera, Thermage	Lift deeper layers; improve skin contraction and elasticity
Thinning skin and reduced elasticity	Decreased collagen, weakened skin structure	EVE TITAN, etc.	Restore skin thickness and elasticity; achieve a natural lift
Repeated expression lines	Repeated contraction of the facial muscles	Botulinum toxin treatment	Control muscle movement; help prevent wrinkle progression
Loss of jawline definition and a heavy lower face	Combined progression of fat accumulation and reduced elasticity	Onda + Thermage combination	Simultaneously address fat reduction and skin contraction

The time I devote the most attention to in the consultation room is not the moment of treatment, but the process of carefully observing and diagnosing each patient’s face.

This is because finding the reason “why these wrinkles and sagging have developed on this patient’s face” is far more important than which famous product is used.

If the cause is different but the same Botox or assembly-line treatment is repeated every time, it is only natural that satisfaction may decrease.

If you are receiving regular treatments but are not seeing noticeable changes or still feel dissatisfied, I believe this may be the time to “reassess the direction of your skin aging,” rather than simply increasing the number of treatments.

Thank you for reading this long post.

This was Tae-oh Park, medical director of Apgujeong Relive.

※ This post is informational content written directly by Relive Clinic in Apgujeong in compliance with Article 56, Paragraph 1 of the Medical Service Act.

※ Treatment results and effects may vary from person to person, and side effects such as swelling, bruising, or inflammation may occur.