Dr. Raffy Karamanoukian is a dual board-certified plastic surgeon in Santa Monica who specializes in natural-looking Botox results to reverse the signs of premature facial aging. His approach is conservative and he performs meticulous Botox injections in a luxury plastic surgery center in the heart of Santa Monica, on Montana Avenue. 

The DAO Muscle: Why Your Mouth Corners Turn Down

The depressor anguli oris (DAO) is a paired triangular muscle originating on the mandible and inserting at the modiolus, a muscular knot at each corner of the mouth. Its function is to pull the mouth corners downward during expressions of sadness, displeasure, or frowning. With age and repetitive contraction, the DAO becomes progressively stronger and more dominant relative to its antagonist muscles — particularly the levator anguli oris (which lifts the corners) and the zygomaticus major (which pulls the corners up and outward during smiling). When the DAO wins this muscular tug-of-war at rest, the mouth corners drop into a permanent downturned position that projects sadness or disapproval regardless of the patient’s actual emotional state.

The DAO’s downward pull also deepens the marionette lines  which are the vertical creases extending from the mouth corners down toward the chin that create the puppet-like lower face appearance associated with advanced facial aging. Relaxing the DAO with Botox reduces the muscular vector driving these lines while simultaneously allowing the lifting muscles to restore the more neutral or subtly elevated mouth corner position that characterizes a rested, youthful facial expression.

Expertise in Precise DAO and Platysmal Muscle Botox 

The reason DAO Botox demands a surgeon’s anatomical precision is the density of the lower facial muscle system. If the Botox spreads too medially or too deeply, the depressor labii inferioris may be affected, causing difficulty with lip control, smile asymmetry, or a "crooked" appearance when speaking or smiling. The margin between the correct injection point and the depressor labii inferioris is measured in millimeters. Dr. Karamanoukian’s formal surgical training in facial anatomy and his two decades of lower face surgery and Botox experience produce the injection precision that keeps the DAO result natural-looking rather than functionally disruptive.

DAO Botox vs. Platysma Botox: Jawline Contouring

Many patients who present for DAO Botox are also experiencing the vertical neck banding and jawline blunting that develops as the platysma muscle becomes increasingly visible through the thinning neck skin of aging. The platysma is a broad, superficial muscle extending from the chest and shoulder fascia up through the neck to insert into the lower face and the corners of the mouth — meaning that platysmal tension is not just a neck problem but an active contributor to lower face descent and mouth corner pulling.

Natural-Looking Botox in Santa Monica

The most common Botox complaint Dr. Karamanoukian hears from new patients in Santa Monica is not that a prior treatment was too subtle: it is that it was too obvious. A frozen forehead. A smile that doesn’t reach the eyes. An expression that has been uniformly flattened rather than selectively relaxed. These outcomes are the consequence of over-treatment, incorrect muscle identification, or the templated high-dose injection protocols that high-volume Botox practices apply regardless of individual facial anatomy.

Dr. Karamanoukian’s approach to DAO Botox and lower face is built on the principle that Botox should modulate expression, not eliminate it. The goal of DAO treatment is not a fixed, artificially upturned mouth but a face whose resting expression is neutral and approachable rather than downturned and stern. Achieving that requires conservative dosing, precise anatomical placement, and the clinical judgment to recognize when the DAO Botox alone is sufficient and when platysma, mentalis, or masseter Botox should be added to produce balanced lower face harmony.