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MV Medical Aesthetics
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By Jillian Caldwell, MS, PA-C

Published 2026-05-15

DAO Botox in Houston

DAO Botox is one of the smallest, most precise neurotoxin treatments I do. The DAO (depressor anguli oris) is a thin muscle on either side of the chin that pulls the corner of the mouth downward. In some patients this muscle is chronically active, even at rest, which produces a slightly sad or angry-looking resting expression regardless of how the person actually feels.

A small dose of neurotoxin into the DAO relaxes that pull, letting the corner of the mouth sit a little higher. The result is a subtle lift that softens the resting expression without changing the smile.

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What it treats

  • Downturned mouth corners at rest ("sad mouth")
  • Marionette-line softening (often paired with filler in the same area)
  • Resting bitch face when it is being pulled by the DAO specifically
  • Asymmetric mouth corners (one side pulling down more than the other)

Products used in this treatment: Jeuveau (prabotulinumtoxinA-xvfs), Dysport (abobotulinumtoxinA)

How DAO treatment is dosed

DAO dosing is small. Typically 2 to 4 units of Jeuveau per side, placed precisely at the inferior edge of the muscle near where it inserts at the mandible. Higher doses or imprecise placement can spread to surrounding muscles (including the platysma or orbicularis oris), which can cause asymmetric smile, drooling, or other unwanted effects.

This is a treatment where injector skill matters. I dose conservatively, watch carefully at the two-week follow-up, and adjust if needed.

Pairing DAO with filler

DAO neurotoxin alone helps if the downturn is from active muscle pull. If the downturn is partly from volume loss in the surrounding area (marionette lines, pre-jowl hollow), filler in the lower face can amplify the result.

For some patients I treat the DAO first to see what the relaxed version looks like, then layer filler at a follow-up visit if we want to push the result further. For others I treat both at the same visit if the consult makes it clear that is the right plan.

Timeline and longevity

Effect starts within 5 to 7 days. Full effect by day 10 to 14. DAO results typically last 3 to 4 months, similar to other neurotoxin treatments.

Side effects to watch for

  • Brief asymmetry of smile if the neurotoxin migrates into adjacent muscles. Usually resolves within 1 to 2 weeks. Proper technique minimizes this risk.
  • Slight difficulty with certain expressions (frowning, pursing) for the first 1 to 2 weeks.
  • Occasional drooling with hot drinks if the dose was too high or spread too far.

I dose conservatively to minimize all of these. The two-week follow-up exists so we can catch and correct any unintended effect early.

Common questions about dao botox in houston

How do I know if I need DAO Botox?
Look at yourself in the mirror with your face fully relaxed. If the corners of your mouth pull down at rest in a way that makes you look unhappy when you are not, the DAO is likely active. We assess at consult.
How many units of DAO Botox?
Small dose - typically 2 to 4 units of Jeuveau per side. The exact dose depends on how strong your DAO is on exam.
Will it change my smile?
Should not, with proper dosing. The DAO is involved in pulling the mouth corner down, not in smiling. Done well, your smile is unchanged and only your resting expression softens.
How long does it last?
3 to 4 months for most patients.
Can I combine DAO with filler?
Yes, often a good combination if the downturn is also driven by lower-face volume loss. We can do both in the same visit or stage across visits.
Does it hurt?
Quick pinpricks at two points per side. Most patients describe it as well-tolerated without numbing.

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The content on this page is for educational purposes and reflects Jillian Caldwell's clinical perspective. It is not medical advice. Individual results vary. Suitability for any treatment is determined at a private consultation. Clinical services at MV Medical Aesthetics are delivered under physician supervision.