DAO Resection Surgery: Causes, Symptoms, Treatment Methods

Facial expressions play a crucial role in the first impression we make on others. However, in some individuals, naturally downturned mouth corners or age-related changes that pull the corners of the mouth downward can create a constantly sad, tired, or unhappy appearance. Although this look may not reflect a person's true emotions, it can negatively influence how they are perceived in both social and professional settings. One of the primary causes of this downward appearance is the overactivity of the DAO (Depressor Anguli Oris) muscle.

Today, DAO resection surgery has emerged as an effective facial rejuvenation procedure in aesthetic and reconstructive facial surgery. By reducing the downward pull of the DAO muscle, this technique aims to create a more balanced, youthful, and positive facial expression. But what exactly is DAO resection surgery, who is an ideal candidate, how is the procedure performed, and what can patients expect during recovery? In this article, we take a detailed look at the causes, symptoms, benefits, potential risks, and treatment process associated with DAO resection surgery.

What Is the DAO Muscle (Depressor Anguli Oris) and What Is Its Function?

The DAO (Depressor Anguli Oris) muscle is an important facial expression muscle responsible for pulling the corners of the mouth downward. This muscle originates from the front and side portions of the lower jawbone (mandible) and extends to the corners of the mouth. It plays a significant role in expressing emotions such as sadness, dissatisfaction, disappointment, and unhappiness through facial expressions. When the DAO muscle contracts, it pulls the corners of the mouth downward, which can give a person a tired, sad, or aged appearance. In some individuals, this muscle may be naturally stronger, or age-related downward displacement of facial tissues may cause the corners of the mouth to appear permanently downturned.

The DAO muscle is also part of the group of muscles that help create balanced facial expressions and contributes to the coordination of mouth movements by working together with surrounding facial muscles. In aesthetic and reconstructive facial surgery, the DAO muscle is considered an important anatomical structure when addressing downturned mouth corners and creating a more youthful and positive facial appearance. As a result, procedures such as DAO resection or DAO Botox are designed to reduce the muscle’s downward pull, helping the corners of the mouth rest in a more elevated and natural position.

What Problems Can Result from Overactivity of the DAO Muscle?

Overactivity of the DAO (Depressor Anguli Oris) muscle can cause the corners of the mouth to be pulled downward more than normal, leading to both aesthetic and functional concerns. This condition most commonly gives the appearance of being constantly sad, tired, angry, or dissatisfied. Even when the face is at rest, downturned mouth corners may cause others to perceive a person negatively, regardless of their actual emotions. Furthermore, as the aging process progresses and skin elasticity decreases, facial tissues naturally descend, making the effects of the DAO muscle more pronounced. This can accelerate the formation of deep grooves around the corners of the mouth, commonly known as marionette lines. In addition, excessive DAO activity may contribute to an imbalanced appearance of the lower face, resulting in a harsher and older-looking facial expression. For these reasons, DAO muscle overactivity is considered more than just an aesthetic concern; it is an important factor that can influence facial expression, social interactions, and the first impression a person makes on others.

What is DAO Resection Surgery?

DAO Resection Surgery is a facial rejuvenation procedure designed to reduce the effect of the DAO (Depressor Anguli Oris) muscle, which pulls the corners of the mouth downward. This procedure is particularly preferred for individuals whose downturned mouth corners create a constantly sad, tired, or aged appearance. During the operation, a portion of the DAO muscle is removed or weakened, thereby reducing its downward pulling force on the corners of the mouth. As a result, the mouth corners can rest in a more neutral or slightly elevated position, giving the face a more positive, youthful, and refreshed appearance.

DAO resection is typically a relatively short surgical procedure that can be performed under local anesthesia. It is often combined with other facial rejuvenation treatments, such as facelift surgery, lip lift procedures, fat grafting, or other aesthetic interventions. It is considered an effective option, particularly for patients who have achieved satisfactory results with temporary treatments such as DAO Botox but are seeking a longer-lasting solution. However, since every patient has unique facial anatomy and muscle dynamics, a thorough facial assessment and individualized treatment plan are essential before surgery. In summary, when performed on suitable candidates using the appropriate surgical technique, DAO resection surgery can help create a more balanced and aesthetically pleasing lower facial appearance while preserving natural facial expressions.

Who is a Suitable Candidate for DAO Resection Surgery?

• Individuals whose mouth corners remain noticeably downturned even when their face is at rest
• People who feel that their facial expression makes them appear constantly sad, tired, or unhappy
• Those experiencing downward pulling of the mouth corners due to overactivity of the DAO muscle
• Patients with prominent marionette lines around the mouth caused by the aging process
• Individuals seeking a younger and more positive facial appearance
• People who have previously undergone DAO Botox treatment, were satisfied with the results, but are looking for a more permanent solution
• Individuals whose overall health condition is suitable for a surgical procedure
• Patients with realistic expectations who can properly understand and evaluate the potential outcomes of surgery
• Those interested in combining DAO resection with other facial rejuvenation procedures such as a facelift, lip lift, or fat grafting
• Candidates who are willing to reduce or stop smoking before and after the operation
• Individuals seeking to improve the aesthetic balance of the lower face
• Patients who have not achieved satisfactory results with non-surgical treatment options
• People who wish to maintain natural facial expressions while achieving a more neutral or slightly elevated position of the mouth corners
• Candidates who can comply with the recovery process and follow their surgeon’s postoperative instructions
• Patients whose surgeon determines, through a detailed facial assessment, that DAO muscle activity is a primary contributor to their negative facial appearance or downturned mouth corners.

Pre-operative Evaluation Process for DAO Resection Surgery

The preoperative evaluation process for DAO Resection Surgery is an important stage during which the patient’s facial anatomy, facial muscle activity, and aesthetic goals are thoroughly assessed. During this process, the surgeon first evaluates how the corners of the mouth move both at rest and during facial expressions to determine whether the downward pull is truly caused by overactivity of the DAO (Depressor Anguli Oris) muscle. The surgeon then carefully examines overall facial symmetry, soft tissue support in the lower face, skin elasticity, the depth of marionette lines, and age-related facial changes. In addition, the patient's medical history, current medications, overall health status, smoking habits, and any previous cosmetic procedures are reviewed. During the consultation, the patient's expectations are discussed, and the potential outcomes of the procedure are explained realistically. When necessary, standardized medical photographs are taken to support facial analysis and surgical planning. Based on this comprehensive assessment, the surgeon can determine whether DAO resection alone will be sufficient or if additional procedures, such as a facelift, lip lift, or fat grafting, may be recommended to achieve the desired result.

How is DAO Resection Surgery Performed?

In DAO resection surgery, the patient's facial anatomy and facial muscle activity are first carefully evaluated to create a personalized surgical plan. Once the planning stage is completed, local anesthesia is administered, and the surgeon accesses the DAO muscle through a small incision made either near the corner of the mouth or inside the mouth. The specific portion of the muscle responsible for the downward pulling force is then carefully removed or weakened. This reduces the downward tension on the corners of the mouth and helps achieve a more balanced and slightly elevated position. As a result, natural facial movements and expressions can be preserved. After the procedure is completed, the incisions are closed with fine cosmetic sutures, and the patient begins the recovery process.

Advantages of DAO Resection Surgery

DAO resection surgery offers several important benefits to patients. Some of the main advantages include the following:

• Helps reduce the appearance of downturned mouth corners.
• Can create a more positive, youthful, and refreshed facial expression.
• May improve the appearance of a constantly sad or tired look.
• Can provide longer-lasting results compared to DAO Botox treatments.
• Helps improve the aesthetic balance of the lower face.
• May reduce the appearance of marionette lines around the mouth.
• Can preserve natural facial expressions and movements.
• May help facial expressions better reflect a person's true emotions.
• Can be combined with other facial rejuvenation procedures.
• Is a relatively short procedure that can often be performed under local anesthesia.
• Allows for a personalized surgical approach based on individual facial anatomy.
• May contribute to improved facial symmetry.
• Can be an effective alternative for patients who have not achieved satisfactory results with non-surgical treatments.
• May enhance self-confidence and improve social interactions.
• Can be a suitable option for individuals seeking long-term or permanent aesthetic improvement.

Risks and Potential Complications of DAO Resection Surgery

As with any surgical procedure, some minor complications may occur following DAO resection surgery. These complications vary from person to person and do not occur in every patient. Some of the potential complications include the following:

• Temporary swelling and edema
• Development of bruising (ecchymosis)
• Pain or tenderness at the surgical site
• Risk of bleeding
• Possibility of infection
• Delayed wound healing
• Temporary numbness around the mouth
• Risk of scar formation
• Development of an unnatural facial expression
• Temporary changes in facial movements and expressions
• Prolonged swelling or firmness after surgery
• Healing complications due to smoking or inadequate postoperative care

Recovery Process After DAO Resection Surgery

First Week

Following surgery, mild swelling, edema, tenderness, and occasional bruising around the mouth are common. Most patients are discharged on the same day and can return to light daily activities within a short period. During this stage, it is important to maintain good oral hygiene, take prescribed medications as directed, and protect the surgical area from unnecessary trauma. A mild feeling of tightness around the mouth is considered normal during the first week.

Second Week

Most of the swelling and bruising begin to subside significantly. Patients generally feel more comfortable returning to social activities. Sensitivity around the surgical site continues to improve, and the new position of the mouth corners becomes more noticeable. However, the healing process is still ongoing, and the final results are not yet fully visible.

Third and Fourth Weeks

The majority of the healing process is completed during this period. Any remaining swelling gradually decreases, and the appearance of the lower face becomes more natural. The reduction in the downward pull of the mouth corners becomes increasingly apparent. Most patients can return fully to their normal daily routines and social activities.

First and Second Months

The facial tissues continue adapting to their new position. Any mild firmness in the surgical area gradually softens. The facial expression begins to appear more balanced, refreshed, and positive. Surgical results continue to improve and take on a more natural appearance.

Third to Sixth Months

The results of DAO resection become well established. Nearly all residual swelling resolves, allowing the new position of the mouth corners to be accurately evaluated. During this period, patients can more clearly appreciate the aesthetic improvements achieved by the procedure.

Six Months and Beyond

Final results are typically achieved. With the reduction of the downward pull on the corners of the mouth, patients often enjoy a more youthful, dynamic, and positive facial appearance. Attending regular follow-up appointments and following postoperative care instructions can help maintain long-term results.

Important Considerations After DAO Resection

There are several important points to keep in mind after DAO resection surgery. Following these recommendations can help support the healing process and contribute to a smoother recovery. Some of the key considerations include the following:

• Take all prescribed medications as directed by your surgeon.
• Maintain proper oral and surgical site hygiene.
• Avoid applying unnecessary pressure to the surgical area during the first few days.
• Use cold compresses as recommended by your surgeon to help reduce swelling.
• Temporarily avoid hard, very hot, or irritating foods.
• Refrain from heavy exercise and strenuous physical activities for the first few weeks.
• Avoid smoking and all tobacco products.
• Limit or avoid alcohol consumption during the recovery period.
• Do not touch, rub, or manipulate the surgical area.
• Keep your head slightly elevated while sleeping.
• Attend all scheduled follow-up appointments.
• Contact your surgeon if you experience unexpected pain, bleeding, or signs of infection.
• Avoid movements that may interfere with the healing of the surgical site or sutures.
• Limit excessive facial expressions during the first few weeks.
• Be patient throughout the recovery process and understand that results develop gradually.
• Follow all postoperative care instructions provided by your surgeon.
• Stay well hydrated and maintain a balanced diet to support tissue healing.
• Protect the facial area from trauma or accidental impacts.
• Limit sun exposure and use appropriate protection when necessary.
• Keep in mind that final results may take several months to fully develop.

What’s the Success Rate of DAO Myectomy?

The success rate of DAO myectomy can vary depending on factors such as the patient’s facial anatomy, the level of DAO (Depressor Anguli Oris) muscle activity, the surgical technique used, and the surgeon’s experience. For this reason, a thorough evaluation of the patient is necessary before making any definitive assessment. However, when performed on appropriately selected candidates, DAO myectomy is generally considered a procedure associated with high patient satisfaction, particularly in reducing the downward pull of the mouth corners and creating a more positive facial expression. In cases where excessive DAO muscle activity is the primary cause of downturned mouth corners, a noticeable improvement in facial appearance can often be observed after surgery. Success is not measured solely by the elevation of the mouth corners, but also by the preservation of natural facial expressions, maintenance of facial symmetry, and the extent to which the patient’s aesthetic expectations are met.

If you would like to learn more about DAO resection surgery, you can contact Dr. Berke Özücer and his team, who specialize in facial paralysis.